excisional biopsy

Lorax

excisional biopsy

Lorax

Hi - thanks for this great site and for the support you guys offer.  I have been reading this stuff ever since I was diagnosed with LCIS in November and finally got up the gumption to ask a question - I had a wire localization excisional biopsy on Friday and the doc said I would hear something in 8 to 10 days about the results.  I should have asked him, but never think of my questions until too late, but I was wondering if any of you know- if there was anything obvious, wouldn't they have been able to tell at the time of the biopsy?  Don't they usually do a quick slide to check for obvious cancer cells?  I am thinking that because nothing was said to me immediately after the biopsy that my chances of nothing being found are pretty good. 

Anonymous

Lorax--I think most doctors hesitate to tell the patient much until it's definitive by the pathologist's report. (although I've experienced both---they did an immediate biopsy of a large ovarian mass during my total abdominal hysterectomy and told me it was benign in the recovery room; yet my results from my lumpectomy took about 7 or 8 days).  I'm not sure why--perhaps they don't want to get into details about a scenario that might not even happen or they just want to be absolutely sure of what they're dealing with, which isn't such a bad idea.  I think it's about 17% of the time that they find something else more serious (DCIS or invasive bc) along with LCIS during surgical excision; but that means 83% of the time they don't! so that's good news to hang on to.   They did not find anything more during mine 4 years ago.  I am doing well--taking tamoxifen and am very closely monitored by mammos alternating with MRIs every 6 months and frequent breast exams. Although it does give some comfort, the close surveillance is also stressful.  Feel free to PM me if you'd like to talk.

Lorax

Thanks, those are the stats I was paying attention to - the odds are pretty good.  Did you also have a diagnosis of LCIS?  I am getting vibes that my doctor is going to recommend no treatment if nothing else shows up.  I am premenopausal and I think they won't recommend tamoxifen at this time...And I have even heard mention of waiting a full year before another mammogram.  I like the idea that this is nothing to worry about but then worry that this could be too little monitoring.  It is worrisome.  I am an expert at putting things out of my mind so if he recommended no further treatment I would probably be fine  with that.  Except in the middle of the night....  What were the conditions that led your doc to recommend the tamoxifen?  Also, my condition was first dx by microcalcifications - so does the finding of LCIS combine with the microcalcifications to increase my overall risk? 

Anonymous

Lorax---my LCIS was also found by suspicious microcalcifications on mammo.  Combined with my family history, my oncologist put my lifetime risk at over 36% (but I have a feeling it's even higher) and my 5-year risk at 4.6%.  Tamoxifen is recommended for a 5-year risk of 1.7% or higher.  My surgeon gave me 3 options: 1) close monitoring 2) close monitoring and tamoxifen or 3) bilateral mastectomies. All my doctors (bs/onc/gyn/pcp) felt #3 was too drastic and unecessary for my situation, and I was already being watched pretty closely due to my mom's bc, so I chose #2 to be proactive and take tamoxifen in hopes of preventing an invasive bc in my future.  At first I only had yearly mammos (and breast  exams every 6 months by onc), but I did not feel comfortable with that level of monitoring. So now I go for MRIs alternating with mammos every 6 months, I see my oncologist every 6 months on an alternate schedule, so it works out I'm really being followed every 3 months.  I figure that way if anything were to develop, it would be found  early when it's most easily treated.

Anne 

Lorax

Anne,  my sister in law is a doctor and she recommended the bilateral mastectomies, but I also think that is quite drastic.  I am also very worried about tamoxifen because I am afraid it will really make me crazy and I can't afford that with work and family.  Have you had a lot of side effects?  I think I am on the verge of menopause and I am already feeling the effects of less estrogen.  I also have osteopenia (osteoporosis runs in the family).  Have you had to have repeated biopsies?  I really don't want to do that every six months. I know these are a lot of questions and I appreciate your help- L.

