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Topic: High Ki-67, but low grade and stage?

Forum: Diagnosed and Waiting for Test Results —

Share with and support others all waiting for test results from CAT scan, PET scan, Oncotype tests, Mammaprint, FISH, IHC, and other diagnostic tests.

Posted on: Dec 10, 2018 05:25PM

evily wrote:

Hi all!

I am currently recovering from a BMX and am getting ready to start my next phase of treatment, whatever that may be. I met with the MO today for the first time. He is saying definitely tamoxifen for 5 yrs, which I expected given my age and cancer type. But the issue of chemo is a big question mark still. He is going to run the Mammaprint test on my cancer because, even though I was Stage I, Grade 1 with no nodes involved, my Ki-67 is 60%, which is very high. Has anyone else had a similar situation - high Ki-67 but early stage / low grade? The MO said if Mammaprint comes back high risk, he would recommend 4 rounds of chemo. It terrifies me to my very core, but I am young and want to make sure I do what needs to be done to live a long healthy life. Appreciate any feedback. :-)

Dx at age 40 Dx 10/10/2018, LCIS/IDC, Left, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 11/13/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Dec 10, 2018 05:46PM Meow13 wrote:

My top notch Seatlle hospital doesn't even do ki-67. I wouldn't place any bets on it. But it is good to have the mammoprint done. Anyone with hormone positive cancer should have it done.

Good luck.

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Dec 10, 2018 07:56PM Georgia1 wrote:

Hi there. I agree: the Ki67 is an unreliable test -- my MO says it varies day to day and lab to lab. I hope the Mammaprint returns low risk for you. You have my best wishes and good thoughts.

Cancer touched my breast so I kicked its ass. Dx 9/3/2017, ILC/IDC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Dx 10/10/2017, LCIS, Right, 0/1 nodes Surgery 10/10/2017 Lumpectomy; Lymph node removal: Right, Sentinel Radiation Therapy 11/27/2017 Whole-breast: Breast Hormonal Therapy 1/2/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 10, 2018 08:36PM Hopeful82014 wrote:

Actually, Ki-67 is still widely used as a marker in a lot of lab work and does still have some clinical utility but primarily when repeated and confirmed by a single lab with a strong emphasis on the pathology of breast cancer.

That's not to say that I'd bet the farm on it in your situation, evily. It's great that you'll have information from the Mammaprint; let's hope you don't have to wait too long for it!

Dx IDC
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Dec 10, 2018 09:22PM Scrafgal wrote:

ki-67 is a major contributor to the Oncotype score...don't know about its role in the MammaPrint test...

Dx 12/2016, IDC, Right, 4cm, Stage IIA, Grade 3, 0/7 nodes, ER+/PR+, HER2- Surgery 2/6/2017 Mastectomy: Right; Reconstruction (right): Fat grafting, Silicone implant, Tissue expander placement Chemotherapy 3/22/2017 Taxol (paclitaxel) Chemotherapy 6/15/2017 FAC Hormonal Therapy 9/27/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 10, 2018 09:40PM Meow13 wrote:

I see no report of it on my oncodx report. I just received the score and er and pr percentages.

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Dec 10, 2018 10:45PM WC3 wrote:

Neither my facility nor the one I had the biopsy at did the ki-67 test. My MO said they would do it after the surgery if enough of the tumor is left (I had neoadjuvant chemotherapy). There wasn't so they have to track down the original biopsy sample.

Dx 2018, IDC, Left, 3cm, Grade 3, ER+/PR+, HER2+ (FISH) Chemotherapy 5/31/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 11/14/2018 Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab)
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Dec 11, 2018 07:06PM Meow13 wrote:

I also see her2 status as well as er and pr status. There isn't much info at all with the report. Disappointed for a $4k test, I guess the process and details are proprietary intellectual property.

The score is based on statistical curve fiiting equations. Not really impressed my document mentions that the sample size was 651. Not very convincing. I have looking at the base Magee equations, not enough info to see how my score was reached.

Can anyone supply a link especially on how ki-67 figures in?

