what does this mean regarding HER2?

windingshores

My reading of this is that I am classified as HER2 positive but am close to being equivocal, but I could be reading it wrong. Will the FISH test mean I will be given herceptin? chemo? Is it urgent to get surgery asap? These are my main questions and I appreciate any help! (I see the MD in 3 days)

First, for a complete picture:

HER2/neu Protein performed on MS15-1690:

Equivocal (2+): Incomplete and/or weak to moderate circumferential membrane staining in >10% of tumor cells

Then FISH:

Clinical History: Calcifications and mass in right upper outer quadrant (my note: 1 cm IDC grade 3 w/pos. estrogen and prog.)

Interphase cells: >+20 Metaphase cells: 0

FISH Results

Positive for HER2 Amplification

HER2/D17Z1 ratio 2.1 (is the cut off 2.0? is this borderline?)

Average copy number signals/cell: HER2: 5.0, D17Z1: 2.4

Nomenclature: nuc ish (D17Z1x1-4, HER2x2-9) {>=20)

FISH assay revealed HER2 (ERBB2) amplification

Histopathological correlation is indicated

Assay Information:

a ratio of >/=2.0 or an average HER2 copy number >/=6.0 in 10% of tumor cells indicates amplification

a ratio of < 2.0 and an average HER2 copy number < 4.0 indicates absence of amplification

a ratio of < 2.0 and an average HER2 copy number per cell of >/= 4.0 and < 6.0 observed in a homogenous and contiguous population indicates an equivocal result for amplification

Lemint

Hi, Windingshores, I hope your your surgery went well. I noticed no one responded. I was originally diagnosed with DCID and after an MRI they said I had IDC mucinous carcinoma type. This type almost always is Her2 negative but mine came back Her2 positive. Now they say I must have chemo. My ratio was 2.7. Did you find out if your 2.1 ratio was borderline. Thx in advance.

larajv

My FISH is 2.6. barely positive but positive. I've extensively researched HER2. Barely positive FiSH results maybe less responsive to targeted therapy (herceptin and Perjetta). Some people have FiSh in the upper teens. I'm proceeding with both of these targeted therapies. They are not chemo drugs, I can live with the side effects

larajv

My FISH is 2.6. barely positive but positive. I've extensively researched HER2. Barely positive FiSH results maybe less responsive to targeted therapy (herceptin and Perjetta). Some people have FiSh in the upper teens. I'm proceeding with both of these targeted therapies. They are not chemo drugs, I can live with the side effects

Nursepatient35

I'm reading all these posts about HER 2, FISH, etc. I have my BMX with reconstruction Feb 14th, met with a general surgeon who specializes in breast cases and also a plastic surgeon. No one has mentioned anything about genetic testing, hormone testing, etc. Do I need to ask about this or does this all come after they're removed and they do pathology?

BarredOwl

Hi Nursepatient35:

Elsewhere you stated your diagnosis was 1 cm DCIS.

This Forum is for people who have Ductal Carcinoma in Situ ("DCIS") PLUS a specific type and size of invasive breast cancer:

This thread is in the Forum entitled "DCIS plus HER2-positive Microinvasion." There are two types of disease present in this particular situation:

(1) some DCIS, which is "non-invasive";

AND

(2) very small "invasive" tumor(s) each ≤ 1 mm in size, at least one of which is HER2-positive.

A lot of the information and posts in this forum would not apply to a person with apparently pure DCIS (with no evidence of invasion).

(Actually, none of the other posters above appears to have DCIS plus HER2 microinvasion--they appear to have larger invasive tumors that may be treated quite differently.)

NCCN Guidelines re ER, PR and HER2 testing differ for DCIS versus Invasive Breast Cancer:

DCIS: Under NCCN guidelines (Version 3.2017), DCIS is tested for ER and PR status only. HER2 testing of DCIS is not recommended under current NCCN guidelines, because it does not affect management of DCIS, (although a minority of institutions may conduct such testing).

Invasive Breast Cancer: In contrast, if any "invasive" breast cancer is present (e.g., microinvasive or larger invasion), then under NCCN guidelines, the invasive component should be tested for ER, PR and HER2 status (as feasible). HER2 testing can be done by a variety of validated methods, but immunohistochemistry ("IHC", which detects HER2 protein) or "FISH" (a type of in situ hybridization method, which assesses HER2 gene amplification) are the most common.

The above is generally applicable to biopsy samples and to surgical samples. Thus, the pathologist will examine breast tissue from surgery and any lymph nodes from sentinel node biopsy. ER, PR and (if applicable) HER2 testing would be performed as described above.

If you have not already done so, I recommend that you obtain complete copies of the pathology reports (including any addenda or supplements, and related testing, such as ER and PR status) from all biopsies to date and from any future surgery for your review and records.

General Information about Genetic Testing:

Regarding "Genetic Testing", if you mean testing for a possible genetic predisposition to cancer, then in due course, you may wish to inquire about a possible referral for genetic counseling for genetic risk evaluation.

I'm not sure how old you are, but note that an "individual with a breast cancer diagnosis" in whom breast cancer is "diagnosed age ≤50" years old is a sufficient criterion for one to "Consider referral to cancer genetics professional." As explained in Footnote (a), "For the purposes of these guidelines, invasive and ductal carcinoma in situ breast cancers [DCIS] should be included." Other criteria may apply that would support such a referral.

For more information, here is a link to the NCCN guideline for "Breast and/or Ovarian Cancer Genetic Assessment" which can be accessed at no charge with free registration:

https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf

This guideline is updated regularly, so as best practice, always access the latest version on the web. The above should be used to inform your consultations with medical providers and is not a substitute for case-specific profesional medical advice.

For a list of the criteria for genetic risk evaluation, see Chart BR/OV-1, entitled "CRITERIA FOR FURTHER GENETIC RISK EVALUATION" on the seventh page of the document (the BR/OV-1 identifier is in the lower right corner of the page).

Note that the criteria in Chart BR/OV-1 go to whether referral for genetic risk evaluation may be warranted. Different criteria are used to determine if genetic testing is indicated in those referred for evaluation.

If applicable, a Genetic Counselor (or other medical genetics professional) would take a personal medical and family history, conduct a genetic/familial risk assessment, and make a recommendation regarding genetic testing. If genetic testing is recommended, the Genetic Counselor will also make a recommendation about the scope of genetic testing (i.e., what genes should be included in the test panel? BRCA1, BRCA2, and possibly CHEK2, PALB2, PTEN and/or others). In addition, information about about the pros, cons, and limitations of such testing should be discussed. The patient may pursue or decline any recommended testing at their option.

Pathogenic mutations in certain genes may increase lifetime risk for breast cancer as well as for other types of cancers***, so certain test results may have implications for the type and frequency of cancer surveillance (screening for certain types of cancers) and/or lead to consideration of the option of prophylactic surgery (e.g., risk-reducing salpingo-oophorectomy (RRSO) to remove both ovaries and Fallopian tubes). Certain test results have implications for blood relatives, such as children (who would have a 50:50 chance of inheriting a defective gene).

I am a layperson with no medical training, so please confirm all information with your team to ensure receipt of accurate, current, case-specific advice.

Best,

BarredOwl

***For example, a pathogenic mutation in BRCA2 can increase lifetime risks for breast cancer as well as for ovarian, Fallopian Tube, peritoneal cancers, melanoma and pancreatic cancer, and for male breast and prostate cancer. Other genes included in common test panels can increase lifetime risk for colon cancer and impact screening recommendations for colon cancer.