Lumpectomy apparently missed the site. How common is this?

lookingforinfo

So glad to have found this website.  Lots of very useful information and support.  I had a lumpectomy for high grade DCIS on 12/27 following mammograms, core needle biopsy, and MRI. I learned after the fact that the radiologist doing the needle loc prior to surgery had difficulty positioning the guidewire because of (1) location of the DCIS near the chest wall, and (2) suspicion of "biopsy clip migration".   This was not communicated to my BS until DURING surgery when he saw that the guidewire wasn't in the same place as the clip.  Now,  path results state that the biopsy cavity was not found and there is no indication of DCIS.   I've had an ultrasound a few days ago with my biopsy radiologist, who also found neither the biopsy cavity nor calcifications.  Have an appointment in March for mammogram when I'm able to tolerate it.  (I'm in a heck of a lot more pain than the brief "discomfort" that was predicted.)  I've also requested the pathology examination be redone.

This is apparently a fairly rare occurrence.  I would be very interested to hear from anyone who had something similar happen. 

Cathy

ballet12

The surgeon and the radiologist discovered that my clip had migrated before my first lumpectomy, but that's because they took a mammogram before placing the wire.  Both the radiologist and the surgeon worked together to review the mammo films (old and new) and the location of the calcs, which were still visible on the more recent mammo.  They have ways to spatially locate the calcs besides the markers.  They found the exact location of the calcs and placed the wire there. I wish they had done that with you.

I wonder why you had an ultrasound after the surgery rather than mammography, if the calcs were found by mammo, although I guess it was because you are still experiencing a lot of discomfort.  If the calcs didn't show on ultrasound before the surgery, it's not likely that they will show again using that form of imaging.  I also hope that the surgeon marked the pathology margins on the slides, so they know to go elsewhere if they need to do another lumpectomy. I recommend a second opinion from a cancer center with another surgeon (where the team can look at all of your data--surgeon, radiologist, pathologist).  It seems that your "team" didn't work together. How large was the estimated amount of DCIS?  There is a small chance that it was all taken out with the stereotactic core biopsy, if it was a small area.  A number of people have had that experience. The only thing my first surgeon did wrong, was that he didn't "mark" the margins of the pathology, so that when I did go to a second surgeon for what turned out to be two re-excisions for dirty margins, the surgeon had to go in there and try to look for where the surgery took place (I guess that would be the cavity you were describing).  She did pretty well, but there was still one very close margin after surgery number two, requiring a third surgery.

Best of luck to you.

lookingforinfo

I had the ultrasound because that's all I can tolerate right now.  There was an off-chance something might be seen to give us more info.  More in-depth mammo is scheduled for March.  I don't know about marking of margins, but that's a great question for my surgeon.  The area of DCIS was thought to be 8 mm, so very small.  Yes, better communication for the team will be high on the priority list if I have to go through second surgery.  Will cross fingers that biopsy did the trick.  Thanks for your helpful reply, Ballet.

ballet12

Hope it was helpful.  Keep us apprised of what comes of this.  At least your biopsy radiologist is following through with this, and you can stick with the same one.  I'm always dealing with large institutions, where the you can't always get the same radiologist twice.

I'm hoping, in your case, that they got everything with the biopsy and/or that they can find what they need to on repeat mammo.

kb70

Had a lumpectomy on 12.20.13 for intraductal carcinoma stage 0. The pathologist's report states that the edges were clean but the marker wasnt in the tisssue removed and the surgeon told me immediately after the surgery that it may have moved or gotten sucked in... will get a mamo in a couple of months but they assured me that abnormal cells were removed at the biopsy due to small size of calcifications. Gotta wait patienly. Currently going through emotional crisis and researching to determine whether to take Tamoxifen or not. I prefer not to. I'm almost 44 and would hate to deal with side effects. Luckily I dont need radiation therapy. Planning on having a reduction in the immediate future, probably after my next mamo. Best luck lookingforinfo

lookingforinfo

Sounds like we're in somewhat the same boat. Best of luck to you, too, kb70. Will check back in when I know more.  Hope your research can help calm the emotional waters.