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Topic: Biopsy vs. Oncotype DX - deferent diagnoses.

Forum: Mixed Type Breast Cancer — Meet others who have mixed type breast cancer.

Posted on: Jan 18, 2019 12:07PM - edited Jan 18, 2019 12:08PM by Julia46uk

Julia46uk wrote:

hello,

I am new here, have been reading bords since my diagnosis in November 2018 and finely decto join. I was first diagnosed with DCIS by biopsy and decided to do Lypectomy. After my surgery in December pathology should that I also have a 3mm IDC and I am triple positive. Now I just got my Oncotype results back and it reported that I am er-,pr - and her2+. Is it even possible? I am waiting on call back from the oncologist but ...what is more accurate with er/Pr diagnosis and how they could be so different in so small tumor?

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Jan 18, 2019 12:50PM LoriCA wrote:

I have had multiple biopsies done since my dx and the pathology has always been ER+ PR- HER2+. Somehow somebody messed up and ordered an Oncotype DX on my last biopsy (I was Stage IV de novo so a recurrence score is pointless) and the Oncotype DX said ER-. Sounds like both of us have pathology reports saying ER+ (in my case multiple times) yet Oncotype DX says ER-. I'm interested to hear what others have to say about their experience because these things make a huge difference in treatments.

IBC Stage IV de novo - mets throughout skeleton, liver, distant nodes, chest wall, skin, tumor in brachial nerves.Still trying to get it to slow down. Dx 9/8/2017, IBC, Right, Stage IV, metastasized to bone/liver/other, Grade 3, ER+/PR-, HER2+ (IHC) Chemotherapy 9/26/2017 Taxol (paclitaxel) Targeted Therapy 2/6/2018 Perjeta (pertuzumab) Targeted Therapy 2/6/2018 Herceptin (trastuzumab) Chemotherapy 11/26/2018 Taxol (paclitaxel) Radiation Therapy 1/30/2019 Whole-breast: Breast, Lymph nodes, Chest wall
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Jan 18, 2019 03:07PM Moderators wrote:

Dear Julia46uk,

Welcome to the BCO community. We are sorry about your diagnosis but so glad that you reached out to our members for support and information. We hope that you will make good use of the experiences shared here and stay active. Let us know if you need any help learning how to navigate your way around the boards.

The Mods

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Jan 19, 2019 01:33AM - edited Jan 19, 2019 01:34AM by Meow13

I thought tumors had to be atleast 5mm to send to oncodx. Maybe they sent the DCIS portion.

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Jan 19, 2019 05:53AM - edited Jan 19, 2019 05:54AM by windingshores

It's possible that the biopsy had more of either DCIS or IDC, and the Oncotype more of the other one.  Also the Oncotype is done with a slurry, not specific discrete pieces of a sample. You can call Genomic Health, the Oncotype company, to discuss. They are pretty informative on the phone.

Dx 2/2015, DCIS/ILC/IDC, Right, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery Lymph node removal; Mastectomy: Right Surgery Mastectomy: Left; Prophylactic mastectomy: Left Hormonal Therapy
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Jan 27, 2019 03:48PM Julia46uk wrote:

So I have somewhat update. My original MO who requested the Oncotype just told me to egnore the ER/PR - as biopsy is always more accurate. I can just ignore things without a good explanation, so I reached out to my second opinion MO and he said that after board meeting with 3 others MO he wants me to get another second opinion with professor at John Hopkins. I am waiting for call back from Hopkins coordinator to get my appointment. If anyone was in the simulator situation and willing to share I would appreciate information. Also the second opinion MO said that he would not send me for Oncotype to begin with as my tumor is only 3 mm and her2 positive, but because we do have Oncotype we can't just ignore it

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Feb 7, 2019 12:59PM windingshores wrote:

My biopsy results were wrong in terms of HER2. If I had gone by the biopsy results I would have had chemo and Herceptin. Luckily I had neither.

Dx 2/2015, DCIS/ILC/IDC, Right, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery Lymph node removal; Mastectomy: Right Surgery Mastectomy: Left; Prophylactic mastectomy: Left Hormonal Therapy
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Feb 7, 2019 01:02PM - edited Feb 13, 2019 09:24AM by Moderators

Chiming in to post this in case anyone would be interested:

$25 for participation: Genomic Health is looking for people (Age 70+) who have used the Oncotype DX test for invasive breast cancer to share their story in a 30 minute phone interview. The project is called NoMatterMyAge. Email BWang@genomichealth.com if you are interested and let her know a bit about you (where you are located, your age, phone number). Thank you!


