Do core biopsies provide enough tissue for ER/PR and HER2 overexpression? If so, is it standard practice to test for these or not? If not, why not? It would seem that especially HER2 overexpression would require more aggressive follow up as soon as possible.
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Q: Can ER/PR and HER2 overexpression be tested for from a Core Biopsy?
Answers (4)
3/12/09 5:40am
Ellen, I'm not sure if it's standard practice to do a thorough pathology report based on a core biopsy; I know that some places do, and some wait to do the complete report once the tumor is removed. The issue is that the core biopsy doesn't provide a complete picture; there may be different kinds of breast cancer in the same breast, and the core biopsy might "hit" just one of them. Yes, they provide enough tissue to tell you whether or not you have cancer; but they may or may not provide enough tissue from enough locations to give the best reading on hormone receptivity and HER2-neu. And the time lag between biopsy and treatment isn't critical. Although breast cancer can be considered aggressive, it's still overall a fairly slow-growing cancer, and days or even a few weeks aren't going to make the difference. Good luck - PJH
3/12/09 6:00am
Ellen, I'm not a pathologist, but when I was diagnosed, there weren't enough cancer cells in the original biopsy to do the tests for ER and Her2 status. They did those at the time of my mastectomy. ER status mainly affects whether you will have follow-up care with one of the hormonals like Tamoxifen. Herceptin, which would probably be part of the treatment if the tumor overexpresses Her2, is also usually started later in treatment.
3/12/09 10:39am
In my own case, Ellen, (diagnosis and core biopsy last October) there was enough tissue to indicate that I was ER/PR negative and Her2 positive, although the sample had to go for further testing (CISH test) on the Her2 aspect. I don't know if it's standard practice here in Australia, but there didn't seem to be any suggestion that it was an unusual practice. It seems to be much easier here than in the US to pay for tests as our health care system (partly taxpayer, partly privately funded) seems to be more generously run. I am sure that it helped to confirm my onco in his treatment plan of neoadjuvant chemotherapy with Adriamycin/Cyclophosphamide to shrink the tumour. Research seems to indicate that Her2+ tumours respond very well to this regimen, and of course, later in the treatment there is Herceptin to deal specifically with this characteristic of the tumour. This is the stage that I'm up to now in my gold-standard treatment for inflammatory breast cancer.
I know that this is one aspect of my breast cancer that I was keen to know as soon as possible. Are they not going to do or have they not done this testing for you? It sounds like you are doing your best to be informed and I think that's a good way to handle things.
Best of luck
Sue
3/12/09 9:16pm
I had my core needle biopsy results given to me on the 23rd of Feb and all it told me was IDC 1 centimeter, poorly diff - no ER/PR or HER2. My breast surgeon said that my gyno didn't request that info on the biopsy order, so they will find all that out through my lumpectomy scheduled for the 25th of March. I had an MRI last week and thankfully it showed nothing else in either breast, except what was found on my call back mammo and US.
Linda
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By Ellen— Last Modified: 12/03/10, First Published: 03/11/09
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