Splitting hairs over margins. HELP!!!!!!!!

Kar324

So, had my post-op appointment @ UPENN on Monday, 2/15/16. The pathology report indicates that all the disease was taken out and that it was all DCIS, low-intermediate grade. One area showed a focal comedo necrosis. My surgeon was pleased with the report, however she states that one margin was " close" 1 mm. She stated herself she was " on the fence" about re-excision but also stated that the guidelines should be 2mms with DCIS. The amount of breast tissue taken was 5 cms x 2.5 cms and the amount of DCIS was 0.2 cms and 0.8 cms, to total 1 cm of disease.( I had a partial mastectomy due to multi-focal disease in the same quadrant.) It seems that most was removed during stereotactic bx, bc, mammogram showed possibly 4 cms of involvement. Anyway, bc this margin was "close" but technically, negative, it was MY decision to proceed with RT or to re-excise. I'm so torn on what to do, I still have limited ROM on the left side and have been out of work. I still feel as though I'm recovering from surgery, which was on 2/3/16. I'm just exhausted, confused, and really just over all of this. I want to get on with my life. I'm already bracing myself for RT and am just starting to feel a little stronger, albeit, my left arm has some issues with ROM and have some pain in my chest, due to the surgeon being " aggressive". Does anyone know the ASTRO thresholds for beginning RT? Should I do a re-excision? I've researched everything I can, including the VNPI. Any and all feedback welcomed. Going on record to state, I despise this disease. Thank you all in advance..just when you thought it was safe to breathe...

Edited by Mods to clean up unneeded text

ml143333

Kar34 - I am so sorry you are going through all of this.

If it were me, I would go back and get clear margins. For me, then I would be able to tell myself that I did everything I could if this horrible insidious disease were to ever come back.

Kar324

Ty for your response. The pathology report stated all margins negative. Not " close", not positive. I'm baffled.

Jelson

it sounds like you would like to avoid more surgery. there is some relatively new standards for margins - check here on bco - http://www.breastcancer.org/research-news/20140402 use the search function for the main site and you will find even more info. I myself had a 1.5mm margin on the anterior - which I believe was the skin side and went with radiation and boosts rather than a resection which would have taken half my aereola. I was told at the time that 2mm was the standard - but that was in 2009. there is also an oncotype test used in dcis that you might want to talk to your doctor about. Here is info also from bco - http://www.breastcancer.org/search?utf8=✓&term=dcis+oncotype+test&commit=Search

LAstar

I would re-excise. I had a second lumpectomy due to involved margins and it was a much easier recovery than the original LX. Also, a margin that had been deemed clear in the first LX actually had more DCIS behind it. It seems that DCIS isn't necessarily continuous throughout the ducts. I found some research when I was diagnosed showing a very clear association between margin width and recurrence rates, and some doctors advocate for margins of 1 cm to be sure that the DCIS is completely removed. The re-excision will be quick! I was up cleaning my kitchen one-handed after mine. Best wishes on all these awful choices.