Her2 equivocal question

KattyC

Hi everyone, my liver mets biopsy came back with a Her2 ratio of 2.04, which is classified as equivocal.  There is not enough tissue for further testing although I will be having the tumor surgically removed next week.  We'll send off the tissue for Her2 test and hoping for a more definitive score.

In the meantime, my Onc. says they treat an equivocal score as Her2+ and treat accordingly.  Has anyone experienced this and if so, how did your Onc treat the Her2 status?

nmi

Kathy, Did you found out any more about this. I hope you are doing well.

Nancy

KattyC

Emory tested the tumor (using IHC) from the liver resection and Her2 is negative.  Onc. wants a re-test using FISH which measures nuclei a different way.  Since we were in the process of relocating from Atlanta to South Florida when the recurrence happened, we'll be seeing an Oncologist at the U. of Miami, Sylvestor Cancer Center on Jan. 5 for a consult.  Ideally we'll do follow-up treatments in Miami rather than Atlanta where I've been in treatment or monitoring for past 8 years.  Anyhow, I'll ask new Onc. if he is comfortable using Her2 test results from the IHC or if FISH needs to be conducted for assurance. 

Anyone with experience on the 2 tests and if both needs to be conducted?  Thanks!

orange1

An equivocal (IHC 2+) should always be sent out for FISH testing.  Her2 IHC testing is delicate to perform and subject to error.  FISH results are considered definitive.  You would not want to miss the opportunity to have Herceptin if your tumor is really Her2+.  About 25% of IHC 2+ will come out Her2+.

lovetosail

KattyC - I was IHC 1+, and here at UCLA they do FISH on that group as well.  I ended up HER2+ with a ratio of 5.03 - firmly positive.  As orange1 says, the FISH results are considered definitive, and I am so glad UCLA does FISH on ICH 1+, as a lot of places don't.  My ONC says about 5% of IHC 1+ end up HER2+ on FISH. I am glad to know my correct HER2 status and to be receiving Herceptin!

Best,

Sue

Cal-Gal

Hi KattyC--

I am HER2+ equivocal by FISH --IHC was 'borderline'

-and I am being treated as HER2+ positive-I am on Herceptin--

-my onc told me same--

Good Luck 

jrlegal

Hi Kathy: How did you know the Stage already? I only see a Grade rating on the biopsy report?

thungate

Hi Kathy,

I was Her2 equivocal 2.0 by FISH.  My oncologist did the other test and I don't know what the number was, but it was still borderline.  I received Herceptin for a year.  I had 3 tumors in a row and 50% was DCIS and 50% was IDC, I guess the DCIS was stronger Her2 than the IDC.  I think they also tested twice by FISH and it was always 2.0.  You can see in my signature that I was ER/PR -.

I am happy that my onc gave me Herceptin, so far so good.

Good Luck!

Tara

KattyC

Hi jrlegal, the grade was actually from my first dx.  They didn't grade the tumor from my recent liver resection on 11/25/09.  Path report came back, ER+ 99%, PR+ 92%, IHC on the Her2 -, but Ki-67 was 43%.  My new Onc was surprised that with such a high expression of ER & PR that the Ki-67 would be so high.  He said it should be around 11%.  He's requesting a FISH test because either I am Her2+ and the KI-67 number is right or the Ki-67 probably wasn't calculated correctly.  He says about 13% of the time numbers change once the tissue is re-tested again.  That seems high to me since we are treated according to our pathology results. 

 Since I also had my ovaries removed during the same surgery as the liver resection, I just started on Femara, 2x annual Zometa, and will be looking forward to receiving the FISH results.   No chemo unless I progress. 

cookie2009

Hi, I am stage 1 , er pr negative, her2 by equivocal-postitve. I had a mastecomy, and clear margins, and my tumor size was .2ml.    My doctor chose not to give me additional treatment, does that sond ok. I wonder, her2 w.o herception recurrance is about 25%. I dont know if I should have found another doctor.

Cookie

Cowgirl13

Definitely you should have Herceptin.  Someone else on the board here will tell you exactly why.

Good luck! 

cookie2009

MY her2 score was positive but equincoal. What does that mean?

