High Ki-67, but low grade and stage?

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Anonymous
Anonymous Member Posts: 1,376
edited February 2019 in Diagnosed and Waiting for Test Results
High Ki-67, but low grade and stage?
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  • evily
    evily Member Posts: 63
    edited December 2018

    Hi all!

    I am currently recovering from a BMX and am getting ready to start my next phase of treatment, whatever that may be. I met with the MO today for the first time. He is saying definitely tamoxifen for 5 yrs, which I expected given my age and cancer type. But the issue of chemo is a big question mark still. He is going to run the Mammaprint test on my cancer because, even though I was Stage I, Grade 1 with no nodes involved, my Ki-67 is 60%, which is very high. Has anyone else had a similar situation - high Ki-67 but early stage / low grade? The MO said if Mammaprint comes back high risk, he would recommend 4 rounds of chemo. It terrifies me to my very core, but I am young and want to make sure I do what needs to be done to live a long healthy life. Appreciate any feedback. :-)

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  • Meow13
    Meow13 Member Posts: 4,859
    edited December 2018

    My top notch Seatlle hospital doesn't even do ki-67. I wouldn't place any bets on it. But it is good to have the mammoprint done. Anyone with hormone positive cancer should have it done.

    Good luck.

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  • Georgia1
    Georgia1 Member Posts: 1,321
    edited December 2018

    Hi there. I agree: the Ki67 is an unreliable test -- my MO says it varies day to day and lab to lab. I hope the Mammaprint returns low risk for you. You have my best wishes and good thoughts.

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited December 2018

    Actually, Ki-67 is still widely used as a marker in a lot of lab work and does still have some clinical utility but primarily when repeated and confirmed by a single lab with a strong emphasis on the pathology of breast cancer.

    That's not to say that I'd bet the farm on it in your situation, evily. It's great that you'll have information from the Mammaprint; let's hope you don't have to wait too long for it!

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  • Scrafgal
    Scrafgal Member Posts: 631
    edited December 2018

    ki-67 is a major contributor to the Oncotype score...don't know about its role in the MammaPrint test...

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  • Meow13
    Meow13 Member Posts: 4,859
    edited December 2018

    I see no report of it on my oncodx report. I just received the score and er and pr percentages.

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  • WC3
    WC3 Member Posts: 1,540
    edited December 2018

    Neither my facility nor the one I had the biopsy at did the ki-67 test. My MO said they would do it after the surgery if enough of the tumor is left (I had neoadjuvant chemotherapy). There wasn't so they have to track down the original biopsy sample.

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  • Meow13
    Meow13 Member Posts: 4,859
    edited December 2018

    I also see her2 status as well as er and pr status. There isn't much info at all with the report. Disappointed for a $4k test, I guess the process and details are proprietary intellectual property.

    The score is based on statistical curve fiiting equations. Not really impressed my document mentions that the sample size was 651. Not very convincing. I have looking at the base Magee equations, not enough info to see how my score was reached.

    Can anyone supply a link especially on how ki-67 figures in?

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  • Scrafgal
    Scrafgal Member Posts: 631
    edited December 2018

    Meow13

    I will see if I can dig up the regression-based formula again. I found it when I was going through all of the testing, which is why I know that Ki67 is, and the cell proliferation genes collectively, are the biggest driver of the oncotype score. I was motivated to find the actual regression formula: my oncotype score was 46. My ki67 was 90%, So, that was motivation enough to find it. I happen to be statistially trained and so when I brought the formula to my doctor he was shocked that I found it!

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited December 2018

    https://www.researchgate.net/figure/Twenty-one-gene-panel-and-calculation-of-recurrence-score-a-The-final-gene-list-16_fig2_7044467

    I think this might be it?

    I had a link on another post but the link to the site no longer works.

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited December 2018

    My ki-67 was high at 22, but low Oncotypedx? I contacted the Oncotypedx peeps to see if they could give me their calculated ki-67 and they could not/would not.

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited December 2018

    woah - glad I stumbled onto researchgate.net. It has some really great articles.

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  • Scrafgal
    Scrafgal Member Posts: 631
    edited December 2018

    I am still looking for the oncotype equation...I didn't save it because I didn't want to keep thinking about it at the time! I just remember that the cell proliferation factors (including Ki67, grade etc.) drove a big part of the score. I think the next biggest driver was PR negativity. It all seems so long ago when I was looking at all of that info...

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited December 2018

    Is there a different one from this?image

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  • carmstr835
    carmstr835 Member Posts: 388
    edited December 2018

    I also remember the KI-67 formula being very heavily a part of the oncoscore. It was algorhythm . I will see if I can find it as well. My Ki-67 was 20% for my right breast tumor and my onca score was 19 for that breast. My Ki-67 score was <5% for my left breast and that came back 16 onco score. Then the right tumor was sent to mammaprint and it came back as low. I still had chemo though, because I was her+ and extra nodal. However, my insurance is not wanting to pay so I am getting billed for lots of money.


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  • Meow13
    Meow13 Member Posts: 4,859
    edited December 2018

    Scarfgal,

    Glad to meet you. I am not a statistician my master's degree was applied math. I have much experience with curve fitting, my special focus and thesis was non linear optimisation. It is a bit disconcerting that our treatment is based on statistical results. Cancer is fairly individualized. I try to read as much as I can. I had 2 tumors one idc and one ilc, tumors were very similar but one had expression that determined 90% it was ilc. It was remarkable that I was 95 % as far as er receptors but 0% pr, her2 negative. I believe that contributed to my oncodx score of 34.

