biopsy pathology report questions
Got the pathology report, but a couple things still pending.
IDC (2.8 cm).
Grade is at least 2 from the first two markers, but the Mitotic score is pending. Hope it doesn't go up to 3, which I understand isn't good.
ER+/PR+, both 100% strong positive
HER2 2.1 equivocal, FISH test pending
Questions:
Is it better to have a higher or lower % for the ER and PR? Is 100% positive preferable to a lower percentage?
Regarding Her2 being equivocal, I can't seem to find anything that explains the significance of an equivocal result. Is it good or bad?
I know things can change when they biopsy the whole tumor, but I like to know where I'm starting out and understand it. The surgeon didn't explain much. He only showed me the first page and I didn't see the 2nd page in the packet until I got home, so I wasn't able to ask him.
Comments
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Sorry you find yourself here Solfeo, but welcome to an informative and helpful place.
Er + is good because there are a variety of anti-hormonal treatment available. They get a lot of bad press, but don't be scared by what you read, its a daily pill that many tolerate well. The more ER the better it will respond to the treatment.
PR+ isn't going to mean much.
A grade 3 mitotic score means it's growing faster than a 2 or 1,so lower is better but doesn't change the prognosis all that much. Grade 3 tumors actually respond better to chemo than a grade 1.
Equivocal means not sure yet, but the fish test will determine. HER2+ is more agressive, so not good. But on the bright side, there are new targeted therapies that are very effective for HER2+, WHICH IS GOOD!
Her2+ means chemo.
It will be important to know if you have any positive lymph nodes to help decide.treatment choices.
Good luck!
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Thank you debiann.
There were no abnormal appearing lymph nodes in the ultrasound. I know that doesn't mean they can't be positive but it's better than looking abnormal to begin with. -
I believe being both ER+ and PR+ generally carries an even better prognosis than ER+ and PR-. So that is in your favor, Solfeo.
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Thanks ShetlandPony. Love these little nuggets of hope to keep me going. A few days ago my mind had my with one foot in the grave.
I also love the way these message boards are divided so you can focus on what you're going through right now with people making the same decisions, without having to read about anything scary others are going through who are further along in he process. Somebody knew what they were doing when they created this place. -
Biopsy was July 28th. Pathology report was sent to my doctor on July 31st, with the two pending items I mention in the top post. Now here we are 11 days later (7 business days), and the two pending items are still unresolved. One was the FISH test and the other was the Mitotic score - both necessary items for characterizing the cancer.
I called the hospital and the desk jockey insisted the report was final. How is it possible for a report with pending items to be final?? She couldn't answer that, but continued to insist it was final and no matter how much I tried to get through to her how pending and final have two completely different meanings, she only got more and more irritated the more questions I asked. She also couldn't give me any reason why pending items would be left unresolved.
So I had the doctor's office call the pathology department directly, and they sent them what was supposed to be the final report, but it was the same exact one with the pending items still on it.
What am I supposed to do to resolve this if neither the doctor nor I can get an answer? I think my HER2 status and tumor grade are pretty important nuggets of information to have when I see the surgeon on Thursday.
Any suggestions? -
Did the surgeon's office call the hospital about the pathology report?
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The original surgeon's office called that had ordered the mammo/US. He's the one they sent the 2nd identical report to, so he didn't get a different answer than I did.
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HI. I'm Bev. I was diagnosed Aggressive invasive ductal carcinoma Grade 3 -nottingham score of 8 on July 13th. I'm ER/PR/HER2 positive. I took my first chemo on the 31st. Scheduled for the next on August 21st. Chemo consists of herceptin, perjeta and taxotere. I made it through the first one ok, but nervous about the second chemo and the next two that follow after that. I am assuming they will get tougher each time. Surgery will be after this first cycles of chemo, then another series of chemo after surgery. Pathology report indicates Ki-67 IHS score unfavorable with >70% what does that mean?
Is being triple positive easier to treat than other breast cancers? So scared!
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Sometimes these things are not really resolved until after your excision surgery.
That was the case for me. The biopsy wasn't very helpful in that regard really - just confirmed the presence of cancer.
Sometimes even when you think you know something, eg grade, this can change with the surgical pathology.
Don't panic; it should all be resolved eventually, then you get a treatment plan
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Triple positive has more targeted treatment options available, certainly!
