Surgical Pathology did not retest ER/PR/HER2 receptors. Common?

sunnysocal11

Hi everyone, I had a question that I can't really find an answer to online. My mom had a mammogram, biopsy, other imaging tests then a mastectomy. Her original biopsy had information about ER/PR/HER2 status (ER+/PR+ (Low positive)/HER2-). After surgery we received her surgery pathology report and the pathology doctor did not retest her receptors. The pathology report clearly states "Reference original biopsy pathology for receptor status". I find this very odd, I would think that they would test the receptor status again in a controlled environment especially since they have the entire tumor and not just a small biopsy. I'm going to contact the doctor tomorrow on my moms behalf. My question is, for everyone that had initial biopsy and then later had a mastectomy/lumpectomy, did they retest your receptor status of the tumor after the mastectomy/lumpectomy or did your pathology report just reference the original biopsy?

NorCalS

Hi. For me, the hospital pathologist did not re-test for hormone status after my lumpectomy. I had to request a re-test and it turned out that the hormone and HER2 status from pathology after surgery was the same as theinitial biopsy. I went for a second opinion after my surgery and the oncologist for my second opinion advised that I should retest for hormone and HER2 status because the grade of the cancer changed from 3 to 2. The second opinion oncologist wanted to make sure that there was no change to hormone status before recommending post-operative treatment.

MountainMia

My lumpectomy was in 2019. My surgical pathology didn't retest, either. I don't know what the standard is, but my hospital is an NCI designated cancer center.

SummerAngel

Neither of my tumors were retested after my BMX, either.

SpecialK

I believe that often times if there would be no change in treatment recommendations the surgical sample is not retested. For the OP, if any of the tumor expresses hormonal receptors, anti-hormonals would be recommended, so even if some parts of the surgically excised tumor did not express receptors the treatment would be unchanged. If multiple sites on the tumor were sampled in the biopsy - the norm - and there was no Her2 over-expression, it is unlikely that there would be any in the surgical samples. Also, if Oncotype or other genomic testing will be done on the excised tumor material the hormonal receptors and Her2 status will be confirmed again in that process. Processing the sample for Oncotype involves blending, which is one reason why there is a minimum size threshold for submission of tumor material, so rather than looking at individual slides the whole sample is looked at in the process. For me personally, as a triple positive, retesting my surgical samples would not have changed any of the recommendations I received post-biopsy.

sunnysocal11

Thank you for the response NorCal! How long from the initial surgery pathology did you wait until you got a second opinion with a retest? I assume all labs keep the tumor and tissue samples in an environment where they can be later tested but not sure how long that lasts for. I'd like for my moms to get a second opinion!

NorCalS

Hi Sunnysocal11.

I am with Kaiser Permanente and they still have my surgery sample. My surgery was in December 2019. After surgery, some of it was used to test for PD-L1, then months later for hormone status and this past March, it was used to test for certain cancer markers. I don’t know if there is a standard protocol for keeping tissue samples.

SpecialK

Generally, tumor material is stored for a number of years. I had the Breast Cancer Index test five years after I started on anti-hormonals and part of my original tumor material from 2010 was prepared by the pathologist in the hospital I had surgery in, and sent off to Biotheranostics for testing.

LaughingGull

Hi,

In my case the sample was not retested after surgery, but it was because my oncologist forgot to ask for it. When I asked about it (a few months down the road), he quickly apologized and ordered the test. Definitely worth checking with the oncologist to confirm if it was omitted on purpose (and why) or not.

LaughingGull

Emily21

Hi I'm a medical scientist in histopathology. Tissue can be retested at any time, all tissue is formalin fixed, and multiple pieces are embedded in paraffin wax for sectioning and for immunohistochemistry to determine hormone receptor status. These blocks of tissue are kept indefinitely. They can be retested years later!! Paraffin blocks of patients sampled are kept filed for at least 10 to 20yrs, probably more.

SummerAngel

Thanks, Emily21. That's good to know!

At this point I'm not going to ask for a new test, but both of my tumors were on the edge between HER2- and HER2+ at biopsy, and tumor in my right breast was never Oncotyped, either. The only information I have about the right-side tumor was the initial biopsy pathology.