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Dec 11, 2018 07:11PM Scrafgal wrote:

Meow13

I will see if I can dig up the regression-based formula again. I found it when I was going through all of the testing, which is why I know that Ki67 is, and the cell proliferation genes collectively, are the biggest driver of the oncotype score. I was motivated to find the actual regression formula: my oncotype score was 46. My ki67 was 90%, So, that was motivation enough to find it. I happen to be statistially trained and so when I brought the formula to my doctor he was shocked that I found it!

Dx 12/2016, IDC, Right, 4cm, Stage IIA, Grade 3, 0/7 nodes, ER+/PR+, HER2- Surgery 2/6/2017 Mastectomy: Right; Reconstruction (right): Fat grafting, Silicone implant, Tissue expander placement Chemotherapy 3/22/2017 Taxol (paclitaxel) Chemotherapy 6/15/2017 FAC Hormonal Therapy 9/27/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 11, 2018 07:15PM farmerlucy wrote:

https://www.researchgate.net/figure/Twenty-one-gene-panel-and-calculation-of-recurrence-score-a-The-final-gene-list-16_fig2_7044467

I think this might be it?

I had a link on another post but the link to the site no longer works.

Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/21/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/11/2012 Lymph node removal: Sentinel Surgery 7/22/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/10/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/14/2015 Prophylactic ovary removal
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Dec 11, 2018 07:18PM farmerlucy wrote:

My ki-67 was high at 22, but low Oncotypedx? I contacted the Oncotypedx peeps to see if they could give me their calculated ki-67 and they could not/would not.

Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/21/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/11/2012 Lymph node removal: Sentinel Surgery 7/22/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/10/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/14/2015 Prophylactic ovary removal
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Dec 11, 2018 07:22PM farmerlucy wrote:

woah - glad I stumbled onto researchgate.net. It has some really great articles.

Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/21/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/11/2012 Lymph node removal: Sentinel Surgery 7/22/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/10/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/14/2015 Prophylactic ovary removal
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Dec 11, 2018 08:06PM Scrafgal wrote:

I am still looking for the oncotype equation...I didn't save it because I didn't want to keep thinking about it at the time! I just remember that the cell proliferation factors (including Ki67, grade etc.) drove a big part of the score. I think the next biggest driver was PR negativity. It all seems so long ago when I was looking at all of that info...

Dx 12/2016, IDC, Right, 4cm, Stage IIA, Grade 3, 0/7 nodes, ER+/PR+, HER2- Surgery 2/6/2017 Mastectomy: Right; Reconstruction (right): Fat grafting, Silicone implant, Tissue expander placement Chemotherapy 3/22/2017 Taxol (paclitaxel) Chemotherapy 6/15/2017 FAC Hormonal Therapy 9/27/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 11, 2018 10:06PM farmerlucy wrote:

Is there a different one from this?

Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/21/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/11/2012 Lymph node removal: Sentinel Surgery 7/22/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/10/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/14/2015 Prophylactic ovary removal
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Dec 11, 2018 11:05PM - edited Dec 12, 2018 04:13PM by carmstr835

I also remember the KI-67 formula being very heavily a part of the oncoscore. It was algorhythm . I will see if I can find it as well. My Ki-67 was 20% for my right breast tumor and my onca score was 19 for that breast. My Ki-67 score was <5% for my left breast and that came back 16 onco score. Then the right tumor was sent to mammaprint and it came back as low. I still had chemo though, because I was her+ and extra nodal. However, my insurance is not wanting to pay so I am getting billed for lots of money.


Dx 3/1/2017, DCIS/IDC, Both breasts, 1cm, Stage IIB, Grade 2, 2/17 nodes, ER+/PR-, HER2+ (FISH) Hormonal Therapy 3/21/2017 Arimidex (anastrozole) Surgery 3/26/2017 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Chemotherapy 5/17/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 6/26/2017 Herceptin (trastuzumab) Chemotherapy 6/27/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 6/27/2017 Perjeta (pertuzumab) Radiation Therapy 9/10/2017 Breast, Lymph nodes, Chest wall Surgery 7/9/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Surgery 10/15/2018 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting Targeted Therapy Nerlynx
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Dec 11, 2018 11:31PM Meow13 wrote:

Scarfgal,

Glad to meet you. I am not a statistician my master's degree was applied math. I have much experience with curve fitting, my special focus and thesis was non linear optimisation. It is a bit disconcerting that our treatment is based on statistical results. Cancer is fairly individualized. I try to read as much as I can. I had 2 tumors one idc and one ilc, tumors were very similar but one had expression that determined 90% it was ilc. It was remarkable that I was 95 % as far as er receptors but 0% pr, her2 negative. I believe that contributed to my oncodx score of 34.

