Oncotype vs. biopsy- which scores reliable?

neugirl

I just received my Oncotype report back and am concerned because my hormone positivity showed up as less on the Oncotype then it did on my biopsy. On my biopsy, I had an extremely hormone sensitive tumor with ER and PR over 90%. On Oncotype report my ER score was 7.6. The score goes from 6.5-12. My PR was a little bit higher but again not near the top of the scale as the biopsy had indicated, 8.5. My her2 was also way more negative than the IHC 1+ score i received. I am just very confused. 

Does anyone know why these scores would be so different? Which one is more reliable, the Oncotype or the biopsy? Should I have my tumor retested? My score was low- 11- and I am wondering if my ER/PR are really not that high, how can I be certain that tamoxifen will be enough? Also, if the Oncotype is not accurate about hormone sensitivity, how can I be certain that the test is even accurate in general? I am being told no chemo, but I am worried the test may not be as good as it is said to be. 

voraciousreader

Neugirl...Lillie Shockney, over at Johns Hopkins Ask an Expert already answered your question.

Hello, My Oncotype Dx score of 11 reexamined my ER/PR. From the initial biopsy I was 90% ER and 95% PR. However, Oncotype says ER is 7.6 positive (positive score goes from 6.5-12.5). For PR 8.5 positive (positive score goes from 5.5-10). I am wondering why my ER/PR came out so much less on oncotype and whether i should ask that my ER/PR are retested? I am supposedly only to be recommended hormonal therapy, but if my ER is only slightly positive according to oncotype, then how can hormonal therapy work? And if Oncotype is wrong for my ER/PR, how can I assume that they are correct about my recurrence risk?
Replied	JHU's Breast Center Reply
12/11/2012	this is still a strongly positive socre. nice low oncotypeDX score too. hormonal therapy is where your benefit is ___________________________________________________________________________________________ I think Shockney gave you a GREAT answer.  You are  ER+ and should do well with endocrine therapy. Just for the record....my biopsy said I was ER positive >90%....but ONLY 10.7 on the Oncotype DX test.  I'm not debating in my mind which one is more accurate.  Both concur that I am ER + and should do well with endocrine therapy. I also answered your other question that you posted on a new thread with a TERRIFIC article that you might enjoy reading.

neugirl

Hi voracious, thanks for the answer to my question. I guess I am still not satisfied with what I have heard so far because I am at the lower end of the Oncotype for hormone sensitivity and i know that women with more ER/PR positivity benefit more from tamoxifen/AI than those with less. I am unhappy there is such a discrepancy in the test. Your 10.7 is definitely higher on the scale then my 7.6. I too was >90 % for both and expect to see that reflected on Oncotype but that is not the case.

I have also done some reading on the Her 2 and there seems to be some doctors that are questioning the oncotype test in general because there do seem to be discrepancies among scores. http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=102&abstractID=82476

If i am to forgo chemo i want to know for certain i will benefit a great deal from hormone therapy. I don't understand how a low risk tumor can have little ER positivity, particularly when the biopsy indicated it was greater than 90%.  It just does not make sense there should be such a wide discrepancy. 

voraciousreader

Neugirl... When physicians put together a treatment plan, they base their decision on many factors. That said, will there be discrepancies? Absolutely, because none of the tools are absolute. For example, there are patients with Grade 3 tumors who report LOW Oncotype DX scores. Now, in my book, that's a HUGE discrepancy! But it happens! Likewise, some patients with Grade 1 tumors have high Oncotype DX scores. Based on the information you provided, there is little descrepency. You have a non-aggressive tumor based on ALL your information. AND, keep in mind, chemo is usually more effective on higher grade tumors. Furthermore, despite your lower ER score than mine, you have a lower Oncotype DX score. It really would be nice if everything could be explained in a linear fashion, but unfortunately it can't. That's why your team will look at as much info as possible to come up with a plan. Perhaps you would have been happier years ago before these genetic tests were available? Before the advent of these tests, most women who received a breast cancer diagnosis had surgery and chemo. With the knowledge derived from genomics, patients like you and me can now be identified and can now be given the choice whether or not to receive chemo. Again, based on ALL the info, you have excellent prognostics despite what you perceive is a descrepency in your ER numbers.



Finally, as Lillie Shockney said, you are conclusively ER + according to both tests. And, according to the Oncotype test, the figure is NOT low and you should benefit greatly from endocrine therapy.



Again, you are looking at research studies that have little significance to your treatment plan or prognosis. I urge you to discuss your concern with your team to align your unnecessary fear that your pathology information is not correct.

voraciousreader

Regarding the ASCO article.... If you believe that the OncotypeDX test cannot be trusted, you can choose to ignore the information. That said, you STILL have a non-aggressive tumor based on all the info you provided.

coraleliz

neugirl-I had a similar "discrepancy". My understanding is that the oncotype looks at things differently. It looks at characteristics that are both unfavorable & favorable for the cancer to raise it's ugly head again. In addition to ER/PR, you have other "good" qualities" & your tumor is unlikely to reoccur if you do the 5yrs of Tamox(5 years of Tamox is factored into your reoccurence score).It does sound like you have alot in your favor. Both on you path report & oncoscore. That being said, I have seen other women go to chemo despite this favorable news. You might have to switch MOs. I hope you make peace with this decision so you can get on with treatment. It's a hard place to be. I took a long time to decline chemo, but I had positive nodes & an oncoscore of 4.