    Both my tumors were low grade with mitotic score of 1, I didn't get a ki-67 my oncologist said we don't report it in our labs. I like to gather as much info as I can. I chose no chemo and managed to get in almost 4 years of AI drugs. I am still NED, happy I did the conservative route of mastectomy. The DIEP reconstruction was pretty good. Most impact was all the surgery but I had no complications. No radiation or chemo.

    I hope I've seen the last of this cancer.

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  • Meow13
    Meow13 Member Posts: 4,859
    edited December 2018

    farmerlucy,

    First time I've seen that, where is it from?

    I would love to see all the components, I wonder if I call oncodx if they still have my information.

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited December 2018

    Chec out the live link above to researchgate.net. Below that article are some really interesting links to other pertinent BC studies.

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  • evily
    evily Member Posts: 63
    edited December 2018

    Wow, interesting info, farmerlucy! I'm not having the Oncotype test, and I don't know if Mammaprint uses ki67 in their algorithm, but it is interesting to know that Ki67 factors so heavily into at least some of these tests. That researchgate.net site is fascinating!

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  • wallycat
    wallycat Member Posts: 3,227
    edited December 2018

    Nothing to add except how in awe I am of you ladies with the math skills. My DH is a math major and a master's in physics and I always say, "really? on purpose?"

    I am math challenged so again...I bow to the smarts of this crowd!


    As an aside, I had er/pr + with a grade 2 (after lumpectomy; biopsy seemed to think it would be a grade 1) and mitosis 0-1. My oncotypedx score shocked my BS and onco....20.


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  • evily
    evily Member Posts: 63
    edited December 2018

    Hi everyone! Just a quick update in case anyone was wondering: my Mammaprint test came back low risk. So, I guess my Ki67 wasn't that big of a factor after all. I haven't seen the full report yet, so I can't provide any other details, but if/when I learn more, I'll post an update. Good news of all this is that I don't need chemo. I'm very happy about that! :-)

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  • Cjzach10
    Cjzach10 Member Posts: 87
    edited January 2019

    Hey ladies!

    I had b/l mx with immediate deip flap reconstruction on Nov 12. I'm on pins and needles waiting on my oncotype score. Monday was 2wks since they sent it off but i hoped with the holidays I would at least get a call in the next 2 days. My ki 67 was 30 percent er 100 percent and pr 100 percent and grade 2. But i don't know my true stage because i had unsuccessful lymph node mapping. I had no dye or tracer absorption. My bs took a section of tissue that felt nodular but no lymph nodes in the tissue. My bs and oncologist agree on no more surgery to find lymph nodes. I don't understand what all of this means without lymph nodes. I've been pretty down over the last week thx to waiting...again. And because its really sinking in that since i had 0 lymph nodes tested and I'm never going to have that information and will always worry. Yes..all my stats are in my favor i guess you could say but I'm a manmo tech and we all know cancer doesn't play by the rules!

    I would really appreciate your thoughts. I feel like im close to my breaking point again!

    Thanks for your input💖

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited January 2019

    Hello from a fellow Okie. Hang in there. I had a sentinel node biopsy post mastectomy and learned on these boards later on that its efficacy could be questioned. Fast forward nearly seven years - I’m so glad my surgeon did not go in and do the axillary node clearance. LE would be a terrible bi-product. We’re always going to have questions. Many times one answer leads to another question. Oh how I wanted guarantees in the early days. I ran the stats in my head over and over and over. And over.

    It took a long time, months to years, for me to learn to live with the uncertainties. When I did, it was a freedom of sorts. I learned I had control over very little in my life and ironically that is quite liberating.
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  • Cjzach10
    Cjzach10 Member Posts: 87
    edited January 2019

    Thank you farmerlucy! You hit the nail on the head with answers leading to questions! Im closer everyday to learning im not in control. That's helped with all the waiting! I've been a mammo tech for 16 years and its quite ironic being on this side of breast cancer. Ive learned so much that I didn't know i didnt know!

    Im so thankful for this forum and i will be recommending it to patients from now on.

    If you're in the path if this supposed ice storm stay warm and safe! I just hope it doesn't pan out!

    💖

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  • Samnjb
    Samnjb Member Posts: 26
    edited January 2019

    hi when i was waiting for my score ( i had simlar numbers to you and got a 12) i found singhing called the magee equation. Google that. It was close to righg for me. Good luc

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  • Georgia1
    Georgia1 Member Posts: 1,321
    edited January 2019

    Evily, congratulations!

    CJZach 10, thinking good thoughts for you.

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  • Cjzach10
    Cjzach10 Member Posts: 87
    edited January 2019

    An update for anyone interested. I called the oncologist today since its been 2 and a half weeks waiting for the oncotype. I was told there was a mistake..something about the wrong tissue sample..and its going to be another 2 wks. I'm furious and so upset! In total since i thought i was getting my results initially plus waiting 2 wks it will have been 6 wks! My abn mammo was July 30. I just want to have a plan and get on with it!

    Thanks for listening!

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited January 2019

    Oh man. 😞

    I hope they put a rush on it! Hang in there

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  • HPFULL
    HPFULL Member Posts: 247
    edited January 2019

    I heard this is fairly accurate in predicting if oncoscore. You need to do the formula for Er and Pr below in the instructions before plugging in the #s

    https://path.upmc.edu/onlineTools/mageeequations.html

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  • Meow13
    Meow13 Member Posts: 4,859
    edited January 2019

    Thanks, I don't know the ki-67 but I tried a bunch of different numbers.

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