How do you interpret and manage discordant HER2 in IDC breast cancer between primary tumor and lymph nodes?

If a patient has ER/PR+ and Her2 positive disease in the primary tumor while axillary lymph node core biopsy is ER/PR+ Her-2 negative, do you manage it as HER2 positive disease overall? Does it change your preference of choice of neoadjuvant chemotherapy to include anthracycline (AC->THP vs TCHP) ?

Answer from: Medical Oncologist at Academic Institution

Trastuzumab and Pertuzumab have made such significant contributions to decreasing breast cancer mortality that I would give irrespective of which site (breast or axillary) is positive. Speculate as why the breast primary is HER2 overexpressing and the nodes are not are 1) falsely negative assay for ...

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Medical Oncologist at Icahn School of Medicine at Mount Sinai
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How do you interpret and manage discordant HER2 in IDC breast cancer between primary tumor and lymph nodes?

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