Conflicting Her2 Status -- please advise

[samdobbs]

I'm posting for my wife Liddy stats below.

We just received results from OnctotypeDX showing
Her2 Negative! Overall RS 24

Previously FISH was +ive (2.8) after equivocal IHC

Anyone encountered this situation? Any pointers to
reliability/accuracy of FISH vs. Oncotype?

Thanks in advance

Sam

--
49 years old, premenopausal, IDC and DCIS present, no family history
12/28/10 Excised tumor 1.5x1.0x0.9 cm, clean margins
Grade: Histologic 2, Nuclear 2, Mitotic 1, Overall grade 1(2+2+1=5)
Sentinel Nodes: 0/3,
ER+ (60%), PR+ (86%)
HER2+ Eqv by IHC, Positive by FISH (2.8), Negative by Oncotye (10.0)
Ki-67 = 3+ intensity, 17% of cells
Overall oncotype recurrence score 24

[Rich66]

Hmmmm....
Didn't think the oncotype could reliably determine Her2 status. Last I heard, a FISH at a reputable lab was the best route. Might try UCLA's lab..connected to Dr. Slamon...Michael Press is the lead pathologist, I believe.

[Becky]

I would contact a large research cancer center. I don't know where you are located to help you and I would get a second pathology opinion. FISH is very reliable and as Rich said, I did not think Oncotype DX diagnosed anything but a recurrence score - it really doesn't have a "pathology" indicator for Her2 (or ER or PR for that matter). When you contact the other cancer center, ensure they redo the Her2, ER and PR as that is what you are most interested in. Some examples of research cancer centers are Sloan Kettering, Fox Chase, MD Anderson, UCLA, Mayo Clinic, Cleveland Clinic, University of Indiana Cancer Center, Dana Farber.

The new pathology department will tell you what to do to get slides sent, then you contact where the surgery and initial pathology was done and give them the info. Have a credit card handy as they will probably charge you a fee to get them sent on dry ice (mine was $40.00 in 2004) but it could be well worth it.