Curious...What was your FISH?

[RhondaH]

Thank you.

Rhonda Hoffman

[jener8er]

Hi Rhonda, mine was 15.2 - which sounds REALLY high to me. My onc said there's no "high", just positive or negative. I hope he's right!

Good thread, interested to see everyone elses' number.
Jen

[Julie2]

Mine is 9.6

julie

[RhondaH]

I guess I should have added my own. *3.16*

Rhonda Hoffman
************
DX 2/1/05
Stage 1, 1.6 cm
Node neg
Grade 3
ER-PR-
HER2+
6 rounds of dose dense TEC (Taxotere, Epirubicin, Cytoxan)
33 rads
Currently on every 3 week Herceptin until 8/06

[BubblesMom]

Mine is 2.1 which was why I gave some serious thought to herceptin or not to herceptin. But after considering that I had a mammogram a mere 7 months prior to discovering the lump (which to me indicated a fast-growing cancer) herceptin was no longer a decision to make but an action to take. Oops...guess that was more than you asked for, Rhonda. ;>)

[saleboat]

Mine was 0! I'm 3+ via the IHC and on Herceptin.

Jen

[michele u]

My IHC was 3+ and my FISH was 10

[janet/FL]

My FISH was in the 6's. Not sure the exact amount.
Thanks for asking this question as I did not know how my score compared to others.
I am stage one/ just finishing my 5th month of Herceptin having completed three months of Taxotere/Herceptin
Janet

[Yorkiegirl]

I guess I am dumb since I'm not exactaly sure what I'm looking at, but my FISH report say's:


HER-2/neu 5.42
Chromosome 17: 2.33

HER2/neu/Chromosome 17 ratio 2.32
HER2/neu Gene Ampllification POSTIVE

So. I'm not sure wheather it is 5.42 OR 2.33 ????

I still have a lot to learn I guess.

I also don't understand the Ki-67 --78%

Vicki

[al from Canada]

Dear Sailboat,

Please review my comment : http://her2support.org/vbulletin/showthread.php?t=22042 as it may answer a few questions.
Al

[Ginagce]

Mine is 7. When I asked Onc what that meant, she said it means you need to be on herceptin. I think she was having a bad day! She's normally more communicative than that!

Gina

[Lolly]

My primary bc was IHC 3+, and my most recent recurrence to right axilla was sent for FISH and came back at with a CEP-17 ratio of 4.26.

FYI, my test was performed by PhenoPath Laboratories in Seattle WA, and included these nuggets of info in the report:



"A ratio of >2 is considered positive for gene amplification. Because signal counting is performed by the Metasystems instrument, the mean number of signals refers to signals per "computer tile" rather than tumor cell. The number of cells per tile varies as a function of tumor cell density and cell size."

And this:

"...Studies in our laboratory and others demonstrate that there exists a strong correlation between amplification of the HER-2/gene detected by FISH and overexpression of the HER-2/neu gene product as determined by immunohistochemistry, although there is a small fraction of cases (3 -5%) without gene amplification but with the presence of protein overexpression..."

[Michelle]

My score was 6.3-Wish I could find the actual report right now.
Michelle

[jener8er]

I'm still winning! (or is it losing???) Does anyone here know if the higher the number, the more aggressive/more responsive to Herceptin/or anything else this would relate to?

[Michelle]

Jen,
I have heard the more aggressive the tumor, the better it responds to chemo. I truly don't know if the same goes for herceptin but I hope so.
Michelle

[Rich]

Yes, Saleboat..
I'm surprised you are on Herceptin since it seems IHC 3+ needs to be confirmed for her2 positivity by FISH test.

[StephN]

Hi Rich -
Maybe most docs would want to reconfirm for HER2 by FISH if the IHC was only ++ or less, but if it is +++ by IHC we get Herceptin.

I was HER2+++ by IHC at my diagnosis and have never had the FISH, even for my mets. I have responded well on Herceptin and that seems to be good enough for my med onc.

