turn around time to pathology/margin report after lumpectomy

L2012

I understand that there needs to be some processing time after a lumpectomy to determine the final pathology and margin report.  I am trying to get a handle on this time frame.  I want to schedule my lumpectomy at a place that determines the margins as quickly as possible.  I am considering Hoag in Newport Beach but am open to other locations.   I am also restricting my selection to those facilities that provide 3 dimensional orientation of the surgical specimen.  In the case of insufficient margins at initial lumpectomy this 3-D information is critical to a second excision of the problem areas rather than the unnecessary tissue removal in areas where sufficient margin was already obtained.  (one article which discusses importance of 3-d mapping of surgical specimen,

Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation, Sarah E Pinder) 

I live in Tennessee near an international airport - so Hoag is not local for me.  Nashville is local but I have worn myself out trying to get Nashville doctors to treat me for DCIS rather than ICS.  My dx is DCIS, if there are no bad surprises in my lumpectomy pathology I will stay in the DCIS camp and not need ICS treatment.  There may well be Nashville doctors who could treat me appropriately but I am 2 month into my dx and need to proceed with treatment and move on to the surveillance stage.  At this time it appears my quickest route to appropriate treatment is to go to a center that is up on DCIS and has consolidated care (not see one doc, get scheduled for doc 2 - gather records, start up in other facility, lag time for doc to doc communication....)

Summary question:  How long did it take to get the margin report after your lumpectomy? What facility used? Same questions for final pathology report.

Thanks for your input!

ej01

I had my lumpectomy on wednesday, and the pathology report was sent to my doctor's office on Friday afternoon ... after the office closed so I did not get my call until Monday...argh...

 I am curious what you mean to "treat my for DCIS rather than ICS.".  What are they telling you that makes you think you are being treated as if you have ICS?  I did not read the article you referenced as it is probably too technical for me to comprehend.       I understand your comment about consolidated care.  It seems a little confusing how things get coordinated between radiologist, BS and RO. (and MO if needed).

At one point, I thought of going out of town for my lumpectomy to be part of a particular trial i was interested in.  If going out of town, make sure you understand what will be recommended in terms of follow-up care for the months and years to follow, and that you either plan to travel again for that or are comfortable with somehow getting the followups locally.   

L2012

Thanks ej01, my 'ICS treatment' statement is short for OVERAGGRESSIVE (without reasonable consideration of side effects) as in lumpectomy + rads or mastectomy - then a  SERM or AI for a DCIS < 1cm, Grade 2 ( low on the grade 2 range) located pretty close to my heart.   That treatment is correct for more serious advanced cases but not a tiny DCIS near my heart (I am thin and small breasted too which makes organ damage more likely with radiation). 

For reasons I don't know both BS wanted me to see the same MO who turned out to only treat ICS patients and saw them for the first time after their surgery as a norm.  I haven't had my surgery - neither she nor I could figure out why I had been referred to her.  It was an expensive waste of time and energy.  I am currently not planning on seeing either of those BS again so I may never find out what they were thinking. 

I appreciate your input re followup care. I have decided that if I try to line up too many ducks in a row though I am never going to 'get them all'.  If I was a CA resident, treated in CA then moved to another state I would be able to transfer care.  I will followup where I get my surgery initially - then will work out 'the details' as time goes on.  I know I may end up pulling my hair out on this down the line but I only have so many balls I can juggle at once and if I don't 'pull the trigger' soon on lining up my lumpectomy provider I may just end up saying the hell with it for months - which would be not as good as finding a good treatment center soon and working out the followup logistics 'later'. 

I have found the breast cancer doctors are not as global a community as some medical areas I have been exposed to where recommendations for the next level of care are much easier to come by.  In Nashville I asked 2 BS, 1 MO and 1 RO for a recommendation for an IORT provider and got dead air all 4 times.   There are no IORT options in Nashville, it seemed reasonable that patients may want to know where to go for it if it looked like a good option in their case.   (I know some places that offer it - this is just an example of how it is hard to get referred to care that isn't down the street from the doctors I have spoken to - including my gp and gyn - for the latter 2 it was not expected that they know expert care but asked JIC)

I get copies of all my studies, pathology, mammography, procedure notes, etc.  It is a deal breaker for me that I get copies as soon as they hit my file or I don't use that service provider (doctor).  I get digital studies when possible - I have all my MRI and mammogram studies in digital format (biopsy radiographs as well) etc.    When I consult with a new doctor I assemble and index the information and provide it up front.  No waiting on all the different groups to send in their stuff, no wondering if everything was sent.  I have not been able to get most pathologists to send me their reports directly but I have been successful in getting the offices of the physicians using the pathology service to send me the results as soon as they arrive.  I never wait for my appointment to go over results for me to get the results - it is in my chart to fax me results as soon as they are in (most places won't email but will fax).  I need to read results ahead of time to know what questions to ask - in some cases I need the time to emotionally process what I am dealing with rather than get it and deal with it right on the spot. Before I schedule a procedure I verify that they will send me the results as soon as they get them, when I show up for the procedure before submitting to it I go through that song and dance again and I find out when the results should be sent, who to call to check with if they aren't in when I expected - I get the name of who is giving me the information - who to call - their number etc.  If I don't get the information when expected I start calling.  We all have a right to this information and if the providers aren't willing to give it to me I pick other providers.  Another reason I am planning to shift out of some Nashville providers at this time - some have made this process much harder than need be and run me around for results. As if there isn't enough stress built into dealing with DCIS already....

At this point I have had 3 pathology reports of my biopsy and 2 of my MRI and 2 of the diagnostic mammogram.  The reports did not disagree but there was significantly more detail in some.    I have more respect for the opinions of those who were willing to put their name next to details rather than the really minimal information on some reports.  Some of the folks interpreting my studies were really ‘phoning it in'.  They didn't say anything wrong - they also didn't say much.

The article I referenced was just 'proof' that it makes sense to know the orientation of the lumpectomy specimen with respect to how it sat in the breast before removal - so that if a margin was not big enough in spot X on the specimen - the surgeons would know where spot X came from in the breast when going back in to get a clear margin.  This seems kind of obvious but it appears that unless there 'is a study' that says something that is really quite obvious then doctors can't use the common sense information.  Why anyone would not store the geographic information for a lumpectomy specimen should be the question - but at this time I do not believe it is common practice to do so.

Weds to Friday seems reasonable for pathology reports - actually fast - do you know if the pathology lab was within the hospital you used or if it was sent out - and if it was sent out was it a long way or within the same city?

Thanks for the info and suggestions!

[Update 2-12-05-22   It took 1 week to get the pathology report from the 'local' pathologist for my lumpectomy.  They did the geographic mapping of the specimen so that any non clear margins could be mapped to where they had orginiated from within my breast (so only non clear areas would need any possible future reexcision).  It is a labor intensive process so a week seemed quite reasonable.]