Topic: Understanding your Pathology Report

I just got the path report with the hormone receptors too.

Mine says ER+ PR- HER2neu-.

Also KI 67 The onc said this is high.

T 1

N 0

M ?

It will still be 2 more weeks until I get the Oncotype score.Is there anyone here who can shed more light?

Anyone here with similar report?

Hello, my name is Arethia, and my daughter, Shawn,who  will be 38 this year, God willing,was told last night by her doctor that she has found cancer cells in her milk ducts. She first had a mammagram done, then she was told she needed a biopsi, now this. We will met her doctor tonight to discuss treatment plans.What should we ask?

Can anyone here tell me what KI-67 is? I think my onc told me it has something to do with how fast the abnormal cells are dividing. Should there be a score on my pathology report? What is considered good...bad??

beergirl & jerseymaria,

Ki-67 is a protein found in the nucleus of cells while they are undergoing cell division.  It is not found in cells that are not dividing.  Since its presence in tumor cells is an indication that the cells are proliferating, Ki-67 is considered a "proliferation marker."  Here's a statement from a journal article on Ki-67 (T. Scholzen & J. Gerdes: J. Cell. Physiol. 182:311-322, March 2000):

"The expression of the human Ki-67 protein is strictly associated with cell proliferation. During interphase, the antigen can be exclusively detected within the nucleus, whereas in mitosis most of the protein is relocated to the surface of the chromosomes. The fact that the Ki-67 protein is present during all active phases of the cell cycle (G(1), S, G(2), and mitosis), but is absent from resting cells (G(0)), makes it an excellent marker for determining the so-called growth fraction of a given cell population. ... The fraction of Ki-67-positive tumor cells (the Ki-67 labeling index) is often correlated with the clinical course of the disease. The best-studied examples in this context are carcinomas of the prostate and the breast. For these types of tumors, the prognostic value for survival and tumor recurrence has repeatedly been proven in uni- and multivariate analysis."

I hope that helps (or I suppose it's not good news, if your Ki-67 index is high).  My path report did not include a Ki-67 index, but I think Ki-67 is one of the components factored into the Oncotype score.

otter

[Edit:  I just realized that I didn't answer your question about the cutoffs for "good" vs. "bad".  I don't know what those are.  Sorry...] 

Can any one tell me what Infultrating ductual carinoma with lobular features means.. Thank you

ok I finally got my path report...this is the 2nd opinion one not the original one (I still want that one..thats the one where some pathologist said cancer some said borderline)...ok Im going to copy this from the paper ANY help would be great...

Dx Atypical papilloma (WHO classification) (surgical margins uninvolved) Se comments* Surgical margins status: Uninvolved; tumor is <o.1 cm from the lateral (nearest) margin

Columnar cell alteration, with flat epithelial atypia

sclerosing adenosis

Comments:  Recieved is a consultaion report from Dr ...Dept of Pathology.  Yale Ct..upon review of the case materials, she thinks that this papillary lesion represents an atypical papilloma (DIN1). She estimates that the atypical cribriform areas constitute 30% or less of the lesion.  Flat epithelial atypia is also present.  No evidence of invasion is identified.  She states that, although the lesion is excised, it is present less than 0.1 cm from the lateral margin, and that it extends to a nearby duct toward the medial margin.  She shuggests therefore that it would be prudent to perform a re-excision to the ascertain that no residual lesion is left in the vicinity of the papilloma. 

Ok...I understand the part of the re-excision but I am confused where it says she "THINKS" the tumor is atypical....thats the whole reason for the 2nd opinion was to tell if it was DCIS or ADH but she says think...doesnt sound too sure?  ..ok thanks in advance everyone :)  Beth

I had a firbroadenoma 17 yrs ago and decided to have it removed immediately, even though it is almost always benighn.  It is is the same breast, but different side, that I now have bc.  I did not want to wait 3 months and my surgeon agreed.  I had some calcifications then which I was told was normal at my age then.  Try not to worry and if your surgeon is of no help ask your gyn for some guidance.  good luck

I am so confused!  The report from my core biopsy indicated I have ILC.  It has taken 3 weeks to get the rest of the report back.  I am ER+ but PR- and HER2-.  All I can find is info on triple -.  I can't find anything about 1 out of 3.  Also, the MRI I had on Friday was comical.  I already know I have ILC and the Clinical History for the test stated that they already know I have ILC on the left.  However, the radiologist gave it a BIRAD 3 and recommended follow-up in 6 months.  This partially makes sense since ILC is not a well-differentiated tumor because, as my surgeon described it, the tumor has "fingers" or "tenticles" that spread out.  This would probably be the "asymmetric enhancing tissue...diffusely distributed.  What concerns me though, is that it also states that there are "a few tiny high signal nodules in the right breast measuring less than 0.5 cm each.  These could be cysts or benign fibeoadenomas."  I already had a PET scan which showed the breast cancer in the left breast as well as in the lymph nodes on that side, but it didn't show anything on the right side.  Given the test results (ER+, PR-, HER2-) combined with the MRI report (which I am not very confident of), should I consider asking my surgeon about a bilateral mastectomy?

my diagnosis is

invasive ductal carcinoma grade 1 size 27mm

ductal carcinoma in-stu

grade.intermediate

size 31mm

lymph node 3 of 19 metastatic carcinoma

ostrogen+  progesterone+ her-2- i dont really understand ive already had mascetomy .doing radiation and they are recommending chemo    x 24 weeks .im also on anastrozole .i dont understand why i need chemo as well

Hi Sue

I's sorry to hear of your current situation, but we're all in this thing together and this site is wonderful and gives us an opportunity to talk to other's in our situation.

