High KI67

It's an indication that you need chemo.  So far they do not know what else it indicates. 

 BTW, they expect if you are HER2+ that you will have a high ki67 number. 

I never had this done, not sure if I'm happy or sad about it.  I believe aggressive tumors respond better to chemo, so if it were high I would have seen it this way, however, if it were low than I would worry more about my four positive nodes....so I guess it's good I have no idea! 

My Ki67 was 59%. I'm four years out and doing fine. The only thing that concerned me was on my diagnosis sheet, the doctor circled Ki67-59% - Unfavorable. Hmmmmmm and I never ask why he said unfavorable. Maybe one of you can explain it to me

My Ki67 was "60% Poor Prognosis" in my original biopsy pathology. (I am Her2 negative, so there is no correlation with Her2neu).   After seeing that, I got conflicting information from various journal articles and my second pathologist...the latter saying "oh, we don't even include that in our path reports and why are they saying "poor prognosis"...i.e. "poor form" on that path's part, YET

After scouring the Oncotype DX website, Ki67 is one the of the 22 elements the Oncotype Score reports on, being included with a bunch of other tests mesuring one of 6 factors in the Oncotype Score "Mitotic Rate."   The "Mitotic Rate" is the most heavily weighted of the 6 major factors in determining the Oncotype Score, so Ki67 does appear to have significance to BC Reccurence rates.

 Also, somewhere else on a different thread, England was using Ki67, ER, PR, Grade and I suppose Her2neu as elements for what I call a "Poorman's Oncotype Text" with good statistical accuracy.

My Ki67 was 60% and my Oncotype Score was high, 39. 

There is a correlation between her2+ and ki67. 

IF you have her2+ they expect you to have a high ki67.  This has nothing to do with her2- it does not mean that you can't be her2- and have a high number.  This is another reason why if you are ER/PR+ and HER2+ the onco. test is the majority of the time not done because they expect a high score.

However saying all of that and there is always someone who will break that code.  I believe that swimangel had a lower onc. score and is HER2+. 

Well I had ER+,,,but only by 6% and PR- Her2-....so almost triple negative but my Ki67 was 6% and my miotic rate was 1. What an odd subtype!!  Ususally the slow growers are highly er+ pr+!!!

NeedtobeSTRONG

The core biopsy may have captured an area that had little mitosis. What was your mitotic count? Mitotic count and KI67 are strongly related but not the same thing. They both assess proliferation. Most her2+ tumors are strongly proliferative. However, some are not. My mitotic index was 1 and I am Her2+++ ER+ weakly < 10% and PR-. I have been told that it was a slow growing tumor. It was certainly there in previous mammograms and was 8mm when found. As you have a high KI67 the chemo would have been effective in wiping out those fast dividing cells.

Best wishes 

The biopsy report and the final path reoprt differ in my case too. My KI67 wasn't even mentioned on my biopsy report but the final path was 25----HIGH, REALLY? and mitoic rate is a 1. My pr+at biopsy was 87% and the final pth was PR-.......0%. and then theres the CEP17 locus 3~8 copies. Does that mean the mitoses score should be a 2??? Is all so confusing. Do all these #'s really change so quickly?? When my Node was biopsied it pos for CA. and after 8 were remove NO LYMPHOVASCULAR INVAS. so which is it?

Adding my stats to add to the confusion!

By core biopsy said Ki67 >20% = High (I don't know how much over 20 it was) My grade was 3, and mitotic rate was 3 out of 3.  (ER+++, PR++, HER2 -)

Pathology after BMX says grade changed to a 2....mostly in part because my mitotic score was now ONE instead of three??? WTH?  ER,PR,HER2 stayed the same.  Ki67 not mentioned this time.

Then, I get the oncotype score back with confirms ER,PR,HER2 and gives me a "low" score of 15. 

So I chose to believe the BMX pathology and oncotype..and maybe they just messed up on the core biopsy analysis?  My onc says it all depends on who's reading the slides.

Also.... when you are talking about a 1.4cm tumor...and FOUR punch biopsies were already taken out of it... how much tissue is actually left to analyze? 

And.. this is probably for another thread.... when they are punchin' around your tumor during biopsy...how the hell do you know that they aren't spreading cancer cells into your system? 

Heidi Too,

I'm with you. I think I will finally put away my path report and stop trying to analize every number.  I have been obsessed with it and it has taken over. I'M DONE.  Its time to move on to Life. The drs never give me a straight answer except what drugs I need to take.

Thank you all for this interesting conversation. A huge weight has been lifted. 

I had my tumor removed by a BC Laser Surgeon. The Laser removed the tumor while simultaneoiusly sealing peripheral blood vessels and lymphatics reducing blood lose and the possibility of spreading diseased cancer cells during dissection. The tumor bed was also Lased to provide an extra barrier to tumor growth. This is not a new procedure. Dr A. has been doing this successfully for 20 years. It is not invasive and is done under intravenous sedation. I had a nipple sparing PMX. I walked out of the operating room, recovered for an hour and returned to the hotel and ordered room service and ate lunch.

I don't understand why this procedure is not used more. It can put breast sugeons out of business. My breast looks good concidering 30% of it was removed. But there is NO possibility of spreading or escaping CA cells.

Oh wow Susan - that is really creepy!!!

SusansGarden

If your interested in reading Dr.A's website it is

                       www.laserbreastcancersurgery.com

VR, does this mean they think that a high Oncotype score may be invalid in cases where cancer is low-grade?  (b/c they say "apparently increased risk")  Hard to decipher this one. 

Our results suggest that the presence of increased stromal cellularity and/or associated inflammatory cells in low-grade invasive breast carcinomas may contribute to an apparently increased risk of recurrence according to Oncotype DX Recurrence Score. Careful assessment and correlation with histopathological features in such cases may help in determining the appropriate patient management.