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Solfeo, the new surgeon you are seeing on Thursday has an interest in having all the information available. I would talk to them, in person if necessary, and ask them to follow up. Try to get past the desk person and talk to the surgeon's nurse, who will better understand what is needed. Offer to go pick up results or slides and hand-carry them if necessary. If you hit a roadblock, see if your new holistic doctor can help. Also, since you are coordinating your care, it would be good to see your new medical oncologist before surgery, so you can make sure you have his/her input on whether it is best to do chemo (if needed) or hormonal therapy before or after surgery. Also, if your Her2 is negative, he/she may order an Oncotype test.
Bev, high ki-67 means a fast-growing tumor, BUT you are already on it, doing chemo. Chemo attacks fast-growing cells. Triple positive means you have a large arsenal of treatments available: chemo, targeted Her2 therapies, and hormonal treatments (which will probably come last).
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Hi Solfeo:
Very frustrating. I would ask them to please confirm that a HER2 FISH analysis has indeed been requested for your biopsy. If so, have they received the results of your HER2 FISH test back, and if so, can you have a copy. If not, ask how long it typically takes to get them back, and if beyond this point, ask them to make a status inquiry for you with the testing entity.
Similarly, you can ask if the outstanding mitotic score assessment has been completed, and if will you be receiving a supplemental pathology report containing a final determination of grade from your biopsy. (I agree with the comment above that the surgical sample will be definitive.) If a final grade of your biopsy is not available at the time of your appointments, remember to ask whether the advice you are receiving would change if it were grade 3, and if so how. (It probably won't.)
Good Luck!!
BarredOwl
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SP, you have no idea how much I appreciate the time and personal attention you have given to my various issues. I hope you have some good karma headed your way!
I'm sorry it's always a long story with me, but this is just one more example of how difficult it has been to find good care where I live. The surgeon I'm seeing Thursday does not have a staff per se, just a single all-in-one, receptionist/office manager/medical assistant, who is harder to get past on the phone to the doctor than the Great Wall of China. In fact she is one of the reasons I chose this surgeon only as a last resort. When I first started to worry about the itching, I was looking for lumps and found one that was ambiguous but maybe something. When I called to make an appointment, this woman, a medical assistant, refused to make one and told me to go to a dermatologist (when I told her there was also a lump!). I tried two more times and the first time was discouraged from making an appointment, and the second my phone message was not even returned. I did go to other doctors but as I've said no one else ever took me seriously either.
My plan to get through the surgery as painlessly as possible is to avoid having to deal with that woman as much as possible. So I guess I'll just have to wait until I see the surgeon, and let her figure it out. I've thought about complaining about the fact that it did turn out to be cancer and I was denied access three times by someone who is not qualified to diagnose me at all, let alone over the phone. However, I don't want to cause hard feelings when I need the surgeon on my side since I have no other choices at this point. Maybe later.
With almost everything I do having to be such an ordeal I should be losing my mind right now, but I'm holding up surprisingly well. After the positive appt with the ND yesterday I haven't needed any anti-anxiety meds, first time since the dx. All it took was one person acting like they actually wanted to help. You'll probably laugh at this, but unfortunately he left for vacation today so he can't help me now. But he did stock me up on supplements and told me how to adjust my diet etc. until he gets back, so I'm fine with that.
Great idea to meet with the oncologist before surgery. I will make that happen. -
Good advice BarredOwl, especially to ask what they would do if it were grade 3, since I don't think I'll be getting any further with the pathology folks. Thank you! I need to write all this stuff down.
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I bet the oncologist will call the pathologist on the phone
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I'm sure you're right Beatmon. Thank you!
Can all of you come to my appointments with me? -
Solfeo, I'm very happy if I can be of any help to you. We are all in this together. You remind me of myself when I was first diagnosed, worried and trying to master a new field of knowledge and wanting to make sure the right things were being done. So at the risk of tmi, here is a link to the NCCN Guidelines in case you are interested. I got the physician guidelines and was able to see where I was on the flow chart and read the details about the recommendations. They also have less detailed patient guidelines. But only use them if it will be more helpful than stressful.
http://www.nccn.org/professionals/physician_gls/f_...
I'll come with you in spirit! (And it is a good idea to bring someone to help take notes.) -
Thanks SP for the resource. I'll definitely look into that, but in small doses. One key to getting my anxiety level down has been to stop looking too far ahead, but I definitely want to know everything about each stage of the process as I get there. I wish I could trust the "experts" to know everything and do everything right, but experience tells me that isn't realistic, especially here. I'm originally from California and I really wish I could be doing this there.
I haven't been able to find a support group close to me and you and the rest of the ladies here have been a lifeline for me that I will never forget. Good news is that I did finally find a psychologist. We hit it off really well on the phone and I'm seeing her Friday. One more member added to the team! I'm gonna have to take 'em all to lunch so they can confer with one another and plan my fate.
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