HER2 Support Group Forums - View Single Post - here we go again: How inexact ER status testing is!!!

Lani · 07-10-2007, 09:18 AM

1) they have found that ER+PR+ react differently to antihormonals than ER+PR-. Hormonallly positive tumors receive much less benefit (if any from Chemo) her2+ER+ may be the exception, but it may not be all of them eg it may be those which are topoIIa + and respond to anthracyclines. It SEEMS her2+ER+ respond to taxanes, whether more or les than ER- is not known. It won't probably be known until they discover how to subclassify the different types of her2+ER+ bc and find which respond best to what treatment.
Ruth's dramatic response portends well!!!

2) did n't understand the question. Sorry!

3) If one is ER- and they miss it, treatment may not include antihormonals which may improve prognosis. If one is falsely diagnosed as ER+, perhaps one decided to forgo chemo thinking the benefit would be small and/or one would be treated with a drug which may have unnecessary side-effects

4) Don't know if the dye can affect anything else. Search for my post on the methylene blue and print it out. Other dyes were used in Europe, but cost more and may not be available to the surgeon here. I just read a paper showing that using the radioactive material alone can miss some metastatic deposits in sentinel nodes, hence the recommendation to use both.

If Ruth was ER+ when methylene blue was not used, the same tissue could be reexamined using another technique to reconfirm the ER positivity. A
pathologist at a breast cancer conference I attended two weekends ago brought up in front of all of his colleagues and oncologists that it is time to reexamine how ER is tested for as better, more reliable methods are available and/or testing in more than one way to assure the results are accurate may be in order.

I am certainly not an oncologist, pathologist, or breast surgeon or in any way qualified to advise you...just well-read.

If anyone is truly concerned, print out some of the articles or abstracts and take it with you when you ask questions. There are such things as pathologic second opinions where you don't even have to go, just send your slides. No
point in worrying unless it will change your treatment . One member of the board had tested initially ER+ on the needle biopsy, then ER- when the tumor was removed. Perhaps in that sort of instance suspicions might be raised. Remember mistakes are the exception, not the rule. But asking questions is part of the process...

Hope this helped more than raised worries!

07-10-2007, 09:18 AM	#12
Lani Senior Member Join Date: Mar 2006 Posts: 4,780	wow--don't know if I have time to answer all but... 1) they have found that ER+PR+ react differently to antihormonals than ER+PR-. Hormonallly positive tumors receive much less benefit (if any from Chemo) her2+ER+ may be the exception, but it may not be all of them eg it may be those which are topoIIa + and respond to anthracyclines. It SEEMS her2+ER+ respond to taxanes, whether more or les than ER- is not known. It won't probably be known until they discover how to subclassify the different types of her2+ER+ bc and find which respond best to what treatment. Ruth's dramatic response portends well!!! 2) did n't understand the question. Sorry! 3) If one is ER- and they miss it, treatment may not include antihormonals which may improve prognosis. If one is falsely diagnosed as ER+, perhaps one decided to forgo chemo thinking the benefit would be small and/or one would be treated with a drug which may have unnecessary side-effects 4) Don't know if the dye can affect anything else. Search for my post on the methylene blue and print it out. Other dyes were used in Europe, but cost more and may not be available to the surgeon here. I just read a paper showing that using the radioactive material alone can miss some metastatic deposits in sentinel nodes, hence the recommendation to use both. If Ruth was ER+ when methylene blue was not used, the same tissue could be reexamined using another technique to reconfirm the ER positivity. A pathologist at a breast cancer conference I attended two weekends ago brought up in front of all of his colleagues and oncologists that it is time to reexamine how ER is tested for as better, more reliable methods are available and/or testing in more than one way to assure the results are accurate may be in order. I am certainly not an oncologist, pathologist, or breast surgeon or in any way qualified to advise you...just well-read. If anyone is truly concerned, print out some of the articles or abstracts and take it with you when you ask questions. There are such things as pathologic second opinions where you don't even have to go, just send your slides. No point in worrying unless it will change your treatment . One member of the board had tested initially ER+ on the needle biopsy, then ER- when the tumor was removed. Perhaps in that sort of instance suspicions might be raised. Remember mistakes are the exception, not the rule. But asking questions is part of the process... Hope this helped more than raised worries!