Both my tumors were low grade with mitotic score of 1, I didn't get a ki-67 my oncologist said we don't report it in our labs. I like to gather as much info as I can. I chose no chemo and managed to get in almost 4 years of AI drugs. I am still NED, happy I did the conservative route of mastectomy. The DIEP reconstruction was pretty good. Most impact was all the surgery but I had no complications. No radiation or chemo.

I hope I've seen the last of this cancer.

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Dec 11, 2018 11:33PM - edited Dec 11, 2018 11:36PM by Meow13

farmerlucy,

First time I've seen that, where is it from?

I would love to see all the components, I wonder if I call oncodx if they still have my information.

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Dec 12, 2018 08:17AM farmerlucy wrote:

Chec out the live link above to researchgate.net. Below that article are some really interesting links to other pertinent BC studies.

Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/21/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/11/2012 Lymph node removal: Sentinel Surgery 7/22/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/10/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/14/2015 Prophylactic ovary removal
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Dec 12, 2018 09:18AM evily wrote:

Wow, interesting info, farmerlucy! I'm not having the Oncotype test, and I don't know if Mammaprint uses ki67 in their algorithm, but it is interesting to know that Ki67 factors so heavily into at least some of these tests. That researchgate.net site is fascinating!

Dx at age 40 Dx 10/10/2018, LCIS/IDC, Left, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 11/13/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Dec 12, 2018 02:30PM - edited Dec 12, 2018 02:30PM by wallycat

Nothing to add except how in awe I am of you ladies with the math skills. My DH is a math major and a master's in physics and I always say, "really? on purpose?"

I am math challenged so again...I bow to the smarts of this crowd!


As an aside, I had er/pr + with a grade 2 (after lumpectomy; biopsy seemed to think it would be a grade 1) and mitosis 0-1. My oncotypedx score shocked my BS and onco....20.


Dx 4/07 1 month before turning 50; ILC 1.8cm, ER+/PR+, HER2 neg., Stage 1, Grade 2, 0/5 nodes. Onco score 20, Bilateral Mast., tamoxifen 3-1/2 years, arimidex-completed 4/20/2012
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Dec 20, 2018 05:05PM evily wrote:

Hi everyone! Just a quick update in case anyone was wondering: my Mammaprint test came back low risk. So, I guess my Ki67 wasn't that big of a factor after all. I haven't seen the full report yet, so I can't provide any other details, but if/when I learn more, I'll post an update. Good news of all this is that I don't need chemo. I'm very happy about that! :-)

Dx at age 40 Dx 10/10/2018, LCIS/IDC, Left, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 11/13/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 1, 2019 11:44PM Cjzach10 wrote:

Hey ladies!

I had b/l mx with immediate deip flap reconstruction on Nov 12. I'm on pins and needles waiting on my oncotype score. Monday was 2wks since they sent it off but i hoped with the holidays I would at least get a call in the next 2 days. My ki 67 was 30 percent er 100 percent and pr 100 percent and grade 2. But i don't know my true stage because i had unsuccessful lymph node mapping. I had no dye or tracer absorption. My bs took a section of tissue that felt nodular but no lymph nodes in the tissue. My bs and oncologist agree on no more surgery to find lymph nodes. I don't understand what all of this means without lymph nodes. I've been pretty down over the last week thx to waiting...again. And because its really sinking in that since i had 0 lymph nodes tested and I'm never going to have that information and will always worry. Yes..all my stats are in my favor i guess you could say but I'm a manmo tech and we all know cancer doesn't play by the rules!

I would really appreciate your thoughts. I feel like im close to my breaking point again!

Thanks for your input💖

Dx 9/11/2018, IDC, Left, 1cm, Grade 2, ER+/PR+, HER2- (FISH) Surgery 11/11/2018 Lumpectomy: Left; Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Jan 2, 2019 12:01AM farmerlucy wrote:

Hello from a fellow Okie. Hang in there. I had a sentinel node biopsy post mastectomy and learned on these boards later on that its efficacy could be questioned. Fast forward nearly seven years - I’m so glad my surgeon did not go in and do the axillary node clearance. LE would be a terrible bi-product. We’re always going to have questions. Many times one answer leads to another question. Oh how I wanted guarantees in the early days. I ran the stats in my head over and over and over. And over.