Cookie

cookie2009

Hi, When I questioned the doctor again, she told guidelines for herceptin is tumor size .5cm or greater. She will not give me the herceptin. 2nd opinion, told me the same thing. I am really confused now.

orange1

Hi cookie,

equivocal means uncertain.  When they say it was positive, without having done additional testing, I am guessing that means your onc is considering anything that is not negative as positive.  Generally equivocal tumors are sent for further testing.  However, you tumor was so tiny, that your onc feels it you don't need further treatment regardless of Her2 status, so no need for additional testing.

Your onc is right about the guidelines.  But if it makes you feel better, get a third opinion at a major cancer treatment.  (I got three opinions regarding which chemo regimen to use.)  Its worth it for your peace of mind.  

Where did you see recurrence rate of 25%?  I don't think stats are available for such tiny tumors. 

LINDAGARSIDE

Hi Katty and other pink sisters.  Can you help me understand this a bit?  I am 100% positive for ER and PR but my Her2 is "equivocal".  They are now doing a FISH test.

I am stage 1/grade1 for IDC and I had clear margins and no cells found in my lymph system.  I don't think I've seen anyone with 100% positive for ER and PR...yet equivocal for Her2.

Have you seen this before?  Any ideas?  Thanks everyone!! 

cbm

Hi, Linda; I was 90% ER/PR and just over the line on Her2 at 2.4.    And grade 2.  All of these numbers refer to the calculated percent of a tumor that has the characteristic.  So I assume you can have any combo, or no combo at all.  

Her2 is tricky because the the test has two features.  First, the number of Her2 signals must reach a certain threshold--I believe it is ten; I've also seen six.  Second, the ratio of signals to Cep17 signals (I think that's another gene) must also reach a threshold, 2.2, I believe.  Between 1.8 and 2.2, the result is equivocal.  Again these are based on counting of both gene signals and then establishing the ratio between them, with two observers looking for indicators.  

From what I understand, in the trials that established the specific results that we all celebrate and that formed the protocols we get, the threshold for a participant's inclusion was a Her2 score of 2.2.  I would assume that does not mean that if your ratio is lower, you would not get benefit, only that the protocol did not establish that you might.  

I hope this helps; please correct me if you think I misstated anything.  All of my info came from online articles and protocols, but it's been a while--there may be better info out there.

Cathy 

Frapp

My pathology report from Dana Farber says Her2 IHC equivocal 2+; Her2 fish not amplified (ration2.35/2.08=1.1)   can someone help me with this?

KattyC

Hi Linda, my tumor was ER - 99% and PR - 92% from recent liver resection.  My IHC came back negative and Ki-67 - 43%.  Even though the ER/PR was high, my Onc. says each tumor has it's own characteristics and should be tested also with a FISH.  Especially in my case with the Ki-67 expressing such a high percentage he felt that there was a good chance I could be Her2 +.  My FISH came back 1.8 so not amplified.  Now I can rest easy that treatment path I'm following is the one I should be on. 

 With your grade 1, ER/PR - 100% tumor one would think that you would be Her2-.  But, good that your Onc has sent off for a FISH since your IHC came back equivocal.  Better to be sure, one way or the other.

 Frapp - I would think the FISH of 1.1, not amplified, is your Her2 score, negative.  My understanding is the FISH is more definitive than the IHC. 

LINDAGARSIDE

Hi all,

I received a copy of the original Her-2 test and it shows a grade of 2+ and the word "equivocal". 

I then had the FISH test and I just got the results back and it shows 1.4 score.   

The oncologist states this (1.4) is a 'negative' reading (and therefore a good thing).  Apparently the Fish score with a ratio of anything 2.2 or higher is positive.  A score of 1.8 - 2.2  is eqivocal.  A score of anything 1.8 or lower is negative.  I made it by the skin of my teeth.

I want to thank everyone for their comments and input as it really helped get me through some rough spots.  I'm such a big baby.

KOE

Hi Lindagarsid,

You and I have very similar diagnoses, can I ask what your doctors recomemnded for your treatment. My mother was diagnoesed 8 weeks before me and I am borderline Her2+. I have had an invasive biopsy and  2 wide resections to get better margins. Waiting for results on final biopsy.  I am considering masectomy. I also had an initial positive her2+ dx, but a SISH (that's the same as a FISH) was perfomed and came back as 1.4. Iam nervous about this.

Appreciate any insight you might have for me.