Lumpectomy pathology

Chloe2

Hello, My biopsy pathology stated DCIS high grade however the Dr is suspicious that it may have an invasive component. Has anyone had their lumpectomy pathology report differ from the initial biopsy pathology report? I am anxiously waiting on my report ( lumpectomy was Tuesday).

Thank you in advance

Moderators

Hi Clynn,

It does happen quite often that the biopsy pathology reports and the lumpectomy pathology report differ. Once you have your full path report back, you'll know more and you and your doctors can start a plan for treatment.

You're sure to have some others weigh in soon with their advice and sharing experiences. Please keep us posted with your path results and we'll all be here to help you sort it out.

Sending positive thoughts,

--The Mods

Chloe2

Thank you so much for the reply. Very tough going thru this a second time. Hoping report will be ready tomorrow. Happy to have the support from this community

Rrobin0200

My initial biopsy indicated high grade DCIS with a small microinvasion. However, the path report from my double mastectomy indicated just DCIS. So yes, the two can differ. Wishing you all the best

Beesie

Clynn, in approximately 20% of cases where only DCIS is found through a needle biopsy, the final surgical pathology includes some invasive cancer as well as DCIS. Usually the amount of invasive cancer is small - often just a microinvasion - but in about 5% of cases the diagnosis may change substantially.

Rrobin, was your biopsy 'suspicious' for a microinvasion, or was a microinvasion actually found during the biopsy? If it was suspicious for a microinvasion but no microinvasion was found when you had the MX, that's great news. However if a microinvasion was actually present in your biopsy sample, then this microinvasion should be included as part of your diagnosis. One's final (pathological) diagnosis is based on the findings from all biopsy and surgical procedures. Therefore finding a microinvasion during either a biopsy or surgery will result in a final diagnosis of DCIS-Mi, which is the entry level of Stage I.

In my case, my stereotactic biopsy found only ADH, my excisional (surgical) biopsy found high grade DCIS and a microinvasion of IDC, and my mastectomy uncovered lots more high grade DCIS, but no invasive cancer (including no more microinvasions). My final diagnosis therefore was Stage I DCIS-Mi.

Rrobin0200

no microinvasion was found in the final path report following my mastectomy

Beesie

But was there a microinvasion found during your biopsy?

If you had only one microinvasion, as I did, the fact that it was removed during the biopsy and therefore not left in your breast to be found during your MX doesn't change the fact that it was there and it's part of your diagnosis.

Talk to your surgeon. If there was no microinvasion found in the biopsy, that's great and your diagnosis is pure Stage 0 DCIS. But if that's not the case, it's really important that you have correct information about your diagnosis.

Rrobin0200

ok, thank you for clarifying. Yes, dcis-mi in biopsy. So you're right... the biopsy eradicated the microinvasion bc it was not found in the final path report after my mastectomy. Thank the good lord for you!!!

Chloe2

Thank you everyone for your replies. My report came back the same as the biopsy high-grade DCIS and atypical cells as well. I have issues with two margins. One is very close to the skin, one the chest wall. Dr's are not concerned with the chest wall and if I choose radiation it will take care of any possible specks below the skin.

My radiation oncologist is concerned about my having radiation again due to the many lasting issues I had 4 years ago as well as how I had to stop taking Tomoxifen last time due to the side effects. The concern is a recurrence and I would need radiation in combination with hormone therapy. My understanding is the recurrence rate increases by about 2% every year.

I am meeting with my medical oncologist and surgical oncologist in few days for more conversations. I am having trouble dealing with the very real fact I may need a mastectomy. If that is the course I take I am not sure if I would take the newly diagnosed breast only. Also I am not sure if reconstruction is the right choice for me due to issues with healing, and quite frankly my difficulty wrapping my brain around the slicing of the chest wall muscle.

I have previously met with a plastic surgeon and he and my radiation oncologist are concerned because I have issues with healing in general (possible lupus) let alone implants after radiation issues.

Can anyone share their thoughts and or experiences with bilateral mastectomy without reconstruction? Are there issues with balance? I am about a 34 C/D cup

Also experiences with expander/implants after radiation?

Thank you in advance!