DCIS-but biopsy Her2 says microinvasive?
I was recently diagnosed with DCIS. I am questioning the biopsy report regarding the Her2 score.
This is what the biopsy says: "DCIS, High nuclear grade, comedo type with calcifications. P63 stain highlights myoepithelial cells. DCIS is positive for estrogen and progesterone receptors (nuclear staining in 100% and 10% of tumor cells respectively.) Ki67 labeling index is 22%
Her 2 stain is positive (score 3)
Score 3-Strong, complete staining in > 30% OF INVASIVE CELLS."
It is the "OF INVASIVE CELLS" that is bothering me. If there were invasive cells, wouldn't the biopsy say "DCIS AND IBC?" wHAT DOES THR 22% ki67 MEAN? What is the signigicance of the P3 stain of myoepithelial cells?
Thank you.
Comments
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Wow. Good question. I'd be asking the same thing.
If you have pure DCIS, there should be no invasive cells. Ask for an explanation from your surgeon, or if possible, even directly from the pathologist. The dots here are not connecting as they should.
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Do you know what P3 staining of myoepithelial cells means?
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I just found an article that describes Her2 score 3 differently:
"Intense circumferential membrane staining in > 10% if cancer cells and the membrane staining ring is thick."
Which do I believe?
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This is some information that I found. I pretty much just copied and pasted so that I didn't take it out of context.
Ki67 is a marker used in determining proliferation (growth) rate. In some cancers, the higher the rate, the more likely a relapse. However after reading for over 40", it was concluded that Ki67 markers have not been shown to be beneficial / or there have not been enough studies done to use it as a marker in breast cancer. I couldn't find anything on p63 but there was something on p53 gene markers.
At this time, "the only uniformly accepted prognostic markers that provide critical information necessary for treatment decisions are TNM stage, axillary lymph node status, tumor size and grade, and hormone receptor status.".
"ER, PR, and HER2 overexpression should be evaluated on every primary breast cancer. Hormone receptor expression should be used to guide therapy decisions in both the adjuvant and metastatic disease settings. The available data are insufficient to recommend that HER2 overexpression be used for determining prognosis in patients with early breast cancer." BTW ER/PR negative cancer has a worse prognosis, however even this was left with a HOWEVER, with advances in chemotherapy, this may not hold true any longer. Also note that the ER/PR is does not predict chances of reoccurance: it is used for treatment options.
High grade lesions typically exhibit aneuploidy, lack estrogen and progesterone receptors, and have a high proliferative rate, overexpression of the HER2 oncogene, mutations of the p53 tumor suppressor gene with accumulation of its protein product, and angiogenesis in the surrounding stroma. Low grade lesions are typically diploid, estrogen- and progesterone receptor-positive, have a low proliferative rate, and rarely (if ever) show abnormalities of the HER2/neu or p53 oncogenes.This was from the ASCO guidelines from 2007, so they may have updated it since then, however I doubt it, as am getting this from UptoDate website which is for physicians and patients.
I have no idea what the invasive cells means...I found that exact same phrase when they were talking about grading HER2. Perhaps they are talking about the percentage of cells that took up the dye they used: 30% = Stage 3. It is contradictory in that HER2 is often not tested in DCIS unless you are going to go on Tamoxifen, yet as seen above, some clinicians use it to classify high grade vs. low grade. DCIS is noninvasive, so how can you get a reliable HER2 test? I would be on the phone tomorrow getting some answers and most likely peace of mind....
I guess in the end, reading and evaluating the data should be done by your doctor. Otherwise it is like me trying to talk Spanish: I know just enough to get me in trouble!
Hope this helps some, although I doubt that it did anything but confuse the issue more.
Good Luck!
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Check out the You Tube of Dr. Brian Czerniecki. He has a vaccine for DCIS/Her2/neu that made mine go completely AWAY and now I have immunity to it. You do have to go to Philadephia and it is a clinical trial (so it is free). My insurance BCBS of Florida paid the rest. When I had surgery the vaccine made my body destroy all the bad cells. You have to check it out. None of the local doctors knew about it, I had to find it through researching info on DCIS and her2/neu. Check out the website of Penniesinaction.org and you can ready my whole story. Good luck, your report did say DCIS the staining showed invasion by Her2/neu proteins. You are lucky and can get great help from Dr. Czerniecki. Thanks, Shelley
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