It seems that a very positive IHC indicates high overexpression and we go from there. But it would be interesting to know my FISH number - just to go with all the other numbers in my life!!

[Unregistered]

Does anyone know a lab in California where I could go (or send my tumor sample) as a patient and pay to have a FISH test done? I had an IHC test (3+) done at initial diagnosis 4 years ago which allowed me to get Herceptin and my oncologist doesn't think that a FISH is necessary. I understand his reasoning. However, I'm really interested in knowing what the results would be. Reading all of your results has really peaked my curiosity.

Have a blessed Christmas and a Happy New Year.
Love, Kay

[Lani]

Stanford University Hospital will usually do a complete second pathological opinion ie, looking at the slides, staining for hormonal receptors and doing FISH as well as IHC for her2neu (and perhaps Ki67) I do not know if they will do the FISH test alone. You could also try UCLA or UCSF, but they are less user-friendly in my experience.

Most hospitals which are not comprehensive cancer centers do less of the tests or even, in most cases, send the test out to various labs, whose experience and expertise are not equivalent (to be polite). That is why it has been so hard to get good info on the prognosis of patients who are her2neu positive--the testing has been so variable that it has not even been certain that they are including the correct patients. The original results of Herceptin were less than spectacular, in fact they almost gave up on developing it, because they did not have a good way to determine who was likely to benefit from it and so the initial results were hardly significant let alone impressive. Once her2neu 1+ and, then most her2neu 2+ (those who were FISH negative)patients were taken out of the trials, the true value of Herceptin became evident.

Good luck!

[saleboat]

Re: testing for HER2. One of the recognized challenges that Oncs are facing given the advent of Herceptin use in early-stage disease is getting an accurate pathology given the two tests that are currently in use...IHC and FSH and thereby ensuring that those patients who can benefit from Herceptin actually get it.

Most tumors that are tested positive by IHC will also get a positive result on the FSH. However, there are a small number of tumors that will be IHC 3+ and test FSH negative, and are excellent candidates for Herceptin. This seemingly contradictory result may lead to a second IHC test to confirm that the first was not a false positive, which if the tests were done at low-volume testing centers, would probably be a good idea. I've also read that there are some patients who will test IHC-, but FSH +. When we read that FSH is a 'better' test, it should be concluded that it is a more accurate test of what it measures, and is subject to fewer false positives/negatives than the IHC. But FSH measures HER2 in a different way than the IHC test does and FSH cannot be considered definitive in 100% of cases.

I've come to the conclusion is that these tests are best read in concert, and that neither should be used alone as the definitive determinant of whether or not to use Herceptin. Also, that it may make a lot of sense to have one's pathology done by a high-volume lab that has a lot of experience with these two tests.

[Unregistered]

In 2002, I was diagnosed with a 2.4cm IDC, negative nodes, ER+, PR+ and IHC 3+. At that time, I did not qualify to enter the Herceptin clinical trials. When all the good news about Herceptin started to come out, I decided to start "late" Herceptin. I started Herceptin 2 years after my diagnosis.

After my first Herceptin treatment, I had many side effects. Being a Medical Technologist, I knew about the FISH test and asked to have it done just to double check I was actually Her2 positive. After weeks (and 2 more Herceptin infusions), my FISH test came back negative (1.5).

My original IHC test was done at a local hospital lab. (I switched to a large breast cancer center after diagnosis.) The pathologist at the local hospital admitted that in 2002, the IHC test was new for them and they didn't do many of them. They found out they were getting quite a few false negatives and false positives. In 2003 because of this lack of compliance, the lab changed the way they were doing the IHC test.

After getting many opinions, I was told that if you are really IHC 3+ and FISH negative, you can still benefit from Herceptin. The tests are measuring two different things. IHC tests for a protein on the outside of the cell. FISH measures the genetic material inside the cell. IHC can be done in most hospital labs but FISH, a more expensive test, needs to be done in a reference lab. IHC has more varibles for error and also is a more subjective test than FISH.

