Conflicting results

DMHGF

So I saw my surgeon today and we went over the pathology report from my biopsy. It is IDC, just over 1 cm. ER positive 98%, PR positive 4%, Her2 negative. She then says this indicates a slow grower. THEN she says my Ki 67 is 88% and the higher the percentage the faster and more aggressive the cancer is. Over 20% is considered high and again mine is 88%!!!! Surgery is in a couple weeks so will get grade/stage then but I'd like to know how the slow growth configuration can be super fast growing and aggresive. Has anyone else had a conflict like this? Which was it once you got your post surgery pathology report, fast or slow???

Tmh0921

I had the opposite, I had a KI-67 that was 14%, but a grade 3 which scared the crap out of me. I am ER+ 95% and PR+ 69%, HER2Neu negative, my tumor ended up being 3.2cm. My oncologist told me that the ER+ % offsets the grade with regards to aggressiveness.

Have you had an Oncotype test done?

**Edited to add, KI-67 isn’t routinely tested by all pathologists, and not all oncologists use it as a prognostic factor. It’s really all of the attributes of your tumor and node status together that determines prognosis/aggressiveness

Beesie

Hmmm.... not sure why the surgeon said that configuration is a slow grower.

Although you have a little bit of PR, you are almost PR-. Some PR- cancers are not aggressive but many PR- cancers have a high Ki-67 and can be more aggressive.

There is a long discussion thread on ER+/PR-/HER2+ that you might find to be informative: https://community.breastcancer.org/forum/137/topics/858729

Assuming that you remain node negative or at most have 1-2 involved nodes (and hopefully none!), the answer with regard to aggressiveness will come from the grade and the Oncotype test. This is a test some on the cancerous tissue that evaluates 21 genes within the tumor. You get a score which indicates how aggressive the cancer is, a related risk of metastatic recurrence, and a recommendation on whether chemo would be beneficial or whether endocrine therapy (anti-hormone therapy) alone would be an appropriate treatment.

So it's not a guessing game on the aggressiveness of the cancer. More information will be availble after your surgery which will tell you if this cancer is aggressive or not. I will say that with the low PR and the high Ki-67, odds are that your Oncotype score will be in the "chemo recommended" range. Possibly not, but most likely, so be prepared for that.

If you read the posts in the thread I linked, I think this will become much clearer.

DMHGF

Thanks! I guess it's back to waiting haha. In the mean time I'm going to the link and doing a little research!!!

Tmh0921

The waiting really is the worst.

Hang in there

DMHGF

Beesie

I read the WHOLE 13 pages of thread and it was enlightening and frustrating! Haha

It seems there is not enough research to see an exact correlation to er+ pr- aggression and response to treatment ...but enough to know that it's an added concern. I am getting oncotype so hopefully between that and the post op pathology they can nail it down. Fingers crossed I'm in the no chemo recommended group when it all comes together!

Thanks for the link. It was just the light reading I needed :-)

windingshores

The Oncotype uses other proliferative factors besides the ki67%. So you will get more info from that.

It's hard not to research but honestly, until you have more information post-surgery, it is hard to make decisions and unlike my usual tendency, I tried to avoid researching things too much

ki67% varies a lot from lab to lab and is considered somewhat unreliable. Some hospitals don't use it. I had a low Oncotype but a ki67% borderline high at 20%. No chemo. Even with grade 3 and (focal) LVI. Still fine after 5 years.

I had all kinds of conflicts. My HER2 was positive, then at another lab equivocal and another lab had it at negative. I found a doc who retested with 60 cells instead of the usual 20 and it was negative so I went with that. My Oncotype didn't match my pathology, as I said. Too bad but this stuff just isn't as clear cut was we think before we have this.

My doctors really relied a lot on the Oncotype.

Good luck!

DMHGF

Thanks windingshores!

I met with my MO on Monday and she has indicated she will be ordering the oncotype after my surgery on the 10th. She wants to start treatment as soon as it comes back so depending on the new pathology and results I will have about a week to decide on chemo/no chemo depending.

I have stopped researching! My only daughter is getting married in 2 days and we are busy with last minute stuff so that has helped me resist googling :-)