Her-2 Positive and Negative

[starsouler]

Had right modified radical mastectomy March 2009 then 4 cycles AC regimen;1cycle taxotere(severe toxicity hospitalized);1 Abraxane (severe peripheral neuropathy, palmar-plantar dysesthesia,nail changes/loss); completed regimen 2more cycles Abraxane reduced dosage. Path staging: pT1bpN2apMX; stage IIIa. DX AFTER MASTECTOMY(15 paraffin cassettes, cassettes 12, 15 tested): Invasive breast carcinoma (multifocal) with ductal/lobular features and multifocal DCIS; tumor site - Central (Subareolar), Lower outer, Upper inner: multiple, small simultaneous ipsilateral carcinomas, Nottingham Histo score 7, Grade II. 7of20 Lymph nodes w/micrometastases at least 1>2.0mm.ER/PR - (90%)positive;FISH-Her2 e-cahedrin neg ratio Her2(Avg 1.9) to D17Z1(Avg1.6) signals=1.2,multiple cells showed<than 2copiesHER2&centromere (D17Z1 control probe) signals for chromosome 17 (suggestive of monosomy chromosome 17.Original Dx Rt Brst Bx( done by a different lab) (From Mastectomy samples -  biopsy site on parrafin block(cassette) 3) - HER@ FISH Results: ER/PR 90%, pos; HER2 & CEP17 FISH - 1.9 equivocal, E-Cahedrin pos, Avg HER2 - 4.33, Avg CEP 17 - 2.27 (results were verified by 2 observers.) 1.Question - Should I be treated with Herceptin also: due to the original Biopsy pathology is E-Cahedrin positive, with gene amplification (The Mastectomy Biopsies had no amplification but with monosomy 17.)? ( Finished 7 of 33 radiation treatments, just started taking Tamoxifen (last Chemo was Sept 23,2009).) Thank you for your help. I am worried because of a negative Mammo June 2008, then Lump in NOV., 2008 and Dx of breast cancer in DEC 2008 & verified FEB 2009, surgery March 2009, My cancer went from Stage1 to Stage 111a quickly(to me), and I really would not like to get an additional Dx of HER2 positive in the future, and have a very bad feeling about this. Possibly ask my Oncologist to have Cassette 3 from mastectomy (Biopsy site) to be tested by FISH?
Thank you sincerely for your time,
Hope

[Cleveland Clinic]

Dear starsouler:  There is no role for herceptin unless there is amplification of the HER2 gene.  If you are concerned about these results, you might consider having the actual pathology slides reviewed at another pathology lab, preferably one who conducts all testing in house.