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** Oct 10, 2020 11:11AM**
**Beesie**
wrote:

Ah, ITC and not micromets. Yes, there is a difference, since ITC is considered node negative. So it's very interesting that your doctor had your Oncotype score done based on you being node positive. I guess that was his way of compensating for the failed SNB and not knowing for sure if there might be any more nodal involvement.

But it's interesting that your MO made a different assumption with your staging. Your Prognostic Pathological Stage is Stage IA, as you indicate, based on your diagnosis being T2, N0 (i.e. assuming node negative based on ITC), M0, Grade 2, ER+/PR+/HER2-. But if your MO had assumed you to be node positive (changing the N from N0 to N1), your Prognostic Pathological Stage would be Stage IB. And just to confuse things further, your Anatomical Stage, which is the traditional method of staging and the only way staging was done until late 2018, is Stage IIA, based on T2, N0, M0.

As for your Oncotype score, just to clarify, whether you are node negative or node positive, your Oncotype score would be the same. The test is the same; 21 genes within the tumor are analysed and scored, resulting in the Oncotype score. So your score would be a 31 whether node negative or node positive. But the recurrence risk and chemo benefit associated with the score is different depending on the nodal status. The node positive results for a 31 score are the results you received. The node negative results for a 31 score are the chart and graph I posted previously (well, the chart shows a 32 score, but obviously a 31 score would be very close to that).

One of the big problems with Oncotype recurrence risk results is that Genomic Health (the Oncotype people) use several different research studies. Even in your report, your recurrence risk with endocrine therapy only is based on one study (TransATAC) while the benefit from chemo is based on another study (SWOG 8814). So this means that there are different risk figures out there for the same score, depending on which study is referenced.

Look at this graph that I found on-line. It shows recurrence risk and chemo benefit (at 5 years, however, not 9 years) based on SWOG 8814; I have added in lines to highlight a 31 Score and the corresponding recurrence risks with and without chemo. This graph also answers the question about how Oncotype handle micromets - you can see that at the top of the chart, it states "Micromets & Node Positive (1-3)".

All this probably just confuses things more. The big problem, of course, is that your diagnosis is not definitive, since the SNB failed. Adding to the confusion is the fact that your MO has made one assumption (node positive) for your Oncotype results and another assumption (node negative) for your Staging. The difference in risk is significant, as the various graphs show. If you truly only had ITC and therefore are Node Negative, you are Stage IA and with your Oncotype 31 score, your recurrence risk after chemo is approx. 7.5% (as per the TAILORx chart I posted yesterday). But if you are in fact node positive, then your stage is higher (although likely just Stage IB), and your prognosis may be more in line with the information from your node positive Oncotype report and the graph that I included in this post. All that to say that your original question about your prognosis - whether it should be based on your staging or your Oncotype results - is something you need to talk to your MO about.

Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole