Decentral gene expression analysis for ER+/Her2- breast cancer: results of a proficiency testing program for the EndoPredict assay

Carsten Denkert, Ralf Kronenwett, Werner Schlake, Kerstin Bohmann, Roland Penzel, Karsten E Weber, Heinz Höfler, Ulrich Lehmann, Peter Schirmacher, Katja Specht, Margaretha Rudas, Hans-Heinrich Kreipe, Peter Schraml, Gudrun Schlake, Zsuzsanna Bago-Horvath, Frank Tiecke, Zsuzsanna Varga, Holger Moch, Marcus Schmidt, Judith Prinzler, Dontscho Kerjaschki, Bruno Valentin Sinn, Berit Maria Müller, Martin Filipits, Christoph Petry, Manfred Dietel, Carsten Denkert, Ralf Kronenwett, Werner Schlake, Kerstin Bohmann, Roland Penzel, Karsten E Weber, Heinz Höfler, Ulrich Lehmann, Peter Schirmacher, Katja Specht, Margaretha Rudas, Hans-Heinrich Kreipe, Peter Schraml, Gudrun Schlake, Zsuzsanna Bago-Horvath, Frank Tiecke, Zsuzsanna Varga, Holger Moch, Marcus Schmidt, Judith Prinzler, Dontscho Kerjaschki, Bruno Valentin Sinn, Berit Maria Müller, Martin Filipits, Christoph Petry, Manfred Dietel

Abstract

Gene expression profiles provide important information about the biology of breast tumors and can be used to develop prognostic tests. However, the implementation of quantitative RNA-based testing in routine molecular pathology has not been accomplished, so far. The EndoPredict assay has recently been described as a quantitative RT-PCR-based multigene expression test to identify a subgroup of hormone-receptor-positive tumors that have an excellent prognosis with endocrine therapy only. To transfer this test from bench to bedside, it is essential to evaluate the test-performance in a multicenter setting in different molecular pathology laboratories. In this study, we have evaluated the EndoPredict (EP) assay in seven different molecular pathology laboratories in Germany, Austria, and Switzerland. A set of ten formalin-fixed paraffin-embedded tumors was tested in the different labs, and the variance and accuracy of the EndoPredict assays were determined using predefined reference values. Extraction of a sufficient amount of RNA and generation of a valid EP score was possible for all 70 study samples (100%). The EP scores measured by the individual participants showed an excellent correlation with the reference values, respectively, as reflected by Pearson correlation coefficients ranging from 0.987 to 0.999. The Pearson correlation coefficient of all values compared to the reference value was 0.994. All laboratories determined EP scores for all samples differing not more than 1.0 score units from the pre-defined references. All samples were assigned to the correct EP risk group, resulting in a sensitivity and specificity of 100%, a concordance of 100%, and a kappa of 1.0. Taken together, the EndoPredict test could be successfully implemented in all seven participating laboratories and is feasible for reliable decentralized assessment of gene expression in luminal breast cancer.

Figures

Fig. 1
Fig. 1
Workflow of sequential validation of the EndoPredict assay and the interlaboratory quality assurance (ER estrogen receptor)
Fig. 2
Fig. 2
Results of the decentral measurement of 70 tumor samples from ten different tumors. The central reference value is marked in red, the blue labels represent the seven different measurements at the seven institutes of pathology
Fig. 3
Fig. 3
Cluster analysis of the results of the RT-qPCR in the different centers. The EndoPredict score is shown on the right
Fig. 4
Fig. 4
Correlation analysis of the EndoPredict test results in the seven different pathology laboratories. a–g Results of the individual laboratories. h Pearson correlation coefficients

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Source: PubMed

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