I stopped the Herceptin and asked to have the IHC repeated. After more weeks, I was told that the local hospital lab could not give me and "accurate" IHC result because the tissue sample was too old. I believe in my case the original IHC test was done incorrectly--I am not Her2 positive and never was. I'm very glad I did not go through a year of Herceptin for no reason.

I know I am a very rare case. It does seem scary to make such a large commitment of a year of treatment when there are still questions about the accuracy of Her2 testing.


So as Saleboat said, "it may make a lot of sense to have one's pathology done by a high-volume lab that has a lot of experience with these two tests."

[kristen]

My FISH was 7.6.

[life]

Does anyone know what the normal range of FISH is and what does it mean your FISH. Mine was 6.1, and I have no idea what it means.
Marcia

[Lolly]

Marcia, here's a link to the "Tests and Treatments" page from this site. You can click on the FISH link to read all about it. <3 Lolly

Tests and Treatments
http://her2support.org/a/newher2_004.htm

[jener8er]

Hi everyone, I still don't know why my FISH test was SO high - it seems at least double to everyone elses here. Does anyone here know if this means anything? I haven't seen anyone else with anything over 8, yet mine was 15.2? Could mine be wrong? Why is it more than double any other result that you all have? Does anyone know if this means I'm better off being on Herceptin, or am I just buying time for something that is unstopable? Please help me not to panic....

[karenann]

My FISH was 6.3.

Karen

[Unregistered]

Jener8er, don't panic!
The report on my FISH analysis states, "...Because signal counting is performed by the Metasystems instrument, the mean number of signals refers to signals per "computer tile" rather than tumor cell. The number of cells per tile varies as a function of tumor cell density and cell size."
My report shows the Mean Number of signals of Her-2/neu in my sample to be 19.4 signals. But the lab that performed the FISH on my sample looks at the HER2 factor in two ways; the above mentioned number of signals per computer tile, and also by looking at the number of signals on chromosome 17. The lab then reports the FISH positivity as a ratio of HER-2/neu signals to CEP-17 signals, and in my case it was then 4.26.

So I think the question for you is, did the lab that performed the FISH on your sample use only one point of reference and report your FISH as the Mean Number of signals, which could give you an seemingly high degree of FISH positivity, when in reality it would simply be showing the number of signals on the tile which according to the explanation above can be variable depending on how many cells are on that particular tile. If you can't decipher this from the report, see if the phone number of the lab is noted on the report, they often are, and give them a call asking for an explanation. I've found labs to be very helpful that way, but they may ask you to sign a release of information form first. If they're out of your area, they can fax the form to you and you can fax it back, to speed things up.

Good luck, and again, don't panic...

<3 Lolly

[Unregistered]

Jener8er, don't panic!
The report on my FISH analysis states, "...Because signal counting is performed by the Metasystems instrument, the mean number of signals refers to signals per "computer tile" rather than tumor cell. The number of cells per tile varies as a function of tumor cell density and cell size."
My report shows the Mean Number of signals of Her-2/neu in my sample to be 19.4 signals. But the lab that performed the FISH on my sample looks at the HER2 factor in two ways; the above mentioned number of signals per computer tile, and also by looking at the number of signals on chromosome 17. The lab then reports the FISH positivity as a ratio of HER-2/neu signals to CEP-17 signals, and in my case it was then 4.26.

So I think the question for you is, did the lab that performed the FISH on your sample use only one point of reference and report your FISH as the Mean Number of signals, which could give you an seemingly high degree of FISH positivity, when in reality it would simply be showing the number of signals on the tile which according to the explanation above can be variable depending on how many cells are on that particular tile. If you can't decipher this from the report, see if the phone number of the lab is noted on the report, they often are, and give them a call asking for an explanation. I've found labs to be very helpful that way, but they may ask you to sign a release of information form first. If they're out of your area, they can fax the form to you and you can fax it back, to speed things up.

Good luck, and again, don't panic...

<3 Lolly