dcis pathology report please help

MyLoveO

I had a lumpectomy in september and I received the following pathology report:

It was taken out a piece of 8/6/2 cm corresponding with the area with suspicious microcalcifications seen on the mamogram. In the surgery sepecinem the pathologist found a 7/8 mm lump (not detected on mamogram, us or mri) located at 9 mm from the nearest resection margin. This lump contain a 1,5 mm portion of high grade dcis with the nearest resection margin at 1mm. The oncologist told me I should do another lumpectomy because the 1mm margin is to close, but I do not understand why because the the lump wich contain the dcis is at 9 mm from the resection margin. It could be a spelling mistake in the path report, maybe? I'm so confused and scared.... Er is 15%, Pr 0% and Her2 +++. The sentinel node was clear, node negative.

I would appreciate any advice or support.

MyLoveO

I don't know what to do next because I'm not sure that I should do the reexcision.

Annette47

There is more than one margin - the area removed is 3-dimensional with several sides, a top and a bottom, so it sounds like on one side the margin was too small, but on the others it was 9mm. I personally didn’t have any need to go back in and get wider margins but many women here do and most say it is a very minor procedure - hopefully someone with personal experience will comment. One option for you would be to get a second opinion to see if they also agree it is necessary.

Georgia1

Just chiming in to agree with Annette. The three-dimensional nature of the removed sample makes it hard for someone who is not good at math (like me!) to read these reports. But -- what is a "clean margin" is under debate; some surgeons want 2 mm or more and some think 1 mm is fine. I'd try to get a second opinion if you can, either from a surgeon or go ahead and schedule an initial consult with a radiation oncologist now. Best of luck and let us know.

Moderators

MyLoveO,

First, welcome to Breastcancer.org; we're so sorry you find yourself here, but really glad you found us. You're sure to find a wonderful support system here, along with some really helpful information.

You may want to check out the main Breastcancer.org site's page on Surgical Margins for some good information on the definition of a "clean margin."

We hope this helps and we look forward to hearing more from you soon as you navigate your diagnosis and treatment!

--The Mods

LAstar

I had a second lumpectomy after my first contained involved margins. In the second LX, a larger area was taken based on the results of an MRI. One of the margins that had been clear in the 1st LX was involved in the 2nd LX. Apparently, DCIS is not always consistent throughout the ducts and can have "skips." So a narrow margin may not really be clear, just occurring in a skip with more DCIS behind it. My 2nd LX was very quick and the recovery was easy. I was glad I gave it a try, even when it was unsuccessful.

There is a lot of research on the effect of margin width on recurrence rates. In this study, margins are considered "close" if <=2mm: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC47396... If you are having radiation, there is little difference in recurrence rates for having a close margin vs a wide margin.

This recent article finds no significant difference in recurrence rates regardless of radiation therapy: http://www.ejso.com/article/S0748-7983(17)30637-6/abstract

So you have research that confirms the effectiveness of a 1mm margin. Perhaps the surgeon wants a wider margin because of the additional lump that was found?

MyLoveO

Thank you so much for your responses!

Annette47 and Georgia 1, I know that the area removed is 3 dimensional but first it says that the closest margin is at 9mm. And at the botton of the path report it says that is at 1 mm. I will try to find another surgeon for a second option.

LAstar, thank you for sharing you story. My area of microcalcifications was estimated at 5 cm based on the mamogram and 4 cm based on MRI. I've done a core needle biopsy US guided that revealed grade 2 DCIS. And in the pathology report it says that the DCIS is hight grade(3). The 2 procedures were made in diffrent medical centres.

In the pathology report it says that they also found benign breast conditions: duct ectasia, areas of fibrosis, apocrine metaplasia among with the 1,5mm of DCIS. Maybe these also could lead to microcalcifications and that is the reason that they thought the area of DCIS was larger.

Thank you so much!!!

Hugs and God bless you all