Oncotype score before surgery

HI Shelly,  I have never heard of Onco being done before surgery. Normally its done on the tumor itself. I do know there are guidelines on the Genomic site on how they are to take the sample and ship it. I'd assume though that with 4 pos nodes and a large tumor your doc is recommending chemo. If you're not comfortable, I'd insist they send another sample and that you're not charged for the review. 

I have understood that diff areas of the tumors can have different facets. I'm not sure if thats fact or not, but recall reading it. 

Good luck , I'm sure others will be along to chime in.

Shelly, if you could have it redone on the large tumor, I would.

Now, I (and someone else here on BCO) had kind of the opposite problem -- we both had excisional biopsies (removal of small lump -- essentially a lumpectomy), followed by mastectomy after initial pathology.  Then the mastectomy tissue was sent for the Oncotype test -- and there wasn't enough tissue!  So the original lumpectomy/excisional biopsy sample needed to be sent for testing.  This caused a delay of at least 3 or 4 weeks.  So that's probably why some places have "learned" to send the initial biopsy material for the test.  But if, as in your case, the initial biopsy was only a small part of a much larger tumor, it probably would be best to test other areas of the large tumor.

(BTW, this happened to me in New York, and the BCO sister in Alabama, so you can't blame it on one surgeon/hospital!)

Shelly, grades often change between biopsy tissue pathology and actual tumor pathology.  It's really not unusual to be told you're a Grade 1, for example, then find out that other parts of the tumor were Grade 2 or 3 -- the same way a biopsy sometimes indicates DCIS, but surgery reveals invasive bc as well.  That's why it doesn't make any sense to do an Oncotype on tissue from a biopsy. The Oncotype would not have even been done or necessary with 4 positive nodes.  So it wasn't the test that was inaccurate -- just that a proper sampling of tissue wasn't provided.      Deanna

Shelly56, when I had my ultrasound guided core biopsy, the Radioligist removed 4 or 5 "plugs" from the tumor. That was what was sent to be examined and that is what determined the malignancy. My onco typing was done after my lumpectomy.

Hi Shelly56, just wanted to clarify something -- you said above "So it seems onco testing was pretty much for nothing, since there was found to be nodes pos "after" surgery, not before."  As I understand it from my mom's Onco testing and research on it, the Onco test does not determine node positivity or negativity.  It gives you a recurrence score and it tells you whether chemo would be beneficial or not, but does not determine the status of your nodes.  I could be wrong about this, but seems that's how it was explained to us.  The Onco test is also different from the grading or staging of your BC.  So the Onco test is really an additional tool to help you and your doctors determine the treatment plan that is best, taking into account it plus your pathology report, the BC grade, the BC stage, and other factors.  Some women on these boards seem to do the Onco test, and some do not.

I think everyone on these boards seems to have some type of node testing.  My mom had a sentinel node biopsy during her mastectomy.  I know there are varying types of procedures that they can do for testing the nodes, and SNB is just one of them.  For her, they tested 2 nodes and they were benign.  Sounds like you also had the SNB

Shelly, I did not have the BRCA testing. I am the 1st in my family for breast cancer and I am sure that my age was a consideration also.

Hi ladies, it seems interesting to me that the drs seem to stage the cancer at different times for different patients.  Dlb823's drs gave an initial stage based on imaging and the another higher stage after surgery, and i have read on these forums where other women had their stage change as well.  For my mom, we kept asking what stage it was for a few months between the excisional biopsy and mastectomy, but her BS and Onc said they would not stage it until they had the pathology report back from the mastectomy.  We did know the Ki67 score, the Richardson Grade, and the Onco Score before the mastectomy, but not the Stage until after the surgery.

I asked my OB/GYN about the BRCA test and she said that generally it is not recommended and generally the insurance will not cover it unless you have at least two first degree relatives (mother, sister or daughter) who have had breast cancer or ovarian cancer.  So, I did not have it.   My mom also decided not to have it as she has no family history of BC or OC.