Anyone good at interpreting biopsy results?

eviec1

I just got diagnosed yesterday with IDC (and DCIS). The nurse read me the bottom line over the phone, and now I have just received the more detailed written results. This is a word salad to me - I have no idea what most of this means. Can anyone break this down into plain English before my head explodes? What is the good and bad of this?

SPECIMEN: A. Right Breast Core Biopsy with Calcs, 10:30 N+8 B. Right

Breast Core Biopsy without Calcs, 10:30 N+8

CLINICAL DIAGNOSIS AND HISTORY:

Breast calcifications; tomo guided breast biopsy.

DIAGNOSIS:

A. Right breast 10:30 N+ 8, with calcifications, tomosynthesis guided

core biopsy:

Invasive Ductal carcinoma with associated calcifications

In situ ductal carcinoma with associated calcifications

B. Right breast 10:30 N+ 8, without calcifications, tomosynthesis

guided core biopsy:

In situ ductal carcinoma with associated calcifications

COMMENT:

Small nests of non-tubule forming invasive ductal carcinoma are

associated with desmoplastic stroma and calcifications. Cribriform in

situ ductal carcinoma with focal micropapillary growth is also present,

and also associated with microcalcifications. The histologic features

are summarized below.

Breast carcinoma summary - Core biopsy

Site. Right 10:30 N +8

Specimen Type. Core biopsy

Invasive Carcinoma Type. Ductal

Size. 4 mm in core. Final deferred to excisional

specimen

Nuclear grade. 1-2

Histologic grade. Defer to excisional specimen. Best

estimated as I

Calcification. Present

Lymph-vascular invasion. Not identified

In Situ Carcinoma. Ductal

DCIS type. Cribriform, focal micropapillary

Size. 3 mm in cores

Nuclear grade. Intermediate to high

Necrosis. Absent

Calcification. Present

ERA (IPOX). Addendum to follow

PRA (IPOX). Addendum to follow

HER-2/neu (Dual ISH and IHC). Addendum to follow

Ischemic time. Less than one hour

Fixation time. 6-72 hours

GROSS DESCRIPTION:

A - Received in formalin labeled as "right breast 10:30 N +8 with

calcifications; in formalin 1450" are numerous similar fibrofatty cores

aggregating to 1.7 x 1.5 x 0.5 cm. The specimen is submitted entirely

in A1.

B - Received in formalin labeled as "right breast 10:30 N +8 without

calcifications; in formalin 1450" is an aggregate of fibrofatty cores, 2

x 1.5 x 0.5 cm. The specimen is submitted entirely in B1.

CP 5/11/2021 05:46 PM

REVIEW OF RADIOGRAPH: Two specimen radiographs accompany the specimen,

showing areas of opacifications on each radiograph that have been

circled by the radiologist.

ADDENDUM:

ADDENDUM REPORT ON ESTROGEN AND PROGESTERONE IMMUNOPEROXIDASE ASSAY

Using paraffin block material and controls, which worked appropriately,

immunoperoxidase staining has been utilized to assay the patient's tumor

for the presence of estrogen and progesterone receptors. The findings

are:

Estrogen Receptor: 3+ in 100%

Progesterone Receptor: 3+ in 100%

The prognostic/predictive markers Estrogen [clone SP1], Progesterone

[clone 1E2], were performed using the Ventana iView™ DAB detection kit

on the VMS Benchmark XT(c) automated immunostainer. The testing was

performed on formalin-fixed paraffin-embedded tissue sections.

The criteria for reporting positive/negative results and scoring on

Estrogen and Progesterone receptors are based on a formula which

integrates quantitative and qualitative staining characteristics into a

single numerical value which varies between 0 and 3.

Beesie

It sounds like some info is being deferred until they have the surgical sample, but here is what you know so far:

IDC:

- 4mm in cores i.e. this is the amount found in the biopsy tissue retreived; it is not the estimated size of the IDC in your breast.

- nuclear grade 1-2, but no histologic grade; nuclear grade is just one of 3 components of histologic grade.

- ER and PR both 100% 3+, which means all sampled cancer cells have ER and PR receptors and your cancer is very strongly ER and PR positive (3+)

- No lymphovascular invasion seen (this is good).

DCIS:

- 3mm in cores, as above, this is the amount found in biopsy tissue retrieved, not necessarily the estimated amount of DCIS in your breast.

- Nuclear grade intermediate to high, i.e. grade 2-3.

- No necrosis identified (this is good).

So what you know if that you have a highly ER+ / PR+ invasive cancer, which means that you will definitely be prescribed endocrine (anti-hormone) therapy and it should be effective. This also means that it is less likely that chemo will be required, although this would likely change if the cancer is HER2+. Nuclear grade, while only one element of the final grade, is 1-2, which means the cells look moderately like normal cells (nuclear grade 3 cells look very different).

