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Topic: Update: First biopsy results

Forum: Caring for Someone with Breast cancer —

A place to share your struggles and concerns about supporting and caring for a person you love diagnosed with breast cancer with others who understand.

Posted on: Mar 5, 2018 12:13PM

KelAppNic wrote:

AN UPDATE:

So I have some updates for everyone, and appreciate any feedback you may have. We went for the ultrasound which resulted in a second biopsy, and we should have the results of that this week. We got some recommendations for surgeons in the area from our PCP and the very knowledgeable and supportive staff at Heritage Valley Women's Health Center in Aliquippa, PA. Here are the results of the first biopsy with my question in italics.

Diagnosis: 1. Invasive mammary carcinoma, right breast. Invasive ductal carcinoma, Nottingham Grade I (tubular formation=2, nuclear picomorphism=2, mitotic rate=1). I think that Grade I is good news, but I'm not certain what the terms in parentheses mean.

2. Ductal carinoma in situ, intermediate nuclear grade. I don't understand why there are two diagnoses, and how it can be both IDC and DC in situ

Here are the ER/PR, HER2, and Ki-67 results:

ER Stain: Positive 77%

PR Stain: Positive 25% This is good, right? A better prognosis if the cells have hormone receptors?

HER2 Stain: Negative (score +1) This is also good, right? Negative HER2?

Ki67: Positive 36% I think this is not so good, is that right? It means the cells are dividing and spreading faster?

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Apr 6, 2018 04:58PM BCwife wrote:

Did you get the answers to your questions from your care team?

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Apr 6, 2018 06:39PM SpecialK wrote:

KelAppNic - grade is comprised of the three aspects in the parentheses - mitotic rate, pleomorphism, and tubule formation. These three categories describe how the cancer looks under the microscope. Each of the three categories receives a score of 1-3, depending on individual criteria for each one. The scores are then added together, a total of 3-5 is grade 1, 6-7 is grade 2, 8-9 is grade 3. On the combination of DCIS and invasive cancer - IDC or ILC, this can mean two things - either part of the the DCIS grew out of the duct and became invasive, or some IDC (or ILC had developed independently simultaneously with the DCIS. Having both DCIS and IDC together is very common. Generally, having PR+ is better than PR- as it seems to mean that treatment therapies may work better, and/or the cancer may be less aggressive. Her2- means that some forms of systemic therapy are not necessary, and that the cancer is potentially less aggressive. Ki67% measures a protein cells give off when they divide, so it is regarded as a proliferation marker, but it is somewhat subjective and not universally regarded as a completely reliable measure of aggressiveness. Also, remember that grade and other markers taken from the biopsy are a snapshot, the full picture is usually determined at the time of surgical pathology.

BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Apr 9, 2018 07:46AM KelAppNic wrote:

Thanks so much for your reply. My wife's surgery is now scheduled for 4/20. The surgeon seems positive about the results (a 2nd biopsy has been done since I posted). My wife has decided to go with the bilateral mastectomy even though there are no visible cancer cells in the other breast. I will keep posting with results.

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Apr 11, 2018 04:19PM bluepearl wrote:

An octoptypeDX test would be in order as to whether chemo is necessary or not. Anti-hormonal are. Ki67 is part of the oncotypeDX, and yes, 36 means it is a bit more aggressive despite the grade 1, but until you get the oncotype and node status, it is still hard to say her stage. So far, so good, I think. I always find it interesting when the mitotic rate and Ki67 don't match. But I am not a doctor. lol. Thank goodness.

Dx 1/6/2011, IDC, 1cm, Stage I, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 2/11/2011 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left Dx 2/2013, IDC, <1cm, Stage I, Grade 3, 0/3 nodes, ER+/PR+, HER2- Surgery 3/9/2013 Lymph node removal: Right, Sentinel; Mastectomy: Right Hormonal Therapy 3/17/2013

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