Borderline

BB3312

If someone is on the borderline of ADH and low grade DCIS, as I am, do most larger hospitals treat it as ADH (monitoring, possible hormones) or as DCIS (lumpectomy,more diligent monitoring, radiation, hormones)?

The ambiguity makes it hard to know what to do and my drs seem to have differing opinions. Anyone else been in this situation ? Thank you!

MelissaDallas

I’d send my slides for a second opinion on the pathology, but if, the current diagnosis is low grade DCIS AND aDHI would imagine you would be treated as having DCIS.

momoschki

I was in this situation (I think I responded to you on another thread?). Large teaching hospital in NYC. I got 3 opinions on my slides: DCIS, borderline ADH/DCIS, and pure ADH. Because there was such a small amount (all removed by needle biopsy), all agreed no rads were necessary, so the diagnostic distinction didn’t matter so much since the treatment would have been the same. Had the excisional biopsy and nothing else was found. I do take Evista and am monitored every 6 months.

BB3312

Thank you so much for reminding me! I guess I’m worried about being “undertreated” and the fact that my drs have differing opinions. So glad you are doing well!

cattledoglv

I have a similar dx as you, except I had it in both breasts. Mine were both 2mm in size, so right at the cutoff. I found a link for you explaining ADH and how pathologists grade it. Surprisingly, some ADH lesions have hormone receptors just like DCIS. Even among experienced pathologists, ADH is a difficult DX. You may have to seek out more than two opinions to get two surgeons to agree on a therapy. For now, I am on a high risk watch and wait and “scanxiety” every six months. It sucks for sure! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314427/

BB3312

Thank you. I am grateful to have this low of a stage, if technically a stage at all, but it is really hard to know how to treat it.

@momoschki Did you have the Prelude Dcis test for radiation Or the oncotype Dcis to make sure nothing more was needed ?

Since I had one path slide called Dcis by my local pathologist but called Borderline in a second opinion (ADH and Low DCIS), and the lumpectomy yielded only benign tissue, it is a hard call to know how/if to treat.

momoschki

I did not have the Prelude DCIS test- in fact, I have not heard of this. Is it new? My dx was over 8 years ago. Didn’t have the oncotype either, since the hospital where I’ve been treated did not consider it DCIS. Neither my breast surgeon, who’s followed me from the beginning, nor the 2 oncologists I consulted with recommended radiation. The consensus was that the focus was too small.

I know it’s disturbing not to have a conclusive dx, but in the end, all of the doctors I spoke with insisted that it didn’t really make a difference what we called it, since the treatment and prognosis would be the sane