  

Anonymous

Lorax-----actually my SEs from tamox have been minimal and very manageable. Tamox is generally well tolerated by most with the most common SE being hot flashes (which you'd get with natural menopause anyway).  No repeated biopsies here--all my tests have been clear (benign or probably benign) so far.  I was recently found to have early osteopenia on my bone density scan, but tamoxifen is good for the bones (it's the AIs that cause bone loss) so it would be even worse if I wasn't taking tamox.

leaf

Lorax-you may be interested in this study. It lasted for 6 years, and they had a total of 22 + 55 =77 biopsies among 378 patients, or even if you count the LCIS patients which were 252. So in this study at most about 1/3 of the LCIS patients had a biopsy over 6 years. There were a total of about 14 cancers among the 378 patients over 6 years.



1: Ann Surg Oncol. 2007 Mar;14(3):1051-7. Epub 2007 Jan 7. Links

Results of MRI screening for breast cancer in high-risk patients with LCIS and atypical hyperplasia.



Port ER, Park A, Borgen PI, Morris E, Montgomery LL.

Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. porte@mskcc.org

BACKGROUND: Magnetic resonance imaging (MRI) can detect breast cancer in high-risk patients, but is associated with a significant false-positive rate resulting in unnecessary breast biopsies. More data are needed to define the role of MRI screening for specific high-risk groups. We describe our experience with MRI screening in patients with atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS). METHODS: We retrospectively reviewed data from our high-risk screening program prospective database for the period from April 1999 (when screening MRI was first performed at our institution) to July 2005. Patients with AH or LCIS demonstrated on previous surgical biopsy were identified. All patients underwent yearly mammography and twice yearly clinical breast examination. Additional screening MRI was performed at the discretion of the physician and patient. RESULTS: We identified 378 patients; 126 had AH and 252 had LCIS. Of these, 182 (48%) underwent one or more screening MRIs (mean, 2.6 MRIs; range, 1-8) during this period, whereas 196 (52%) did not. Those who had MRIs were younger (P < 0.001) with stronger family histories of breast cancer (P = 0.02). In MRI-screened patients, 55 biopsies were recommended in 46/182 (25%) patients, with 46/55 (84%) biopsies based on MRI findings alone. Cancer was detected in 6/46 (13%) MRI-generated biopsies. None of the six cancers detected on MRI were seen on recent mammogram. All six cancers were detected in five patients (one with bilateral breast cancer) with LCIS; none were detected by MRI in the AH group. Thus, cancer was detected in 5/135 (4%) of patients with LCIS undergoing MRI. The yield of MRI screening overall was cancer detection in 6/46 (13%) biopsies, 5/182 (3%) MRI-screened patients and 5/478 (1%) total MRIs done. In two additional MRI-screened patients, cancer was detected by a palpable mass in one, and on prophylactic surgery in the other and missed by all recent imaging studies. For 196 non-MRI-screened patients, 21 (11%) underwent 22 biopsies during the same period. Eight of 22 (36%) biopsies yielded cancer in seven patients. All MRI-detected cancers were stage 0-I, whereas all non-MRI cancers were stage I-II. CONCLUSION: Patients with AH and LCIS selected to undergo MRI screening were younger with stronger family histories of breast cancer. MRI screening generated more biopsies for a large proportion of patients, and facilitated detection of cancer in only a small highly selected group of patients with LCIS.

PMID: 17206485 [PubMed - indexed for MEDLINE]

Lorax

Leaf,  that study reminds me of my favorite cartoon I saw recently in a New Yorker magazine.  The doctor is talking to the patient, saying, "Well, it really looks like it is nothing to be concerned about but we will continue to monitor it closely in order to avoid a major lawsuit". 

   I think the stats that I have been told are that 10% of women with LCIS are found to have an invasive cancer on further biopsy.  You have to wonder if this is  just "conventional wisdom" or actually substantiated in research studies.  Thanks for your reassuring post.

L. 

Lorax

Thanks Anne and Leaf for your input - I just got good news from the doc that the biopsy was negative for cancer, just confirmed the LCIS.  I have a follow up appointment scheduled with him and I would like to ask him some intelligent questions.  I have read on this site about things like pleomorphic cells, columnar cells, etc.  Is that information that comes from the pathology report and worth questioning?  Can you think of anything else about the path report I should ask?  I always become stupid when I talk to this guy for some reason.