Pathology report conflicting her-2 score

I am ER/PR - and my path report for HER2 goes like this:

Immunohistology was 2+ which is borderline - could go either way (a 3+ on this test is a strong postitive for HER2)

FISH test was negative (for gene amplification) but low positive for protein overexpression which technically makes me HER2 +

So my oncologist is starting me on TCH - the treatment for HER2+ tumors.  Assuming the test is correct, am I really HER2 positive even though it is so low or am I more triple negative and I would benefit more from ACT or even ACTH?  My tumor is aggressive and growing quickly so I hope we get this right the first time.  I am interested to hear what others have to say.

There was a randomized study a couple of years ago that showed at least some benefit of TCH in all breast cancer groups regardless of HER2 status (a LOT of benefit for HER2+).  There has been a push for TCH instead of ACT since Adriamycin is so heart toxic and THC appears to be effective in all types of breast cancer.  I just want to make sure that test is right since it's kind of in the gray area.  I'm going to talk to my doctor about this tomorrow.

As far as KarenT goes, 3+ is supposed to be a strong positive so I'm not sure why it says negative.  What did the onco say?

I think my path report says Her2+ +3 and I was considered Her2+. I'm sure you will ask them about this.  You should be positive.

I think women with questionable HER2 tissue status--maybe all women--should get a baseline serum HER2 test. If that value is elevated, then a re-evaluation of the tissue is in order. In either event, the serum test can be (should be) repeated fairly often--a falling value during chemtherapy is a good sign. Check www.oncogene.com or see www.hertestonline.com and the new article discussed in the March blog section.

Karen, I'm not Her2+, but this article from the New York Times has always stuck in my mind, partly because a FISH test was never even done on my bc until I happened to go to an NCI-designated comprehensive cancer center for a second opinion after an initial lumpectomy at a local, regional hospital.  (My bio page gives the whole story.)

http://www.nytimes.com/2007/06/12/health/12canc.html

The article is from 2007, but I think its points re. the importance of getting a proper dx are still valid and extremely valuable.

kyrste, it is possible to have lesions with different or mixed ER/PR values.  Not sure about Her2, but I wouldn't be surprised if it's also possible, since UCLA (where I had my mx) did comprehensive pathologies on each of my 4 lesions.

(((Hugs))),    Deanna

Please get a second opinion on your H.E.R. status. My diagnosis was wrong and the herceptin gave me congestive heart failure. H.E.R. is tricky to diagnose. I didn't know that at the time I was diagnosed or I would have gotten a second opinion at another facility. Please spread the word to other ladies that they all should have the H.E.R. part of their diagnosis tested at least twice. I don't want anyone else to go through what I have because of a wrong diagnosis.