Any insight-hormone receptor change between biopsy and surgery?

nitto

I just saw a new oncologist at a teaching hospital as my first dr left for greener pastures to full time research. The new onco reviewed my entire history and is now recommending more treatment.

My diagnosis 4/2013 via biopsy was ER- and low PR+ (less than 10%) and HER2-. After surgery (double mastectomy) the the diagnosis was Stage 1 no nodes and ER-/PR-/HER2-. Did chemo for 4 months.

Now saw new onco 11/2014 who wanted to review my path w/team because concern was I was not TNBC, but possibly estrogen positive based on the estrogen turning on progesterone. She said that the tumor can have positive hormone receptor cells as well as negative.

As a result she is recommending an aromatease inhibitor - Femara - with Zometa infusions every 6 mos.

Anyone out there experience this situation? I would appreciate any insight.

besa

I have not dealt with this situation personally but a question I have (or would want to ask)... What method are they using to determining ER and PR positive? Are they using immunohistochemistry (antibody staining) or realtime rt PCR (as is used in the OncotypeDX test)?

Immunohistochemistry results are more variable (less exact) because someone is judging staining intensity (color intensity).Realtime PCR results give a firm number that is easier to interpret. Both tests have their strengths and weaknesses. If I was in you shoes and the treatment path was not clear I would want both tests to be done. (Also as an aside-- as I think your doctor was explaining a tumor can be heterogeneous with different areas of the same tumor having different ER, PR results. This was something I experienced. Another possibility which might also give some additional information is asking about making more slides or additional realtime testing from the tumor block. ) Just my thoughts....