Biopsy results w/in 4 hours—is this normal? Can’t look :(
Hi all, I'm sure this sounds crazy on multiple levels. I had an MRI guided biopsy this morning on my remaining “good" breast for a 4 x 3 x 4mm “focus of homogeneous enhancement with suggestion of early spiculation" that was found incidentally while investigating an issue that turned out to be a non-issue on the other side. Anyway, I was floored to see biopsy results posted within four hours in my patient portal. (I was told tomorrow at the earliest, more likely Wednesday). This auto release of test results is new for my network and it seriously messes with my mind. I far prefer to get whatever news this is from my oncologist directly so I can get an explanation at the same time. So, from 11:45 to close of business I sat here waiting for him to call and nothing. Does it need to go before a tumor board before he plans to call me? Are there additional tests they run? Does anyone know how this works? And no—I don't plan to read them, I know myself too well, weird as that sounds. Thank you!
Comments
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If you prefer to get results from your doctor, tell him that and don't look at the portal and set it to not send you emails when something new is posted. You don't have to use the portal if you don't want to.
Much as we wish it was the case, our doctors aren't sitting at their desks waiting for results to come in. Your doctor is probably busy with other patients and checks for biopsy results whenever he has a chance or maybe just at a specific time of day that he sets aside for doing this. He may not see the results until tomorrow and might not have a chance to call you right away.
Don't read anything into how long it takes for the doctor to call you.
I hope your results are benign!
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The MyChart portal I use has a bold print warning to not look at results if you don't want to see them before talking to your doctor. Personally, I like seeing mine first so I can make a list of questions, but I understand if others don't.
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Hi Maeby,
The law changed in January 1 of this year. All test results must be posted for access by patient's as soon as they are available. There are good aspects to this for those of us who know how to read them but perhaps not so much for those who prefer to have a conversation. If you don't want to see the, don't click on the link. But, you can see when your Dr received the results because he/she received them at the same time as you did.
I hope the results are what you are looking for,
Jane
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Thank you both! My portal too has the warning and now I understand why. It’s great for some things—stuff like this, maybe not so much. I will look into having it modified. I still wonder why it changed in the first place?
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Good luck with your results.. I would not be able to not look! I like to see the results before seeing the Doc. My sister is like you though, she lets the Doc give her the results. Thanks jhl, I wasn't aware of the law change.
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Thanks again, all. And it’s good to know about the law change—thanks Jane! Guess I should have read the fine print on MyChart. And turns out the crazy early “results” were just a summary of the biopsy procedure (it should have said as much—it literally said biopsy results) which the nurse told me today after I asked them to call me. Now the actual results came in just now at 7:00 pm so I get to sit and wait to find out until tomorrow. I had resigned myself last week toa new occurrence based on the dreaded spiculated descriptor, then the radiologist went and gave me hope, darn it. I’m such a knotted mess right now.
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The doctor called me tonight—invasive carcinoma, grade 2. Just hoping the rest of the testing comes back favorably.
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Ah, I'm so sorry. Yes, fingers crossed that the rest comes back favorably!
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maybe, I’m sorry.
Jhl, is this a US national law you are talking about? Is it all medical results
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Sorry about the result but glad it's been caught and you can erradicate it asap!
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Maybe, so sorry to hear of invasive!! Please let us know when you hear more about specifics...
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Can anyone now help me decipher how "good" or "bad" this is for me? Results are ER+ (90%) and totally negative for PR or HER2. I also knowthat Ki-67 is 10% and largest measurement on 12 cores is 2mm. I was surprised to hear oncologist mention it would be better it was PR+ too. I didn't know that, but admittedly have a lot to learn yet since this was a non-issue with my DCIS. Can anyone help me understand why and how serious is it that it's not also PR+? I'll note I've been on tamoxifen since my SMX. I suppose that is what has kept this so small. Thanks in advance.
