How do you know the HER2 status of your microinvasion?

jadeblue

Hi all. I was told that I had micro-invasion ("clusters of infiltrating cells") visible in my pre-excision biopsy slides. Actually, the first hospital's pathology team did NOT see this, but the second-opinion review did. Post-lumpectomy, they were not able to isolate any IDC and therefore do not have an HER2 status for it (they know the DCIS is ER-/PR-). I haven't yet seen my full pathology report, but I believe I am still classifed as stage 1 DCIS with microinvasion. Is it typical in these cases that the invasive cells cannot be found/analyzed? Is there anything that can be done other than cut it out and hope for the best? (My SNB was 2 nodes -- both neg.) If the microinvasion were HER2+ I'd consider Herceptin, especially since I am not a candidate for Tamoxifen.

Thanks! -JB (ER-/PR- grade 3 DCIS with possible microinvasion, unknown HER2 and neg. SNB)

momof2greatkids

I don't have an answer but I sure would push the docs to find a way to analyze for Her2, you are right, if you are Her2 positive, darn skippy you want the Herceptin!

CarylC

Interesting question.  Going into my bi-mx, I had 2 different foci of microinvasions and asked my BS about HER status and she said "we don't test that for pre-cancer."  

I came out of surgery with positive nodes, stage 2 and HER+++.

Pre-cancer my butt!   

jadeblue

CarylC: How awful! So sorry that happened to you. I don't think they should tell women anything about stage 0, pre-cancer, etc. until they know for sure. It's just so often not the whole story and I think it's more stressful to be given the 'you don't really have cancer' speech before they have any idea whether or not that's true.

My first surgeon (who I later replaced) started out her speecth with, "You have a 'something.' It's not a 'nothing,' but good news: it's not cancer!' Uhh, OK. Turns out it's high-grade ER-/PR- DCIS with comedo-necrosis and microinvasion. By no means the worst case scenario, I realize, but aggressive high-grade DCIS mixed with stage 1 cancer is not exactly 'good news!' either. Really, our docs need to think really carefully about what they are saying and the effect it has.

Anonymous

girls,

there is no way (at least not yet) to classify your tumuor above stage 0, without cutting (mastectomy/lumptectomy) or poking (biopsy) your tumuor.

they have to get at least a portion of the tumour and probably a section of breast tissue, and in most cases your lymph nodes, in order to classify them above stage 0.

only after disecting the tumuor and testing it can they make a call whether you are stage0 or above it.

laurakay

I also don't know.  I have a 1.5 mm IDC.  Three oncologists have told me that they can't test for her2, but also that unless the IDC were 5mm or larger, no one would give me herceptin.  My own research leads me to think it probably IS her2+, because DCIS microinvasion, high grade, very often are.  So, this is probably no help, but I decided to try to just forget about this her2 aspect, since there's nothing I can do whether I knew or not.  I drink a lot of green tea, meditate, and take Zyflamend.  And every time I get a cough or a pain I assume I'm going to die!!!  (HOping this last will start to taper off...'cause it's not helping...)

Liz08

Laura,

I'm sorry you weren't able to find out your her2 status but it broke my heart to hear you say that every time you cough or have a pain you assume you're going to die. Please stop that & enjoy everything life has to offer. I too take an arsenol of supplements to help keep my immune system strong..

Here's a reassuring study that another member posted:

In this study, there were such minor differences between DCIS prognosis (really good) and DCIS with microinvasion (defined as 1-2mm) that I thought you might like to see it.  I hope we're all well, or very soon to be!

http://www.facs.org/cancer/mtgpdf/parikh.pdf

and yet another study I found..

I thought that I would start off by a study I had on microinvasive breast cancer...

I thought that I would post an abstract I found on the ASCO website from 2008-

Microinvasive breast cancer (Tmic): A descriptive mono-institutional report.

Sub-category:

Local-Regional Therapy

Category:

Breast Cancer--Local-Regional and Adjuvant Therapy

Meeting:

2008 ASCO Annual Meeting

Printer Friendly

E-Mail Article

Abstract No:

11508

Citation:

J Clin Oncol 26: 2008 (May 20 suppl; abstr 11508)

Author(s):

A. Ferro, A. Caldara, R. Triolo, M. Barbareschi, E. Leonardi, O. Caffo, M. Pellegrini, M. Frisinghelli, D. Bernardi, E. Galligioni

Abstract:

Background: Tmic is considered a separate pathologic entity with good prognosis, but its clinical significance and management remain controversial. We present our retrospective review of 69 cases of Tmic, among 6,023 BC pts (1%), observed at our institution from 1990 to 2007. Methods: We considered Tmic a single focus of invasive carcinoma < 2 mm or up to 3 foci < 1 mm in greatest dimensions (according to Silver and Tavassoli, Cancer 1998). Descriptive analysis of pts characteristics, treatment and clinical outcome are reported. Results: Among 69 women (mostly asymptomatic, presenting mammographic abnormalities, with median age 52, range 20-78), T< 1 mm in 55 pts (80%) and T< 2 mm in 14 (20%) were observed. Radical mastectomy was performed in 31 pts (45%) due to extended in situ component or multicentric disease, and breast conserving surgery (BCS) in 38 (55%). All pts but 4, received axillary node dissection (61 pts) or sentinel node biopsy (4 pts), with only 1 N+ pt. The "in situ" component presented ductal in 91% and lobular histology in 9% of the cases, with predominant comedo subtype in 45%. All Tmic presented ductal histology with positive hormone receptor status (HR) in 45%, negative in 22% and unknown in 33%. Among 32 HER-2 evaluable pts, HER-2 was overexpressed in 34% and normal in 66%. Adjuvant treatment consisted of radiotherapy in 87% of BCS pts, chemotherapy in 5 HR neg pts, endocrine therapy in 7 and chemo-endocrine in 1 N+ pt. At a median follow-up of 93 months RFS and BC specific OS were 91 and 100%, respectively. Three pts experienced a local relapse (2 DCIS and 1 invasive) and 1 distant metastases (bone). None of relapsed pts had received systemic adjuvant therapy. Three pts died for non-breast cancer causes. Six pts developed a controlateral BC (9%): none of them progressed or died of disease. Conclusions: Our data appear in large part comparable to those of the literature on Tmic and, in our experience, the inclusion of microinvasion > 1 mm and < 2 mm did not change the good prognosis of microinvasive cancer.

The above is cut and pasted word for word.  Wishing everyone the very best.

laurakay

Oh my gosh, Lizzie!  I didn't see this until today!  thank you so much for posting this.  I really needed this positive thinking!  You're so generous to spend so much time and energy getting this to us.

Laura