Biopsy confirmation of metastatic breast cancer: interim results of a prospective biopsy study
Bibliographic record
Abstract
Decisions about systemic treatment of women with metastatic breast cancer are often based on oestrogen receptor (ER), progesterone receptor (PgR), and HER2/neu status of the primary tumour. The present study prospectively investigated concordance in receptor status between primary tumour and distant metastases at various stages of progression and assessed the impact of any discordance on patient management. Biopsies of suspected metastatic lesions were obtained from patients and were analysed for ER/PgR and HER2/neu. The receptor status of metastases was compared with the primary tumour. The treating physician completed questionnaires before and after biopsy to determine whether the biopsy resulted in a change to the treatment plan. Eighty women were enrolled and 70 of them underwent biopsy. Of these, 43 (61%) were newly diagnosed with metastatic disease, 10 (14%) had received one line of treatment in the metastatic setting and 17 (24%) had received two or more lines of treatment in the metastatic setting. Fifty-six samples were sufficient for analysis; of these, 4/56 biopsies (7%) showed benign disease and one biopsy (2%) confirmed a different malignancy (idolent lymphoma). Changes in hormone receptor status were observed in 34% and in HER2/neu status in 5% of women. Loss of PgR was the most common change in hormone receptor status (29%). All changes in HER2/neu involved gain of receptor. Biopsy results led to a change of management in 9/70 patients (13%). Patients with newly diagnosed metastatic disease were more likely to show discordance than those previously treated in the metastatic setting. Triple-negative tumours were least likely to show discordance. This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumour and metastases. The number of patients needed to biopsy to alter management is 7.8. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".