Ki67 and Oncotype

My Ki-67 was 5, my Oncotype was 24. BTW - my Mammaprint was low. The explanation I received is that since my tumor was heterogeneous, maybe the Ki-67 was Done on the grade 1 portion of the tumor and the Oncotype on the grade 2. Both were taken from the core biopsy. Hope that helps. Doing chemo now based on Oncotype, age 48 and tumor size 3.6cm.

My Ki67 was 22 and my oncotype was 3. I've decided the oncotype is correct and the high Ki-67 is not.

From the Genomic Health Website, I looked at the equation on how they weight the different categories of the test. Some with a higher ki67/low oncotype may have had more protective factors such as a higher ER/PR % to bring the score down. I noticed on another thread that some women had a lower ki67 but were neg PR so they ended up with a high score. HER 2 definitely influences score . Someone pointed out on another thread that there can be HER2 activity (just not enough to be counted as positive by FISH) 1+ and some 2+ but this contributes to the oncotype.

Some with high oncotype will have a high ki67 but this is only a piece of the puzzle. I found the link below from genomic health very helpful/

Pat

http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/RecurrenceScoreResults/InsightBeyondTraditionalMarkers.aspx
 The Phase III West German Study Group (WSG) Plan B Trial prospectively evaluated the Recurrence Score results in 2,448 patients with hormone receptor-positive early-stage invasive breast cancer. Ki-67 assessment was done by IHC through central pathology.

• There is a wide range of Recurrence Score results for varying Ki-67 cutoffs. There is only moderate correlation between the Recurrence Score result and Ki-67 (rs = 0.374; p<0.001)^6,7
• The Recurrence Score result cannot be predicted by Ki-67
• Currently the clinical utility of Ki-67 in early-stage invasive breast cancer is limited due to lack of analytic reproducibility and standardization⁸

Both my Ki67 and Oncotype scores were at the low to intermediate cutoff range.

Ki67 was 12%; Oncotype was 18

kcat - OK, that makes sense!  I am glad your MO felt that the Oncotype provided good info, you got a definitive Her2 result, and that you are receiving the treatment she feels will give you the best benefit.  I was also curious because more and more patients with equivocal Her2 results are receiving Herceptin - there is some evidence that it benefits slightly lower expressing Her2 patients too - so Oncotype testing for the population that does not express Her2 as strongly may provide a pool of informative data going forward. 

My Ki67 was 40% and I also had very low PR+ and some weakly stained HER2 activity. Oncotype of 30. I had very high ER+, so that kept the Onco score from being higher. Everything measured come into play on the score.

PatRN - Yep. That would be me too. My MO questions the validity of my ki67 at 40% with my midrange mitotic score that showed on 2 pathology reports. I hope he's right but it worries me.

I didn't even get the Ki67. I asked about it. My onc said they don't use it anymore. She said mine would have come back low. Hmmm,

Nancy - That is interesting and puzzling. The questions nag at us don't they. For the longest time I could not let go of the my unseen IDC - Who missed it?? Did anyone miss it? Then one day I let it go. It only took three years to let it go - but who's counting!! Hugs my friend!

on my path report the mitotic rate was low a 1, my cell differentiation was poor a 3.

I had a Nottingham score of 5 and 6, tumors were classified grade 2.

But, my oncodx was 34. Really rather high I was not convinced I needed chemo or that chemo was going to be beneficial.

I keep asking my mo if there is new treatment or testing I should consider the answer is always no keep on the AI drugs. I am not convinced the AI drugs are helping maybe even making my overall health worse.

Well at least he has ordered bone density and the results are good. Fatigue is probably my biggest health concern. I am not buying the you are getting older story. I mean over 2 year period big time fatigue.

This is an interesting topic. I am awaiting oncotype score, and my Ki67 was 3-5%. I am hoping for a low score, I am so tired now that I am back to work after my surgery, I can't imagine how it will be working through chemo. My BS said she would be very surprised if I need chemo. I sure hope she's right!

windingshores,

I've read the same. I was digging up research about this, but couldn't find what I've read. Only that Ki67 increases with wound healing. If a wound is not healing well, then it indicates poor cell proliferation. So high Ki67 is a bad in terms of cancer, but good for healing normal tissue.

The problem is that each tumor can test differently each time it is tested because cancer is heterogenous. Mine was tested twice, after the excision and with the Oncotype. I didn't have a punch biopsy. The two results lined up even though my grade was a high 2. Grades are somewhat subjective. High ER+, very low PR+, and Ki67 40% with a Onco 30.

ER/PR is also part of the equation when you look at genomic health website. If you were highly ER/PR pos. that could have balanced out your score. Also any HER 2 activity will raise oncotype. Even if you are equivocal and neg. on FISH, the activity is also part of equation.

If your needle punch biopsy was 2-3 weeks before your surgery, it's unlikely that elevated Ki67 associated with healing of the biopsy site would be found. Most healing action would have happened sooner according to the research I've read. That's partly why I don't put much stock in this. I assume most don't have the biopsy and then go the next week or two into surgery. It usually takes more time for tests and a decision on LX or MX. But is an interesting question to pose. Was your Ki67 higher from a surgery sample if surgery was within two weeks of the biopsy?

My surgery was 3 weeks after biopsy so I fit that time frame. In any case, despite a Ki67 of 20% (high being 19%) and grade 3 (or 2 in one lab), with LVI, my Oncotype was 8- twice.