Oncotype/Sentinel Node test results prior to surgery?

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Watersong
Watersong Member Posts: 7
edited May 2020 in IDC (Invasive Ductal Carcinoma)

Hi All,

First time posting, newly diagnosed, and having trouble deciding between a MX or LX + radiation. If my Oncotype score is high - or if SND are positive - I'd opt for a MX and hopefully avoid radiation. Otherwise will follow OS rec for LX+ rads (which probably is bad for atherosclerosis and osteopenia...?)+ hormones. Chemo TBD.

The OS and MO said they cannot do either test prior to surgery- which feels like I'm making a decision without all the facts. After the hurry up and wait during the holidays, it feels things are moving fast with a surgery date of 1/10.

Has anyone done those tests prior to surgery?

Thanks for sharing your insights and opening your hearts in this community. You've already helped me more than you know!


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  • flashlight
    flashlight Member Posts: 698
    edited December 2019

    Watersong, I wasn't able to get any of that information until my surgery was done. I have read other post where the information from the MRI changed after surgery. What did your BS say? Usually they give you an option from what they learned from the biopsy. Good luck to you.

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  • Beesie
    Beesie Member Posts: 12,240
    edited December 2019

    Why are you thinking that a high Oncotype or positive SNB would have you choose a MX vs. a lumpectomy + rads?

    The Oncotype score and having positive nodes provides an indication of your risk of distant recurrence, not local recurrence. These indictors would be used to determine whether or not chemo will be recommended, and having a MX vs. a lumpectomy + rads would not change that recommendation.

    Most studies have shown that survival rates are the same with a MX vs. a lumpectomy + rads. Where recent studies have found a difference, I believe the results actually favor a lumpectomy + rads, with the thought being that it may be the rads after a lumpectomy that provide some additional benefit, particularly if rads are given to the nodes.

    Edited to answer your specific questions: It's not common to have the Oncotype test done prior to surgery because the core needle biopsy sample size is usually too small to get an accurate result. An SNB can be done as a separate operation prior to the surgery to remove the tumor. It's unusual but there are some people here who've had that done.


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  • letsgogolf
    letsgogolf Member Posts: 263
    edited January 2020

    Watersong - It is unusual to have your stage prior to your surgery. That is usually determined after the actual tumor is evaluated and measured and the lymph node or nodes are tested. With a small grade 1, HR+ tumor, one would expect your Oncotype score to be pretty low and your prognosis to be excellent. Best wishes! Oh, and I have never heard of anyone having the Oncotype test done prior to surgery. I asked about having this done from my biopsy and was told it couldn't be done that way. It may create insurance issue...not sure what the exact reasoning was.

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  • labelle
    labelle Member Posts: 721
    edited January 2020

    I had mine done prior to surgery using a sample from my core needle biopsy. My OC at Vanderbilt is apparently a fan of neoadjuvant chemo, so my understanding is that she routinely orders onco testing prior to any surgeries. Not sure why it is not done like this more often . Also had genetic testing and consult prior to surgery, the results of which had more baring on the type of surgery I would choose than my onco test results did.

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  • Salamandra
    Salamandra Member Posts: 1,444
    edited January 2020

    Usually the sentinel node biopsy is done at the same time as the tumor surgery. But it is a separate procedure and I guess could technically be done before if you found a surgeon willing to.

    Also, I believe that once you’ve had breast cancer, your insurance must pay for a mastectomy even if you already had a lumpectomy. So I Fire’s you could do the lumpectomy, see the results, and then opt for mastectomy.

    But I agree that it’s not clear to me why the invite and nodes would necessarily indicate Mx. My understanding is that Mx is mostly strongly indicated when you have multiple tumors or a very large amount to be removed or if it’s in a location where an lx wouldn’t have a good result. Or if your risk for a new local cancer is known to be exceptionally high because of genetic mutation, I think.

    Also speak with your doctor by my understanding is that they’re now more often using radiation in case of positive nodes, on that area, so I’m not sure that avoiding radiation is a coherent goal.

    Good luck whatever you do! There are not easy decisions

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  • OCDAmy
    OCDAmy Member Posts: 873
    edited January 2020

    I had oncotype from biopsy. I also had MX because of tumor size and DCIS. I also had radiation because of positive node so MX does not always mean no rads.

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  • Imdtm23
    Imdtm23 Member Posts: 27
    edited January 2020

    I had my sentinel node biopsy done prior to my surgery. Since I was having immediate reconstruction, my plastic surgeon wanted to know if I would need Chemo or not. The Oncotype was done after surgery.

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  • Kel25
    Kel25 Member Posts: 25
    edited May 2020

    OCDAmy,

    If you don't mind me asking, what was your ONCOTYPE Score and age at diagnosis?

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