Recently diagnosed with DCIS, undecisive on the surgery option

paradise123

Hi, I've just been diagnosed with DCIS, intermediate grade with focal comedonecrosis during a recent mammogram-guided biopsy on my right breast (due to suspicious cluster of microcalcification). My breast surgeon has asked me to go for MRI as I have dense breast and she wanted to check if there's any residual from biopsy. MRI finding could not detect the biopsy site but there's a new lesion which was not picked up by ultrasound or mammogram. My breast surgeon offered me 2 options - 1) do a MRI guided biopsy before lumpectomy to determine if the new lesion is cancerous. 2) pre-op WRI wire localization biopsy during the lumpectomy. the pathologist will test on the spot (i think 95% accuracy). If cancerous, the surgeon will perform a second lumpectomy during the surgery. Oncoplastic reconstruction will be done at the same time if the distortion on the remaining tissue is obvious.

My thinking is that it makes more sense to do the biopsy before surgery as the outcome will determine if i want a lumpectomy or MX. My original DCIS is just beneath the nipple and no marker was placed during first biopsy, so not sure if clear margin can be obtained during lumpectomy. I'm in a dilemma now as i also want peace of mind going forward, with less surgery, less surveillance. I'm even prepared to go flat unilaterally but need to overcome the psychological impact and accept the longer recovery period associated with MX.

I'm wondering if anyone has similar experience struggling deciding between lumpectomy and MX and with MRI findings not correlating with other imaging results. Thanks for sharing your experience.

Beesie

Hi paradise123, welcome!

Quite a few people have found themselves in a similar situation to you. My case wasn't quite the same, but I did have some similar issues. My diagnosis came after an excisional (surgical) biopsy, which was scheduled after my stereotactic core needle biopsy found ADH (a high risk condition) in one area of suspicion and the needle was not able to retrieve a good sample in the other area. The excisional biopsy found high grade DCIS in both areas, a tiny microinvasion of IDC in one spot, and I didn't have clear surgical margins anywhere. So another surgery was necessary to clean up the margins. A MX was recommended, but I would have preferred to have a lumpectomy. At that point I went for a second opinion. This led to an MRI and to a biopsy of my other breast because of something seen there. That biopsy turned out to be benign, but the MRI had found that my breast with the DCIS was full of "stuff". As the surgeon said, that "stuff" (that was the word he used) might be more DCIS, or it could be a benign condition. However with the MRI looking like that, it was enough to convince me to the MX. Because of the clear biopsy on the other side, I decided on a single mastectomy. As it turned out, the "stuff" was a lot more DCIS, so the MX was the right decision - there was no way that a re-excision lumpectomy would have been able to get clear margins.

Until others respond, take a read in the following thread; although not everyone responding had DCIS, it's in the DCIS Forum so most of the people posting did have a DCIS diagnosis. Reading why others have decided on a MX or a lumpectomy might help you sort out what's best for you. I do think that having the biopsy first, as you are leaning, certainly makes sense, in that it will give you and your surgeon more information prior to surgery, making it less likely that you will require a second surgery.

Topic: lumpectomy vs mastectomy - why did you choose your route?

Good luck with your decision. Ask away if you have other questions and let us know what you decide.

prepmom

Hi Paradise,

Sorry that you find yourself here, but this forum is unbelievably helpful, with such a generous & knowledgeable group of women.

I agree with your instincts and Bessie's thinking regarding having the biopsy pre-surgery. I think that the more you & your surgeons know going into surgery, the better all can be prepared. I wouldn't want any decisions made for me while on the operating table that could have been avoided with more information beforehand.

That said, I was diagnosed with a small area of intermediate grade DCIS on my left side. My surgeon ordered an MRI which showed an additional area of concern on my left, as well as one on my right. I had biopsies on both sides - the right was benign, but the left was LCIS along with a large area of ADH. Like you, prior to the 2nd biopsies I was having a difficult time deciding between lumpectomy and MX. But the finding of LCIS (which increases risk on both sides) and my strong family history (mother) made my decision much easier and I had a BMX. Going into the surgery and knowing for sure that I was doing the right thing for me, with all the information in front of me, gave me peace of mind that I wouldn't have had otherwise.

Sending you good wishes for the best possible outcome.

LivinLife

Welcome paradise123! I was diagnosed with Grade 3 DCIS with expansive comedo necrosis. I went through the regular 3D mammo, diagnostic mammo, stereotactic biopsy which diagnosed this initially. The MRI showed larger area. Another biopsy was recommended. Had I planned to undergo lumpectomy I would have had the additional biopsy. As it's been said it could change the surgery you are thinking about. I had already decided on BMX for various reasons so the biopsy was really not necessary and I did not undergo it....