Biopsy vs. Oncotype DX - deferent diagnoses.

Dear Julia46uk,

Welcome to the BCO community. We are sorry about your diagnosis but so glad that you reached out to our members for support and information. We hope that you will make good use of the experiences shared here and stay active. Let us know if you need any help learning how to navigate your way around the boards.

The Mods

It's possible that the biopsy had more of either DCIS or IDC, and the Oncotype more of the other one.  Also the Oncotype is done with a slurry, not specific discrete pieces of a sample. You can call Genomic Health, the Oncotype company, to discuss. They are pretty informative on the phone.

My biopsy results were wrong in terms of HER2. If I had gone by the biopsy results I would have had chemo and Herceptin. Luckily I had neither.

After a core needle biopsy of a 7mm spot on 1/10/19  A pathologist reported Invasive Ductal Carcinoma ER & PR Pos and HER neg by FISH. 2 weeks later Breast MRI showed 3 additional suspicious spots spread around and neoplasm around previous biopsy site which was marked with a clip. On Feb 8th had a double mascectomy as they could not biopsy all the sites or remove & leave a breast. The pathology from mastectomy came back including the slide with the clip from biopsy as NO INVASIVE CANCER any where on 25 slides all margins clear, I assume  the entire breast is on slides but not sure. Surgeon said I should be happy no cancer! Oncologist sent off the slide from Biopsy and it came back with a Onco score of 28 which suggest a benefit of chemo.  I was not expecting that as I do not see how the Invasive could have all been gotten with a core biopsy. I was told Onco test would not have been able to score if Invasive Cancer not there. So if the Onco test came back a 28 does that mean I had to have had Invasive it was somehow just not there after mastectomy? 

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Thank you Beesie you have explained this so much better than anyone I've talked to Drs included. I was hoping the IDC was wrong dx. 4 weeks later and I still have a lot of swelling chest & underarms not the arms themselves, but wondering how there is room for a port. I will be getting a 2nd oncologist opinion if possible before starting any chemo. I  have been told with each week on waiting on chemo past the 4th week from surgery the risk from reoccurrence goes up I have not seen this addressed on this site but sure it may be somewhere.  Again thank you for your prompt & clear response!

Desirr77, depending on the size and shape of the tumor, the size of the needle and where the needle enters the tumor, it is possible to remove all the cancerous tissue during the biopsy, and it is possible to slightly reduce the size of the tumor by removing portions during the biopsy.

Not all tumors are round like an apple, many are misshaped masses, some are spiculated with pieces jutting out and in the case of DCIS (or DCIS with small amounts of IDC), the suspicious tissue is usually not a mass at all but is linear. In those cases, the needle might capture an area of tissue that does change the size of what's left to remove during surgery. Or when there are small amounts of IDC mixed in with DCIS, the needle might remove the entire IDC specimen. That doesn't happen often but it does happen sometimes.