To send a Private Message to the Mods: community.breastcancer.org/mem...
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Mar 9, 2019 08:10PM CherylFl wrote:

After a core needle biopsy of a 7mm spot on 1/10/19  A pathologist reported Invasive Ductal Carcinoma ER & PR Pos and HER neg by FISH. 2 weeks later Breast MRI showed 3 additional suspicious spots spread around and neoplasm around previous biopsy site which was marked with a clip. On Feb 8th had a double mascectomy as they could not biopsy all the sites or remove & leave a breast. The pathology from mastectomy came back including the slide with the clip from biopsy as NO INVASIVE CANCER any where on 25 slides all margins clear, I assume  the entire breast is on slides but not sure. Surgeon said I should be happy no cancer! Oncologist sent off the slide from Biopsy and it came back with a Onco score of 28 which suggest a benefit of chemo.  I was not expecting that as I do not see how the Invasive could have all been gotten with a core biopsy. I was told Onco test would not have been able to score if Invasive Cancer not there. So if the Onco test came back a 28 does that mean I had to have had Invasive it was somehow just not there after mastectomy? 




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Dx 1/10/2019, DCIS/IDC/IDC: Cribriform, Left, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 2/8/2019 Mastectomy: Left, Right Hormonal Therapy Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Mar 9, 2019 09:25PM Beesie wrote:

Cheryl, the final diagnosis is based on the combined findings of both the biopsy pathology and the surgery pathology. While it's not all that common, it certainly can happen that all the cancer was removed in the biopsy. And if invasive cancer was found in the biopsy, then unfortunately yes, you do have a diagnosis of invasive cancer, even if no invasive cancer was found in the surgical pathology.

Given the different findings between the biopsy and the surgery, a logical next step would be to have the biopsy sample reassessed, to ensure that the finding of invasive cancer was correct. Since your biopsy sample was submitted for the Oncotype analysis, and since the Oncotype analysis would have noted if no invasive cancer was found, this second step has in effect been done. The Oncotype score is the confirmation of the invasive cancer diagnosis.

As for the need for chemo, the question to ask is how much risk reduction benefit you will get from chemo. The TAILORx study that was released last year showed no benefit to chemo for anyone with an Oncotype score up to 25. With a score of 28, this means that there will be some benefit from chemo, but your Oncologist should be able to tell you how much benefit is estimated. In other words, what is your recurrence risk with hormone therapy alone, and how much lower is your recurrence risk if you have chemo and then take hormone therapy? That information can help you decide if chemo is worthwhile for you

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Mar 10, 2019 08:30AM CherylFl wrote:

Thank you Beesie you have explained this so much better than anyone I've talked to Drs included. I was hoping the IDC was wrong dx. 4 weeks later and I still have a lot of swelling chest & underarms not the arms themselves, but wondering how there is room for a port. I will be getting a 2nd oncologist opinion if possible before starting any chemo. I  have been told with each week on waiting on chemo past the 4th week from surgery the risk from reoccurrence goes up I have not seen this addressed on this site but sure it may be somewhere.  Again thank you for your prompt & clear response!



Dx 1/10/2019, DCIS/IDC/IDC: Cribriform, Left, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 2/8/2019 Mastectomy: Left, Right Hormonal Therapy Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Mar 19, 2019 01:34AM Desirr77 wrote:

Dear Beesie,

is it possible to shrink or remove a tumour via biopsy? I compare a tumour with an apple - if you take sth from the inside, as a biopsy does, the apple does not shrink. Or does a biopsy take away a few mm from the original size?

Dx 2/4/2016, IDC: Medullary, Right, <1cm, Stage IA, Grade 3, 0/1 nodes, ER-/PR-, HER2- Surgery 2/9/2016 Lumpectomy: Right; Lymph node removal: Right, Sentinel Chemotherapy 3/2/2016 Cytoxan (cyclophosphamide), Ellence (epirubicin), Taxol (paclitaxel) Surgery 9/28/2016 Prophylactic mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Mar 19, 2019 08:09AM Beesie wrote:

Desirr77, depending on the size and shape of the tumor, the size of the needle and where the needle enters the tumor, it is possible to remove all the cancerous tissue during the biopsy, and it is possible to slightly reduce the size of the tumor by removing portions during the biopsy.

Not all tumors are round like an apple, many are misshaped masses, some are spiculated with pieces jutting out and in the case of DCIS (or DCIS with small amounts of IDC), the suspicious tissue is usually not a mass at all but is linear. In those cases, the needle might capture an area of tissue that does change the size of what's left to remove during surgery. Or when there are small amounts of IDC mixed in with DCIS, the needle might remove the entire IDC specimen. That doesn't happen often but it does happen sometimes.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke

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