her2 and low mitotic index?

penelope · 06-25-2006, 12:13 AM

I know we are all her2+ but does anyone have a low mitotic index as well? If her2 is so aggressive doesn't it make sense that you would have a high division rate as well?

Becky · 06-25-2006, 08:15 AM

My mitotic score was 1 (with a histological score of 3 and nuclear score of 2 so my Nottingham was 6/9). Ironically, although my mother was not Her2, her scores were the exact same as mine.

I feel that about 2 months before diagnosis, I began a "health" regime. I started eating right and started looking at the fats I ate (as well as started taking fish oil tablets). Maybe this started to down regulate things or maybe the score is the score. It's very good to have a low score for mitotic value so be happy about that (mine was confirmed at Sloan and Johns Hopkins - sent the slides there).

Kind regards

Becky

Jean · 06-25-2006, 08:22 AM

Becky,
Could you explain what this is and where do I find it in my reports?
Also, How important is this?

Hope your well...

Jean

penelope · 06-25-2006, 08:36 AM

Becky,
The breakdown of you score is identical to mine. Although I am not sure if you were est+/-. I was thinking it was a mistake but you say that it was confirmed at Sloan Kettering and Johns? Can you tell me what you have learned about the prognositic value of this?

Also my FISH score seems to be on the low end comparatively. How is yours?

And inicidently...I also had a super clean diet for about 8 years before finding my tumor.

Cathya · 06-25-2006, 01:39 PM

Hi;

My mitotic score was 1, nuclear grade was 1 and tubule score was 3 for 5/9 total score and a Modified Scarff Bloom Richardson Grade of 2 (for whatever this means?). I am ER/PR positive but don't know the percentages.....although it says that it was positive for internal control present and reactive. I don't have the pathology on the second tumor as it was not removed.

Cathy

Chelee · 06-25-2006, 02:14 PM

Like Jean asked already...I too would like to now where you fine this mitotic score? I have never heard of it? Whats it mean?

I know I have a Richardson score of 9 of 9, High nuclear grade. What is the importance of knowing your mitotic score? Sorry..but I haven't clue?

Chelee

Becky · 06-25-2006, 03:08 PM

It's difficult to know where on your report this information is. Some labs just report your grade and the grade is determined as such:

They subjectively measure histological grade - this is how the cancer cells look. A score of 1 means it is abnormal but looks very close to a normal cell. A score of 2 means it is more abnormal looking (in the middle) and a 3 means very abnormal looking. The nuclear grade - this is how the nucleus of the cancer cell looks in comparison to a normal nucleus. Scoring is the same as that of the whole cell (ie: histological grade). The last thing to be scored is the mitotic index. This is the rate of cell division going on within the slide they are looking at. A score of 1 is that it is dividing faster than normal cells but not super fast. A score of 3 means extreme cell division and a score of 2 is inbetween. Then they add up your scores for the Nottingham grade. Like I said before, I had a 3 histological, a 2 for nuclear and a 1 for mitotic so that's a 6/9. For grade 1 cancer the score is 3-5, grade 2 is 6-7 and grade 3 is 8-9. So if all you know is that you were grade 3 cancer, you can kind of figure out your scores as they would add up to 8 or 9.

Some pathology labs measure and report Ki67 which is another way to measure the rate that the cells are dividing but since my lab did not do it this way, I don't know anything about it.

Someone asked about my hormone status. I am ER+ 50% but I am considered PR negative as my pathology report says less than 5%.

I hope this has helped.

Kind regards

Becky

Chelee · 06-25-2006, 03:47 PM

Thanks for helping us out here. Much appreciated. If I understand this right...then I would believe mine would be 9. I am going to dig out my path report and check it out a little harder now that I read your post. Thanks again.

Chelee

Jean · 06-25-2006, 09:10 PM

Many Thanks Becky,

Regards, Jean

tousled1 · 06-26-2006, 03:46 AM

I am assuming that my mitotic index is 8 according to your description. My histologic grade was 2 out of 3; tubular formation 3 out of 3, and nuclear grade 3 out of 3. So if I add those up it comes up to 8. My pathology report say mitotic index: less than 10 mitotic figures per 10 high powered field.

06-26-2006, 08:19 AM

My pathology report says greater than 20 mitoses/10 high powered field. My Bloom Richardson score was Grade III of III. I'm not sure where to find the histologic grade.

penelope · 06-26-2006, 08:40 AM

tousled what you are describing is your bloom richardson histologic grade. The mitotic score, nuclear score and tubule formation each add to create a score between 3 and 9.

mitotic score is rated by looking at how many are dividing in a given sample seen by the field of view in a microscoope....or 10 high power field (HPF) and then it is given a score based on how fast it is dividing, which is then added to the other characteristics of the tumor in order to grade it.

0-9 mitoses/10hpf=1
10-19 mitoses/10hpf=2
20 or > motoses/hpf=3

Her2 is said to be very aggresive and therefor dividing very fast, but that does not seem to be the case with mine. Mine shows that it was dividing at 2/10hpf for a score of 1. My question then is how does that effect herceptin and chemo since they both work on fast dividing cells.

tousled1 · 06-26-2006, 09:20 AM

Penelope,

Could be that your tumor size was relatively small? My tumor size was 2.5cm with a 3.0cm invasiveness.

Breast cancer that is HER2 positive or amplied is more likely to recurr.

Other factors, rarely seen mentioned on this board, used in overall breast cancer prognosis are:

Ploidy/DNA index: diploid having a favorable prognosis, tetraploid an intermediate prognosis, and aneuploid an unfavorable prognosis.

S-phase: <7% favorable, 7-12% intermediate and >12% unfavorable

My Ploidy/DNA index is aneuploid and my s-phase is 24.2%.