Ki 67 elevated...?

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Khakitag
Khakitag Member Posts: 46
edited March 2020 in DCIS (Ductal Carcinoma In Situ)

My Er was 87%, Pr 10%, and Ki 67 was unfavorable at 43%. Anyone else have a high Ki 67 with an intermediate grade <1 cm dcis with no necrosis? My Dr acted like that was normal, but the research is all over the place, with some studies saying that increases your risk of recurrence Here’s my dilemma... had my lumpectomy and one margin was .5mm but Tumor board was not worried about it (I think, assuming I would do rads and tamoxifen, which I won’t). Waiting for the MRI to be sure theres nothing missed, then I need to decide my plan of attack. Should I insist on re excision for clean margins even if my SO was ok with them, or just be extra vigilant about surveillance? My SO also didnt have a problem with me continuing with my original plan of getting implants before my dcis was discovered, and getting testosterone pellets. Does this plan sound crazy and irresponsible?

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  • Beesie
    Beesie Member Posts: 12,240
    edited February 2020

    I don't know that Ki-67 is even provided for most cases of DCIS. In fact it's often not provided for IDC either. My facility, a major cancer center, doesn't include Ki-67 in pathology reports. I know from reading here that many other leading hospitals don't as well.

    Regardless of your Ki-67, if you won't be having rads and are passing on Tamoxifen, with a 0.55mm margin, I'd strongly recommend a re-excision to get wider margins. I've been around here long enough to have seen too many recurrences in women with DCIS who had close margins, including many that were not found until the cancer was invasive and some not found until the cancer was metastatic. That's not to scare you, and of course the risk of that happening is low, but it can happen. Having a re-excision and getting nice wide margins will drop that risk down to a very tiny percent.

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  • JRNJ
    JRNJ Member Posts: 573
    edited February 2020

    my dr at Sloan looked at ki 67. She thought 18 was high enough to justify chemo along with my other factors that are different than yours. You have to be comfortable with your decision. But if you are asking for an opinion if it were me I would do radiation. Scans don't pick everything up and it covers a larger area. My mri did not see node invasion.regarding implants i think under the muscle would be better for cancer screening and feeling lumps but my PS does over the muscle and didn't think it was an issue. But still makes me nervous. but with bmx I won't get any screening. You will still have screening at least.Why do you want testosterone?

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  • Khakitag
    Khakitag Member Posts: 46
    edited February 2020

    JRNJ: I've used BioTe testosterone pellets in the past to help with symptoms such asirritability, low energy, low libido. I'm trying to build muscle as well, and that really helps.

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  • JRNJ
    JRNJ Member Posts: 573
    edited February 2020

    ok. Just curious, never heard of that for women but you just reminded me my husband was on it for a while lol. Good luck with your decisions. I suffered great anxiety making treatment decisions and dr decisions. I thought in the beginning it was cookie cutter then began to realize it wasn’t. When I got second opinions drs had polar opposite opinions. You have to do what you’re comfortable with. I wanted to be aggressive even though I was told it was slow growing, localized, then surgery showed a different story. Doing chemo now. Will do radiation after. And will get my ovaries out. That is another option if you don’t want tamoxifen. They wanted to suppress my ovaries with Lupron I’m like why go on another drug that might not work and has side effects. I don’t need them any more.

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  • Skwashie
    Skwashie Member Posts: 25
    edited March 2020

    https://www.ncbi.nlm.nih.gov/m/pubmed/26060263/


    This paper reports on a study on the effects of the menstrual cycle on KI 67 levels. As you will see, results indicate that there may be an effect depending on the stage of the menstrual cycle.

    My core biopsy showed a reading of less than 10% Ki67 and three weeks later the pathology report from the removed tumour was more than 40%. During surgery to remove the tumour I was in the luteal phase of my menstrual cycle. The study links possible higher readings to the luteal phase.

    Hormone receptive tumours would be more active during phases of elevated eostogen and progesterone hormones ... stands to reason.


    And Ki67 readings remain controversial when considering treatment plans.

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