Oncotype Dx Test Anyone?

I'm so confused I'm a stage I I a grade 2 sentinel lymph node positive. My onco test came back 16. My oncologist said I dont need chemo just tamoxifen? With lymph node positive not sure what decisionI should   make. I've heard ok stories about chemo and then stressful stories. My lump was misdiagnosed 2 times by different radiologists since November..., with a score of 16 it's hard to make a decision?

Dinabug, I had scores of 8 and 15 (two ILC tumors). I opted for no chemo and with a mast there were no rads. When onco suggested chemo with the 8, I refused and she took the case to the tumor board (onco, BS, pathologist) and they recommended getting the 2nd tumor tested. When it came back 15 -- still low risk -- everyone agreed no chemo. I was more afraid of chemo brain than of distant metastasis, although we never know exactly what will happen. The thing with low oncotype scores is that chemo is not that effective, not so much that it isn't necessary. 

Hi bicky6, If you are referring to the link on page 1 that I posted many weeks back....I just clicked it from this forum and had no problem.  Not sure what problem you are having. 

MsP

Dinaburg - cookiegal is right. I had a micromet in my SN that my BS said had to be dissected and dissected again to find. I had the Oncotype test done and that micromet was still categorized as node-negative. It is very small...thus the micro. Also node involvement used to mean you couldn't have the test done but that is no longer the case...see the link from cookiegal. My score was 11 so there was nothing to talk about as far as chemo for me. You do need to look at the benefit of doing it vs not. With a lumpectomy, 33 RADS treatments and 5 years of Tamoxifen the chance of recurrence for me is 8%.

It goes without saying there are no guarantees but at least the Oncotype test gives us more information about our particular tumor and it affords our Oncologist another tool in determining treatment. Prior to taking the test my BS said the node involvement would get me chemo. It didn't. Bottom line is our Oncologists are the go to people for treatment. The one bit of sage advice I can offer is whatever you decide don't second guess yourself or look back at say if only. When in doubt get a second opinion. It is definitely worth it. You might want to read the link on this forum to ladies who did elect to do the chemo. Horror stories for some, not so much for others. Good luck with whatever you decide. Remember its your body and your life. Diane

All, the reason that the on line predictor isn't accurate is that most people under or over estimate their % of ER/PR.  The reason is that Genomics uses a different way to determine the % ER/PR receptors than the pathologist who look at biopsy or surgical tissue.  

When I did the test, I was told I was 100% ER positive on my surgical pathology, but Genomics turned out to be only 85%.  I was aware When I used the model, I allowed for their to be differences and I created a high/low model where on one I was 100% ER Positive and another I was 90%.     My higest score was 21 and I ended up a 24 but I was still mentally ready to be in the dreaded intermediate zone.

Sandra

Kam,  the Genomic scale is 12 and I was about 10 on that scale.  = 83%.  I was trying to relate it to the way the pathologist expressed ER/PR expression.  In my case, the pathology said I was 100% ER Postive and 0 % PR.  Knowing that the pathology "score" was suspect,  I discounted the ER score when I used the "analyzer"..  I used 90% and that was still not low enough.   Now that said because the spreadsheet uses a H score 0-300, I assumed 100% was 300 and everything below that was a fraction of 300.  So when I discounted my ER score to 90%, that made my H score 270.   Just a way to normalize everything.

 I was like everyone else waiting on the Oncotype score....hoping for a low recurrence score, but wanting to prepare emotionally if it was not low.  In my case it was a longer wait because the lab didn't send enough carcinoma to Genomics the first time, so they had to "start over"  GADS!!  Because I had a longer wait time, I had more time to surf the web and that's how I stumbled on the spreadsheet that tries to predict the Oncotype score.

MsP

btw...interesting you are ER+ PR-.  Usually you see that with higher scores and higher grades.  Do any of your pathology report out your Ki67 %??  Has your MO told you if you are Luminal A or Luminal B subtype?

The cutoff for luminal B is Ki67 13%.  Compared to my 60% you are low    Hmmm....I learned something new - that a 3-5 is Grade 1 in Nottingham.  I guess I never thought of it, but 3 is the minimum total score, not zero!

Interesting, from your stats/Oncoscore and my Oncoscore (similar in many respects - I am almost PR-), it appears I got a lot of my extra points from my very high Ki67%.  What size was your tumor?  Do you know how your Nottingham got to "4?"   I assume, a 1, 1, and a 2?  Do you know what the "2" was in?  (Tubular Formation, Mitoses, Nuclear Pleomorphism).

I love learning about others' test scores - and then am frustrated with the lack of info I have from mine.  My original path reports states my ER is ">50%" and PR is "~10%".  No Nottingham score, just notes that I am Grade 2.  In the end, I got more info from the Oncotype report, which completely blew my path report out of the water (I was a 6.6 on the ER scale (6.5 being cut-off for negative), and my PR changed from + to -.)   I've become kind of a BC nerd.

 My pathology
lab never did a Ki67, and (as I was warned by everyone here) Genomic
Health refuses to release my (*MY*) score from their testing. It's the
one piece of my puzzle that I really want, but two years later still
don't have. I wonder if it's too late to ask for it...?

I received a very curt, yet polite, email from Genomics that said they do not release proprietary information regarding test results.  MY results, but they own them, I guess.  And I've always been surprised that my MO does not seem to feel strongly that having that information would be helpful, although given my test results I suspect they think they already know all they need to know.  But you know me, Kam - I devour this kind of information like a picnic lunch.  I'm seriously considering contacting the pathologist to determine if there's any way to get more information.  That little piece of pesky Ki67 info drives me crazy!

Since my oncotype score was low, I assume my Ki67 is low. Pathology report doesn't include Ki67. My onco-score was 4. I assume I'm luminal A, but never asked. In some ways, I feel the oncotype just confirmed my "grade 1".I can't really ask my MO, he was against me having the test done. He usually doesn't use it, just goes by "Adjuvant" online program.

It seems those of us with a PR-  DX have higher Oncotype scores......

I am guilty of pouring over every little piece of my reports as well. My K-1 was 22, which was also deemed high (except my report says over 10 is high). My oncotypeDX came back at 3. My grade was 2. I have been tempted to get a second opinion on the grade, but I haven't done it. After I received my oncotype score I called my genetic MD who only does BC research. He said no doubt that oncotype trumps grade. He said grade is subjective to the pathologist. He also said that some believe oncotype trumps size, but most onco's aren't going there yet.

 I asked my onco at a visit last year about the Ki-67 being high, and she basically waived it off and said they don't put much faith it in.

My burning question is what was the actual size of the tumor, since it was not seen pre-PBM, and only found microscopically in the final path, yet it was 1.1cm. However it seems with this stuff the answer to one question creates another question.

Johns Hopkins will do a second opinion on the pathology. You can go to their website to check it out. I wish I had done that.

The also have a free service where you can ask a pathologist a questions. (Yep - I'm guilty of using it too!)

Have a wonderful weekend ladies!

 I need helpI am Erpos pr pos negative nodes  oncotype 24. What should Ido.. Chem or not

I just declined chemo this week.  My onco score was 26 which is in the dreded grey area. My MO said she did not know if I would benefit from chemo or not. I begin radiation therapy next week with tamoxifen to follow. I decided I wanted to live my best life now and move forward. It was the best decision for me but Totally the toughest I've made in my life.