Breast Cancer Prognostic Gene Signature Assay (Prosigna®)

CPT: 0008M; 88381
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Test Details

Synonyms

  • Prosigna®

Use

The Prosigna® breast cancer prognostic assay is an FDA 510(k)-cleared assay that provides a risk category and numerical score to assess a patient's risk of distant recurrence of disease at 10 years in postmenopausal women with node-negative (Stage I or II) or node-positive (Stage II), hormone receptor-positive (HR+) breast cancer. The Prosigna® assay measures gene expression levels of RNA extracted from formalin-fixed paraffin-embedded (FFPE) breast tumor tissue previously diagnosed as invasive breast carcinoma.

Limitations

Prosigna® is not intended for diagnosis, to predict or detect response to therapy, or to help select the optimal therapy for patients. Performance characteristics of the Prosigna® assay have been established for postmenopausal women with hormone receptor-positive early stage breast cancer treated with five years of adjuvant endocrine therapy. Performance with other treatment regimens or in other patient populations has not been established. The interpretation of Prosigna® assay results (Prosigna® Score, risk category) should be evaluated within the context of other clinicopathological factors, the patient's medical history, and any other laboratory test results.

Methodology

The Prosigna® assay is performed on RNA isolated from FFPE breast tumor tissue. It simultaneously measures the expression levels of 50 genes used in the PAM50 classification algorithm, eight housekeeping genes used for signal normalization, six positive controls, and eight negative controls in a single hybridization reaction, using nucleic acid probes designed specifically for those genes. Prosigna® is a registered trademark of NanoString Technologies Inc.

Specimen Requirements

Specimen

Formalin-fixed, paraffin-embedded (FFPE) tissue block or slides. Fixative should be neutral buffered formalin.

Volume

As many as six unstained slides (see table below) at 10 μM and one matching H&E-stained slide or formalin-fixed, paraffin-embedded (FFPE) tissue block. The tumor cellularity percentage within the circled tumor area on the H&E-stained slide must be ≥10%. The circled tumor surface area on the H&E-stained slide must be ≥4mm².

Minimum Volume

See table.

Measured Tumor Surface Area

on H&E-stained Slide (mm²)

Number of

Unstained Slides

4−19

6

20−99

3

≥100

1

Container

Slides, blocks

Collection

Submit at room temperature. Indicate date and time of collection on the test request form.

Storage Instructions

Maintain specimen at room temperature.

Causes for Rejection

Tumor block containing insufficient tumor; broken or stained slides; core needle biopsy; DCIS specimen; specimen with four or more positive nodes; fresh, frozen, or nonbreast cancer tissue

Clinical Information

Special Instructions

The gross size of the patient's primary tumor and nodal status are required to perform the assay. A copy of the original pathology report is required for testing. If a pathology report is not received with the sample, testing will be delayed. Please direct any questions regarding this test to customer service at 800-345-4363. Note the following:

1. The Prosigna® assay is not intended for patients with four or more positive nodes.

2. Micrometastases were not considered node-positive during the Prosigna® validation, so they should be considered as negative nodes.

3. Only invasive breast carcinoma is qualified for the Prosigna® assay. DCIS (ductal carcinoma in situ) is not qualified for the Prosigna® assay.

4. The Prosigna® assay is intended for use only on formalin-fixed, paraffin-embedded (FFPE) breast cancer tissue specimens from surgical resections. It is not intended for use on needle biopsy samples or fresh, frozen, or nonbreast cancer tissue.

5. Multifocal breast tumors should not be combined. Each should be considered an independent tumor.

References

Gnant M, Filipits M, Dubsky P, et al. Predicting risk for late metastasis: The PAM50 risk of recurrence (ROR) score after 5 years of endocrine therapy in postmenopausal women with HR+ early breast cancer: A study on 1,478 patients for the ABCSG-8 trial. Ann Oncol. 2013; 24(Suppl 3): iii29-iii37.
Parker JS, Mullins M, Cheang MCU, et al. Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Onc. 2009 Mar 10; 27(8):1160-1167. 19204204

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
481210 Prosigna(R) 76546-1 481216 Block Number: N/A
481210 Prosigna(R) 76546-1 481213 Tumor Size: cm 21889-1
481210 Prosigna(R) 76546-1 481214 Lymph Nodes: 76397-9
481210 Prosigna(R) 76546-1 481211 Patient Prosigna Score 76544-6
481210 Prosigna(R) 76546-1 481212 Risk Group 76545-3
481210 Prosigna(R) 76546-1 481217 Distant Recurrence Probability 74019-1
481210 Prosigna(R) 76546-1 481221 Clinical Validation Study 62364-5
481210 Prosigna(R) 76546-1 481219 Test Information: 49549-9
481210 Prosigna(R) 76546-1 481218 Director Review 72486-4
481210 Prosigna(R) 76546-1 480903 Microdissection Performed 8100-0
481210 Prosigna(R) 76546-1 481233 PDF Image N/A

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