Conflicting path reports

SunCrystal

I am 48 and diagnosed with BC 2 months ago and had a mastectomy 3 weeks ago.  The path report from the needle biopsy said I was HER-2 positive (FISH results=3.3) but the path report on the tumor following surgery says I am HER-2 negative (FISH=1.46).  We are having both sets of slides retested with a 3rd lab.  Both labs confirm I am ER- and PR-. Has anyone ever of such different path results?  Are false positives or false negatives for HER-2 more likely?  This has major implications for treatment and so we've had to delay the start of chemo until we know whether it should include herceptin.  

ReadingMama

My reports were also conflicting.  First one said no, secong one said yes.  My MO said as long as there was ANY indication of Her2+, I should take Herceptin. As I understand b/c these tumors are so aggressive and Herceptin really substantially increases the trmt response.  I don't know my FISH numbers off hand.

SpecialK

suncrystal - different parts or areas of the same tissue can yield different path results.  Generally speaking, the post-op path report is more conclusive than the biopsy because the biopsy samples are so small.  I don't even know if I would feel comfortable with a 2 out of 3 thing, if you did have a positive Her2neu at some point. 

lovetosail

I had HER2+ and HER2- sections in my tumor.  I agree with thoughts above, I'd push for Herceptin if you have had a + her2 result, even if some results were negative. good luck with your treatment!

SunCrystal

Well, due to a bunch of screw-ups at the labs who were supposed to send unstained slides for the 3rd independent pathologist to repeat the FISH test, I had to start chemo without a definitive answer on whether I am HER+ or HER-.   I am taking dose dense AC every 2 weeks for 4 sessions with Taxol to follow for 12 weeks and they can add the Herceptin in with the Taxol if the final results indicate I am HER2+.  My oncologist felt that we should not go more than 6 weeks after my surgery to start chemo and she would have had me start chemo in Week 3 had the initial biopsy indicated I was HER2-.This has been the most stressful week of my life.  Even more stressful than finding out I had breast cancer.  It's the not knowing the results of tests which make you unable to persue the best course of treatment but have to go with a compromise.  At least I will be able to add Herceptin if the final tests indicate it is warrented.

bak94

I know my onc would push for the herceptin. He wanted to do herceptin even though mine is +2 or mayb e it was +1, I forget now!, he said there is some thought that it still can do some good. I did neo chemo and my path report will be redone after my surgery to confirm. I don't think my insurance will pay for herceptin if I am negative.

SunCrystal

I've now had 5 FISH tests done and the final conclusion is that my tumor is heterogeneous.  The 2 FISH tests (at 2 different labs) of the post-op tumor were HER2- and the 3 tests (at 2 different labs) done of the biopsy were HER2+.   My oncologist initially thought that the biospy results were wrong but when an independent lab confirmed HER2+, she has changed her mind about my treatment and will be adding Herceptin to the Taxol.  I'm glad to finally have this resolved and glad to be getting Herceptin.