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Generally speaking, there is some indication that both ER and PR + is a good sign as it's more likely to respond to hormone therapy. With ER+/PR- there is a bit less response. And if ER is weak, or both are weak (like in the =< 10% range) then some of those cancer behave like triple negative.
for ex this study: PR- associated with tamoxifen resistance https://pubmed.ncbi.nlm.nih.gov/16145046/
however, this study suggests that hormone blocking should still be used as it was associated with better 10 yr survival https://pubmed.ncbi.nlm.nih.gov/32519274/
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Thank you for the additional info, Moth! Iam getting the impression this is a less common combination and especially because I'm in my early 40s. I suppose I won't know how it all fits until after my surgery, though.
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Maeby,
PR- cancers can be more aggressive - they are more likely to be larger, more likely to be grade 3, more likely to be node positive. But there are a subset of PR- cancers that are small, not high grade and that have a low Ki-67 that appear to be no more aggressive than ER+/PR+ cancers.
Poor prognosis of single hormone receptor- positive breast cancer: similar outcome as triple-negative breast cancer https://bmccancer.biomedcentral.com/articles/10.11...
"When we additionally analyzed according to Ki-67 level, in cases with a high level of Ki-67 (≥14.0%), the differences among the four subtypes were still shown consistently. However, in patients with a low Ki-67 level (<14.0%), the prognosis of ER + PR- tumors was not different from that of ER + PR+ tumors."
As for Tamoxifen, the results are not consistent about the effect of being PR-. The BIG 1-98 trial did not find that Tamoxifen efficacy was reduced for those who are PR-.
Prognostic and Predictive Value of Centrally Reviewed Expression of Estrogen and Progesterone Receptors in a Randomized Trial Comparing Letrozole and Tamoxifen Adjuvant Therapy for Postmenopausal Early Breast Cancer: BIG 1-98 https://ascopubs.org/doi/full/10.1200/JCO.2007.11...."Our study shows that the endocrine treatment effect on DFS of postmenopausal patients with breast cancer is primarily influenced by ER status. The role of PgR could be determined only in patients with ER-expressing tumors, since few with tumors not expressing ER entered the trial. Of these, a better outcome was seen among patients with PgR-positive (≥10%) tumors—a finding consistent with the report of Bardou et al.13 Patients treated with letrozole manifested better outcome than those treated with tamoxifen regardless of their PgR status, and there was no statistical evidence of heterogeneity in the treatment effect whether PgR was considered as a categorical variable or as a continuum in the STEPP analysis.
Using real-time polymerase chain reaction assessment of ER and PgR status, Baehner et al28 found that the level of PgR was prognostic in untreated patients but not predictive of tamoxifen benefit, a finding parallel with our observation that PgR expression level did not predict the additional value of letrozole on ER-expressing tumors.
Our data do not confirm the hypothesis that aromatase inhibitors may offer a particular advantage over tamoxifen in patients whose tumors express ER but not PgR raised by Dowsett et al16 based on local laboratory PgR assessment in the ATAC trial. Our results conform more closely with the findings of no effect of PgR on relative efficacy of aromatase inhibitor and tamoxifen in the IES9 and the lack of significant difference seen in the ARNO/ABCSG trials."
What's important to know is that overall, AIs perform somewhat better for all post-menopausal women, versus Tamoxifen. Although some studies have suggested that Tamoxifen may be less effective for those who are ER+/PR-, a number of trials, including the large BIG 1-98 study, have not found this difference and instead have found that the performance of AIs vs. Tamoxifen is similar for those who have ER+/PR+/HER2- cancers or ER+/PR-/HER2- cancers. Therefore, while it is preferable that post-menopausal women taken an AI, for those who are unable to tolerate an AI because of side effects or other health concerns, Tamoxifen is a good alternative, regardless of whether the cancer is PR+ or PR-. -
Here's a thread for you to read:
Topic: Single Hormone Receptor Positive -> ER+/PR-/HER2-
https://community.breastcancer.org/forum/137/topics/858729?page=1
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Beesie, your insight is also greatly appreciated. I just felt foolish for feeling relief when I saw it was strongly ER+ without realizing the potential implication of the PR- part. I will look at it all this more closely when I’m off of work (having a super hard time focusing today, imagine that). Because mine is grade 2 and Ki-67% of 10% I’ll just hope to fit in the category you mentioned. I also appreciate the link to the other thread. Clearly haven’t thoroughly navigated the site yet! Thanks again.
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