DCIS/Grade 3 in multiple sites of Left breast

CindyS2

Hello all

My problems started over 18 months ago with a bloody nipple discharge, after MRI, Ultrasound and 3D mammogram, I was told no problems we could follow in 6 months. Went for 2 nd opinion and waited another 6 months, when discharge didn't resolve had the duct removed. Showed atypical cells in both ducts and tissue. Waited another 6 months had another clear MRI,3D MAMMO, and Sonogram in 6/2017, With my fear and anxiety I chose BMX. A week later DCIS Grade 3 with 3 different areas of left breast involved. Problem was less than 1 mm margins and nodes were not biopsied. Should I request a biopsy of sentinel nodes, I feel like I am left not knowing. And do you think they missed it somehow on radiology or has someone not had it show up before. Worried and thinking of getting a second opinion. So many unanswered questions.

CindyS2

Annette47

Do you mean you already had the BMX? If so, it’s impossible to now do a sentinel node biopsy as there is no longer any way to identify the sentinel nodes. If pathology showed pure DCIS though, even if it was grade 3, there is really no reason to need to check the nodes, as pure DCIS by definition cannot escape the breast. A SNB is usually done in the case where either there is known invasive cancer, or where it is suspected, because as I said, once the breasts are done it is no longer an option, so they do it just in case invasive cancer is found. In your case, if none was found, you don’t need to worry about the lymph nodes, even though they weren’t checked as the odds of any invasive cancer having developed and spread to the lymph nodes without being seen on pathology is, while not zero, pretty darn close.

The concern with the small margins is that if there were any DCIS cells left on the edges, you could face a recurrence down the road. It might be worth asking a radiation oncologist for a consult, to see if they would suggest doing radiation. Usually radiation after a mastectomy for DCIS is not recommended, but inadequate margins can sometimes be a factor that would cause it to be recommended.

It must be very scary that none of the imaging found your cancer, but if you did have a BMX, and all of the pathology returned as DCIS, then your risk of dealing with this again really is very, very small.

MTwoman

Annette has given you good advice. A RO consult would be a good next step, given your margins. A SNB isn't possible, and not really warranted if there are no areas of micro-invasion. There is a really great thread on DCIS here: https://community.breastcancer.org/forum/68/topics/790992?page=1 that can give you quite good info. Good luck!

CindyS2

Thank you both for your response. I am having second thoughts about node biopsy as I agree hard to map nodes when both breasts have been removed. My oncologist discussed injecting dye and attempting to map to make sure my nodes were clear to help reassure me. I guess with everything that was missed I have no faith in Radiology and afraid to not explore all areas. I also did speak with Radiation oncologist who offered radiation but she felt like it may impose more risk from side effects later. She said they calculated my margins were better than less than 1mm after they factored in the basement membrane behind the breast tissue that was removed. My BMX was 8/2017. I had a grandmother pass away at 42, so I get really paranoid and have had multiple issues with my left breast. I am still in the expander phase. Not exactly the most comfortable phase, I sleep on my side or stomach so sleeping on my back is challenging. I also worry about the implants, not sure which to choose, do any of them really look natural. Then I remind myself I am alive and lucky that I am not facing tougher decisions. So any advice is appreciated and I am grateful for having someone to talk too. I keep most of this to myself so it is nice to have this blog. Thank you again for your response.

Cindy