I was diagnosed 10/08 and had a bilat on 10/28/08 my choice. I had the stereotactic biopsy which to me was the worst thing ever and would have rather had a surgical biopsy, and one of the reasons I opted for the bilat mastectomy. So why the wait? And why so many biopsy's?

 I am now debating what treatment I should have as I have gotten conflicting answers from 3 Oncologist. I went to Sloan Kettering and was told due to the smallness of the tumor 0.6 cm ER + 90% and PR +20% HER + 3 (not great) stage one I could get by with either hormone treatment alone or Taxol and Herceptin. I am lost it's a tough time.I will probably start the Chemo after the first of the year just to be safe. If anyone has any information or is in a similar please let me know. Happy Holidays to all.

I'm new here--within the past few weeks. Had a single mastectomy because too many lymph nodes were affected.  I have yet to get the pathology report, but printed out the guide to it.  The doctors feel mine is a stage 3 because of the lymph nodes, and I should have final results the end of this week.

cw

There is a section on the home page about path reports under "symptoms and diagnosis".

Estrogen receptor 99% - your cancer is highly affected by estrogen

Progesterone receptor 53% - your cancer is affected by progesterone

These are good - it means that you will be able to use the hormonal drug Tamoxifen and/or Aromatase Inhibitors - drugs which stop estrogen from reaching hormone receptors on cancers (tamox) and eliminate estrogen from the body (AI)

Ki-67 - tells how fast the cancer is growing

HER-2/neu - I think overexpression means the cancer is more aggressive, but as it isn't measured in my type of cancer (DCIS, Stage 0), I don't know with any certainty.

From an "ask the expert" conference on Path reports -  

Beth DuPree, M.D., F.A.C.S.: Currently, my pathology department does not report S-phase or Ki-67 index. This is because we are relying more on the estrogen progesterone receptor, the HER2 status, and the tumor grade.
Marisa Weiss, M.D., president and founder: These two tests of how fast the cancer is growing have limited usefulness when it comes to understanding the nature of the cancer and figuring out the best treatment plan. The tests are good, but they tend to be unreliable, so you can't depend on them too much. There are other ways of figuring out if the tumor is aggressive and fast growing. The tumor grade largely reflects this issue.

The presence of a HER2 abnormality, lymphatic/vascular invasion, lymph node involvement, and absence of hormone receptors all go along with a more aggressive problem. But even if there is an aggressive cancer identified, there are effective treatments that can be used to successfully combat it

Marisa Weiss, M.D., president and founder: If your hormone receptor status is positive, that predicts two things-first, a better overall outcome, and second, a good response to hormonal therapy. The difference in outcome between positive and negative test results is only moderate. The meaning of the test in terms of choosing treatment options is much more important. The higher the percentage of estrogen receptors positive, the greater your chance of responding well to hormonal therapy. The lower the hormone receptor positivity, the better response you'll have to chemotherapy

If you know what type your cancer is (like IDC or ILC), you will find lots of help and caring in the discussion group for that type.

Take care...hope someone else comes along with more info.

I was diagnosed over 3 years ago and have read my path report numerous times.  I have always been confused by the fact that my ultrasound core biopsy showed my tumor to be invasive ductal grade 2, with a high KI67 (>30%).  When I had my surgery, my final pathology indicated both ductal and lobular, grade 1 with a low miotic count.  I guess the final pathology trumps the biopsy but I have always been somewhat haunted by the high KI67. 

Hi Carol,

My pathology was similar to yours in that I was also diagnosed with invasive mammary carcinoma with ductal and lobular features (I do consider myself as having both ductal and lobular and have read that it is a sub-type that is not all that common - IDLC).   

ER - 80% strong staining

PR - 75% strong staining

Her2 - negative - 1.2 by FISH

I was diagnosed in 2005.  My tumor was 2.1 cm and I had one positive sentinel node.

That was in fall of 2005 and I had bi-lateral/reconstruction, chemo (dd AC plus DD Taxol), radiation, oophorectomy and I am now on Femara.

That is interesting that he is starting you on Arimidex before surgery.    I have heard of neo-adjuvant chemo and neo-adjuvant hormone therapy but had not heard of anyone going on hormone therapy for a few weeks before surgery.  Sounds like a good idea to me.