Inconsistent Pathology Reports

erinrich

I was diagnosed with DCIS in early October by stereotactic biopsy.  The path report noted a focal microinvasion.  Three weeks later, I had a lumpectomy, and the pathology report from that procedure concluded that the disease was pure dcis without microinvasion.  I will meet with the med onc next week, but my surgeon said that they usually go off of the final path from the lumpectomy for purposes of staging and treatment, given the size of the tissue removed during lumpectomy v. the small sample obtained during a core biopsy.  I don't really care about my staging (Stage 0 v. Stage 1), but does anyone have thoughts on the inconsistency, what could have caused it, and whether I should perhaps get a second opinion on my final surgical path?  Thanks.

kcshreve

Personally, I'd always go for a second opinion.  You'd never regret it.

rianne2580

At least one second opinion. I'm going out of state to Loyola Medical Center for a second opinion on the original path slide. They will only accept the original slides. Many pathologists have differing opinions about the diagnosis. I find it odd the patient never gets to meet or talk to the pathologist who's opinion sets the stage for treatment. Actually, many years ago, in 1994, I was able to talk to the pathologist. He explained everything about the cells (I had DCIS and LCIS). Said they may never metastasize I actually had no treatment and for 17 years nothing happened. Last Oct. 2010 they found a 12mm section of DCIS, non invasive. I knew I had it, so I was not surprised. I may choose a different course of treatment this time.

sweatyspice

Get a second opinion, and/or a third, and fourth......get as many as you need to feel satisfied that you understand what's going on.

3monstmama

nothing wrong with a second opinion especially when the first opinions raise questions.  If they are telling you to do rads, they usually want to start within 6 weeks of lumpectomy so start finding your second-third-fourth opinions now.  good luck.

Deirdre1

Again - a second opinion can really change your outlook and they are very easy to do.. just make a request of the bs and ask him/her if he/she would send out your original slides to be reviewed by (then state the facility you would like it reviewed at) for a clean opinion (second opinion).  I did mine at Vanderbilt and I did get a different result, but there are so many experts on DCIS now you can find many so whatever your choice after doing some research..  it may cost your $3 or $4 Hundred (if your insurance doesn't cover a second opinion) but when you consider many of us are not having our original pathology reviewed by a "specialist" in DCIS this allows you access to some of  the best opinions from some of the best pathologists in the country and you may also get re-assurance as to which direction is correct for you!  Good luck!!! 

erinrich

Thanks, everyone.  Deidre -- I actually live in Nashville and had my surgery at St. Thomas.  Getting a 2nd opinion from Vandy is a good idea.  I had also thought having them sent to Dr. Lagios in CA.  I have no idea whether the pathologists at St. Thomas are "experts" in DCIS.  I think that a second opinion makes a lot of sense, though.  Will meet with med onc on Tuesday and will discuss with her.  

mbordo

Get a second pathology opinion.  It really *is* important to know whether you have a microinvasion or not, so you can make fully-informed decisions about your treatment plan.  I had Dr. Lagios review my slides, as I, too, had conflicting info from the pathology report.  Pathology is really as much an art as a science, and many things fall into a "gray area".  For example the path @ my local hospital said my margins were clear after my re-excision - with just some ADH cells @ the margin.  Dr. Lagios disagreed, he said they were low-grade DCIS, so in fact my margins were *NOT* clear, and to leave them as is would put me at an unacceptably high rate for recurrence (from my perspective - about 60%).  I changed my plan based on this information.  You will *not* regret getting clarification on the diagnosis.  It will really give you peace of mind.  Do it.  Worst case it will confirm what you already know...

Mary

Beesie

It's actually not unusual at all to have two pathology reports that say something different.  Breast cancer is usually a mix of a lot of different conditions so it's not surprising that one sample would include only certain conditions and another sample would include others.  My stereotactic biopsy had only ADH and some fibrocystic conditions.  My first surgery pathology had a microinvasion of IDC, grade 3 DCIS with comedonecrosis, every other type of DCIS (solid, papilllary, micro-papillary, etc.), plus ADH and a bunch more fibrocystic conditions.  My final surgery pathology had grade 3 and grade 2 DCIS and fewer different types of DCIS and fibrocystic conditions.

It is true that normally staging and treatment is based on the pathology report from the larger sample, which is usually the report that's available after surgery.  But this 2nd pathology report does not negate what was found in the first sample and documented in the first pathology report.  If the conditions noted are different and the first report included only lesser conditions (as in my case, where it showed only ADH), then the first report can be ignored.  But if the first report included a more serious condition (as in your case), then it cannot be ignored. In your case it sounds as though a microinvasion was found in the tissue sample from the stereotactic biopsy.  If this was the only microinvasion that you had (which would not be that strange - I had only one 1mm microinvasion in over 7cm of DCIS), then it's not inconsistent that your pathology report after your lumpectomy would note only the presence of DCIS.  But just because you didn't have a second microinvasion doesn't mean that the first one wasn't there.

If you are going to have any sample re-read, I would suggest getting the stereotactic biopsy sample done, in order to confirm whether or not a microinvasion really was present.  If there was a microinvasion, then from a treatment standpoint, the only change would be that you would need to have a sentinel node biopsy, if you have not already had one.  Any amount of invasive cancer dictates the need to have your nodes checked.  Other than that, your treatment will be the same as it would be if you had pure DCIS.  I say that from experience, and from reading the posts of dozens of women who've come through here who've had microinvasions. Of course, as you noted, the presence of a microinvasion would change your stage to Stage I and along with that, it would mean that you have a very slight (about 1% or less) risk of mets.  This is a risk that those with pure DCIS don't face and that's the reason for the change in staging from Stage 0 to Stage I for those of us who have microinvasions.

erinrich

Gosh, this is all really helpful info, everyone.  I did have a snb during my lumpectomy, because of the microinvasion found in the biopsy.  They took four nodes, which were all clean.  I completely agree with you, Beesie, that if I'm going to get a 2nd opinion, it should be on both samples, not just the lumpectomy path.  My surgeon thinks that I may not have really had a microinvasion, and that the report of microinvasion could have been due to the manner in which the sample was extracted, etc.  Since I've had the snb which was clear, though, and assuming that the worst case scenario with a second opinion would finding microinvasion that the 1st reading didn't find, do you all still think a second opinion is warranted?  I had thought that if the 2nd opinion found microinvasion, my med onc, with whom I'll meet next week, might want to do the oncotype.  My surgeon said that based on the good path we got on the lumpectomy, she didn't think the oncologist would order the oncotype.  I'm scheduled to start rads in December, and I know that the oncotyping takes a few weeks.  I'll discuss all of this with the med onc next week, but it's so great to have you all to bounce these things off of!!  Thanks again.  

roseg

it was my understanding that they don't treat DCIS with microinvasion differently from plain old DCIS. So even if the pathology is a little different it's not like you'd get a different treatment.