ArticleBreast (Edinburgh, Scotland)2026
Prospective assessment of incomplete ovarian suppression in breast cancer using LC-MS/MS and immunoassays for estradiol.
Article in Breast (Edinburgh, Scotland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDuring gonadotrophin-releasing hormone agonist (GnRHa) therapy some patients do not adequately suppress estradiol, termed "ovarian escape" (OE). We prospectively measured estradiol using liquid chromatography-tandem mass spectrometry (LC-MS/MS), the gold standard to determine the prevalence of OE and assess discordance with estradiol immunoassays.
methodPatients receiving endocrine therapy plus GnRHa for ≥3 months were enrolled at two Dublin hospitals. Estradiol was measured by LC-MS/MS, Abbott Alinity i (Alinity) and Roche Cobas e 801 (Cobas) immunoassays. OE was defined as estradiol >10 pmol/L during aromatase inhibitor (AI) treatment or >77 pmol/L during tamoxifen.
results94 patients enrolled, 10 had OE (11%; 95% CI 5.2-18.7%) and were younger than those without OE (40 years, IQR 38-43 versus 46 years, IQR 42-49; P < 0.005), all OE cases were receiving an AI (14%, 10/71). Exploratory multivariable logistic regression suggested increasing age was associated with lower odds of OE (OR 0.85 95% CI 0.73-0.99), BMI was not (OR 1.00, 95% CI 0.82-1.23). None of the 10 cases of OE were detected by immunoassay (sensitivity 0% both immunoassays). For Alinity and Cobas specificities were 86.5% and 100%. Seven false-positive (FP) results occurred with Alinity, including 6 patients receiving CDK4/6 inhibitors. Retesting of the 7 Alinity FP samples using Cobas demonstrated persistent FP results in 3 cases, all were receiving fulvestrant.
conclusionOE occurred in 11% of women receiving GnRHa and was more common in younger women. Standard immunoassays demonstrated clinically relevant discordance compared to LC-MS/MS. These findings support LC-MS/MS for estradiol monitoring in this setting.
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