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Topic: Ki67 and Oncotype

Forum: Just Diagnosed — Discuss next steps, options, and resources.

Posted on: Aug 23, 2020 10:28AM

robinorbit wrote:

I keep reading about these tests, but haven’t heard anything about either ofthese from my doctor. I just had my lumpectomy.

When are these tests typically done?

Surgery 8/20/2020 Dx 9/3/2020, DCIS, Left, <1cm, Stage 0, Grade 2 Dx 9/3/2020, IDC, Left, 1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (IHC) Radiation Therapy Whole-breast: Breast
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Aug 23, 2020 10:51AM moth wrote:

Ki67 can be done on biopsy or post surgery. Not every pathologist report contains it and it's considered unreliable by many doctors for clinical decision making. My lab never reported a Ki67 score. If it is reoorted, it's usually at same time as type, grade, and hormone receptor status. Do you have copies of your biopsy pathology reports? Are your final surgical pathology reports in yet?

Oncotype is usually done after surgery on a tumor sample to help determine need for chemo.

Seriously???? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." nevertellmetheodds2017.tumblr.... Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab)
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Aug 23, 2020 12:44PM Beesie wrote:

My hospital does not do Ki-67. It is not used independently for any treatment decisions, but it is one of the 21 genes from the cancer cells that the Oncotype test includes in their assessment.

Robin, is your next appointment a follow-up with the surgeon? Whoever you see next, you should ask for a copy of the surgical pathology report - that may or may not include a Ki-67 figure. And you should ask if a tissue sample was sent for the Oncotype test. Because that assessment is done by Genomic Health, a 3rd party company, the results aren't included with the pathology report and take longer to get. Usually the Oncotype results will be reviewed with you by the Medical Oncologist, but the surgeon may know if the test has been ordered.

One addendum to the above. I don't recall how large your area of IDC was estimated to be. If in the final pathology it is less than 0.5cm, then an Oncotype test might not be ordered. The reliability of Oncotype results for very small tumors is questionable because so few small tumors were included in the Oncotype validity testing.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 23, 2020 04:40PM robinorbit wrote:

Thanks, Moth and Beesie for explaining.

I do need to make a 2-week follow up appt to discuss pathology after lumpectomy and SNLD, so perhaps I’ll hear more then. None of my biopsies included Ki67 assessment.

My original IDC tumor was 7 or 8 mm; but after core biopsy removed much of it, it showed as only 4mm on MRI so I guess too small for Oncotype testing.

Surgery 8/20/2020 Dx 9/3/2020, DCIS, Left, <1cm, Stage 0, Grade 2 Dx 9/3/2020, IDC, Left, 1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (IHC) Radiation Therapy Whole-breast: Breast
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Aug 23, 2020 05:45PM Beesie wrote:

The Oncotype people don't need 5mm to do the testing - they can use a much smaller sample. And the final tumor size for staging combines what was removed in the biopsy and what was found during surgery. So if your total tumor size is larger than 5mm, Oncotype testing might be appropriate.

The way the Oncotype test works is that based on the genetic make-up of a tumor, an Oncotype score is assigned, and each score is associated with a recurrence risk and a particular benefit from chemo. The most recent and extensive research study that was used to determine these recurrence risk estimates, the TAILORx study, to my understanding included no tumors that were smaller than 5mm, and the average tumor size of participants was 1.75cm. So it is questionable (to say the least) to apply to a <5mm tumor a recurrence risk and chemo recommendation developed based on a 1.75 tumor. That's the reason why Oncotype testing is not recommended for small tumors.


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 24, 2020 08:15PM robinorbit wrote:

Beesie—

Thanks very much—I think I understand now. I’ll definitely bring it up with my surgeon at the post-op appt!

I appreciate you!

Surgery 8/20/2020 Dx 9/3/2020, DCIS, Left, <1cm, Stage 0, Grade 2 Dx 9/3/2020, IDC, Left, 1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (IHC) Radiation Therapy Whole-breast: Breast

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