What you don't know is the size of the cancer - the imaging you've had would provide an estimate, but it since you have a mix of IDC and DCIS (which is very common), it's probably difficult to estimate how much is IDC and how much is DCIS. Only the size of the invasive component counts towards staging and treatment decisions. You also don't know the histologic grade. And you don't know the HER2 status, although based on the comment in the report (HER-2/neu (Dual ISH and IHC). Addendum to follow) this will be coming shortly.

There's other stuff (the sub-type if the DCIS, for example) that doesn't mean much.

Hope that helps.

moth

The important bit from a treatment standpoint is that it is Invasive Ductal Carcinoma (IDC). That's the bad bit.

You also have DCIS which might affect surgical options because the more extensive it is, the more they have to remove .

It's ER+ and PR+ - that's a postive thing. Opens up hormone treatment options. You're likely still waiting for the HER2 test - it usually takes longer.

They're saying the sample IDC is 4mm but final size will be determined post surgery. They're also not giving a firm grade - looks like 1-2 but again they want to look at the full sample after surgery. That's normal as these little core samples are just a small bit to look at and final grading & staging is done after surgical excision. Did your imaging give estimates of the mass size?

Does that help a bit?

eviec1

Thank you so much, Beesie! The nurse had indicated that the idc was 4 mm, and while I understood that this could change with surgical results, I didn't realize that it was essentially a meaningless number - I was really hoping it meant that it was super small still.

Based on this report, would it be at all possible to believe that the stage will be found to be early? Is there anything in here that I should be worried about in terms of a larger/more advanced cancer than I am currently expecting? I just don't want to be blindsided (which I know, in some cases, is impossible to avoid because that's the nature of this beast). I just want to be as mentally prepared as possible.

eviec1

Thank you, moth, that does help! I am so glad to have found this community. I can't imagine trying to sort through all this on my own.

Edited: I missed your last question. I don't know the size from imaging, but the radiologist (who believed it would all be found to be DCIS, not IDC) said it would be a lumpectomy rather than a mx based on its size, so I'm hoping that still means it's small-ish? But I don't really know.

Salamandra

Everything so far is consistent with very early stage cancer.

That doesn't mean there couldn't be surprises later on.

But sometimes it really is what it appears. My surgical oncologist said she expected my tumor size to be under 2cm, my lymph nodes to be clear, and that I would not need chemo. Yay! She still did a sentinel node biopsy and oncotype test just in case. Scary! But it turned out she was right and I have a pretty low risk profile cancer. Yay! But that doesn't mean I won't some day fall on the wrong side of statistics and have a metastatic recurrence. Scary! And that's life...

I don't know how helpful that is. Not much to say really beyond hang in there, things do get easier as you move forward and get more info, and no way out but through.

eviec1

Thanks, Salamandra - I hope my experience will be similar to yours, because the seems like the best possible outcome at this point. Obviously no guarantees, but still hope. I guess I will know more on Wednesday when I meet with the surgeon.

(I was originally supposed to meet with the whole team - surgeon, MO, RO - but there was no availability for a team appointment until the 26th, so the nurse navigator asked the surgeon if she would like to go ahead and meet without waiting for the MO and RO to get things moving faster and she agreed. I was happy for that because I don't want to wait, but I'm also trying hard not to read anything into it - like, why does she not want to wait a week, is this really bad so we have to move fast? Ugh. Hopefully, she was just being courteous and not super concerned about things.)

Janet_111

I am sorry eviec1 . I hope your treatment will be successful. Best wishes.

Salamandra

I agree that it doesn't pay to read into things, but fwiw, I think it's likelier to be a good sign than a bad sign.

Fast growing tumors that have more urgency tend to need chemo and would be sent directly to a medical oncologist. If they think there's a good chance you won't need chemo, they'll send you to a surgeon first, usually with the procedure of surgery first to get it out and make sure. Many of us don't meet a medical oncologist until after our surgery.

I think if you had a more complex or less clear issue or more urgent issue, it's less likely they would plan to have you go first to the surgical oncologist alone.

(Generally even for more urgent cases, a week will make 0.00% difference, so I am guessing they are being courteous and aware of how very very long a week can feel to the patient emotionally. If so, that's an excellent sign of a caring treatment center also).

eviec1

Thanks, Janet_111. Have you done your biopsy yet? Any news for you? (Fingers crossed that it's good)

Thank you, Salamandra - these are the things I keep trying to tell myself, but sometimes those bad thoughts still sneak through.

Janet_111

just had it today.

Thanks eviec

eviec1

Good luck for good results!