It took a long time, months to years, for me to learn to live with the uncertainties. When I did, it was a freedom of sorts. I learned I had control over very little in my life and ironically that is quite liberating.
Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/21/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/11/2012 Lymph node removal: Sentinel Surgery 7/22/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/10/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/14/2015 Prophylactic ovary removal
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Jan 2, 2019 12:26AM Cjzach10 wrote:

Thank you farmerlucy! You hit the nail on the head with answers leading to questions! Im closer everyday to learning im not in control. That's helped with all the waiting! I've been a mammo tech for 16 years and its quite ironic being on this side of breast cancer. Ive learned so much that I didn't know i didnt know!

Im so thankful for this forum and i will be recommending it to patients from now on.

If you're in the path if this supposed ice storm stay warm and safe! I just hope it doesn't pan out!

💖

Dx 9/11/2018, IDC, Left, 1cm, Grade 2, ER+/PR+, HER2- (FISH) Surgery 11/11/2018 Lumpectomy: Left; Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Jan 2, 2019 05:25PM Samnjb wrote:

hi when i was waiting for my score ( i had simlar numbers to you and got a 12) i found singhing called the magee equation. Google that. It was close to righg for me. Good luc

Dx 9/2018, LCIS/ILC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Jan 2, 2019 07:53PM Georgia1 wrote:

Evily, congratulations!

CJZach 10, thinking good thoughts for you.

Cancer touched my breast so I kicked its ass. Dx 9/3/2017, ILC/IDC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Dx 10/10/2017, LCIS, Right, 0/1 nodes Surgery 10/10/2017 Lumpectomy; Lymph node removal: Right, Sentinel Radiation Therapy 11/27/2017 Whole-breast: Breast Hormonal Therapy 1/2/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 3, 2019 10:58PM Cjzach10 wrote:

An update for anyone interested. I called the oncologist today since its been 2 and a half weeks waiting for the oncotype. I was told there was a mistake..something about the wrong tissue sample..and its going to be another 2 wks. I'm furious and so upset! In total since i thought i was getting my results initially plus waiting 2 wks it will have been 6 wks! My abn mammo was July 30. I just want to have a plan and get on with it!

Thanks for listening!

Dx 9/11/2018, IDC, Left, 1cm, Grade 2, ER+/PR+, HER2- (FISH) Surgery 11/11/2018 Lumpectomy: Left; Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Jan 4, 2019 08:56PM farmerlucy wrote:

Oh man. 😞

I hope they put a rush on it! Hang in there

Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/21/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/11/2012 Lymph node removal: Sentinel Surgery 7/22/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/10/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/14/2015 Prophylactic ovary removal
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Jan 5, 2019 01:33AM HPFULL wrote:

I heard this is fairly accurate in predicting if oncoscore. You need to do the formula for Er and Pr below in the instructions before plugging in the #s

https://path.upmc.edu/onlineTools/mageeequations.html

Dx 10/2018, IDC, Right, 2cm, Stage IIB, Grade 2, 1/3 nodes, ER+/PR+, HER2- (FISH) Surgery 12/10/2018 Reconstruction (right) Hormonal Therapy 1/14/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast, Lymph nodes
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Jan 5, 2019 01:53AM Meow13 wrote:

Thanks, I don't know the ki-67 but I tried a bunch of different numbers.

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Jan 5, 2019 04:30AM Cjzach10 wrote:

Thank you so much! I used the er and pr as it was on my path report...i only have one number of 100 percent for both er and pr. If i plug in 100 on both it gives me a score in the twenties. If i plug in 300 it gives me 12 to 14. I called the lab. They cant rush it. It was a mistake made by the pathologist. All about specimen id numbers not matching up with their documentation. Now im skeptical of the entire process.

Thank you for the support. Cancer sucks!

Dx 9/11/2018, IDC, Left, 1cm, Grade 2, ER+/PR+, HER2- (FISH) Surgery 11/11/2018 Lumpectomy: Left; Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap

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