DCIS with Microinvasion

Marinergal

Having right breast lumpectomy next month along with Sentinel Lymph Node Biopsy. I've read a few articles about SLNB that seem to suggest that it may not be necessary in the case of DCIS with microinvasion. Plan to discuss with doctor but would appreciate any feedback from fellow cancer patients. Sorting through all of the info as a non-medical person is challenging.

ajminn3

So, my biopsies of my original tumor all came back as only DCIS. Due to the size, I opted for a BMX and with that they did take a few sentinel nodes. While they couldn’t find anything invasive within my original tumor, there was 1/3 nodes with a macromet of IDC. If they hadn’t take those nodes I would have not found the IDC and moved forward with treatment to *hopefully* kill the cancer and keep away a reoccurrence in the future. I would suggest the SLNB. It will give you more of a greater picture of where the cancer has/has not moved to and what the best treatment plan would be. Just my (non medical) opinion from my experience! Wishing you the best!

AmusingSoprano

I had pure DCIS but my surgeon opted to do SLNB because I was Grade 3 with comedonecrosis. If it was me, and I had microinvasion, I would opt for SLNB, but it's entirely your choice. Talk to your BS about it and see what his reasoning is.

Marinergal

Thank you so much for sharing your experience. Definitely leaning toward SLNB but I am concerned about possible physical side effects. I tend to want to do the minimal treatment. I just know that I will be followed very closely after this diagnosis and feel that if cancer returns it will be caught early. A lot to think about...

Thanks for your support!

Rrobin0200

definitely get the SLNB for peace of mind.

Marinergal

Thanks for your input. I appreciate it.

Ingerp

My BS gave me the option to have a SLNB or not with my DCIS and I opted not to. Ultrasound didn't show any funky lymph nodes and I figured I'd just as not have that area messed with. (I did have a SLNB with the IDC.)

Marinergal

Thank you for sharing. I appreciate your perspective. It sounds like you don't regret not doing the SLNB in 2016 but decided it made sense for you in 2018. My ultrasound also showed nothing in the nodes but I realize different modalities can show different things. My DCIS was visible on MRI but not mammogram or ultrasound. Luckily I had the MRI due to being in a surveillance program. Under surveillance due to high risk.

It's a lot to consider.

kksmom3

My original diagnosis was DCIS, but mine was the worst kind, comedonecrosis, grade 3, although just a small amount, about 6mm. My team suggested that a lumpectomy with sentinel node removal would be the best choice for me. I agreed to that, frankly, it never occurred to me not to. I'm glad I did because it was clean, and pathology revealed 3 mm of IDC along with the DCIS. I. think they would have wanted to go back in and check the node after that if it hadn't been done. It wasn't a big deal. Peace of mind for me anyway.

Marinergal

I really appreciate your story and what you decided. If I understand correctly, the stage is determined by pathogy after my lumpectomy which could play into my post-surgery plan. I assume the pathology report will be the biggest piece of info I will receive as we plan my future medical care? Current plan is radiation no chemo.

In other words, I could go back in for SLNB once pathology report is available if my doctor and I wanted to at that time?

I would love to hear about side effects experienced from community members that underwent SLNB.

kksmom3

Yes, the final on all of it will be the pathology on the tissue removed with the lumpectomy. If they had to go back in, I don't know why they couldn't, if you had a lumpectomy, but that really is a question for your doctor.

Do you have pure DCIS, or did they find invasive? I'll hope it remains DCIS. In my case, my treatment plan never changed. Unfortunately, we just never know what is what till the pathology........but here's hoping you stay at stage 0.

LivinLife

I had Grade 3 DCIS with comedo necrosis and opted for a BMX. My understanding is with mastectomy they generally always do a SNB b/c if they don't they cannot go back and do it once the breast is gone, thus I had one. You're going with lumpectomy so there is a choice there. With micromet I'd likely rest easier with a SNB..... Wishing you the best as you proceed.....

Beesie

Marinegal, with DCIS-Mi, you are Stage I. So this is different from the situation of a several of those who have commented.

I had DCIS-Mi too. I had the SNB. Both prior to my surgery and in the many years since, I've read lots of research about the risk of nodal involvement associated with having a microinvasion. While individual studies vary greatly (0% - 20%), the meta-analyses I've seen put the average rate of nodal involvement at approx. 7.5%.

This chart summarizes many of the studies:

Source: Sentinel lymph node biopsy in microinvasive ductal carcinoma in situ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393177/

And following is a single study, involving an analysis of the SEER database and reflecting the results of 8,863 patients with DCIS-Mi - much larger than any of the other studies or even the meta-analyses. The % of DCIS-Mi patients found to have nodal involvement (not including Isolated Tumor Cells since ITC are considered node-negative) was 7.7%.

Source: The Demographic Features, Clinicopathological Characteristics and Cancer-specific Outcomes for Patients with Microinvasive Breast Cancer: A SEER Database Analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292735/

So with the microinvasion you face a risk of approx. 7.5% that you might have nodal involvement. Certain pathological features of your diagnosis may increase or decrease this risk, but the studies are very inconsistent on which features affect this risk. The question is, are you willing to take the chance of not finding out your nodal status when the risk that you might be node positive is approx. 7.5%?

Marinergal

Wow, this is great info. It supports a little bit of what I've been reading and "calculating". You put it in a nutshell when you ask if the 7.5% risk is worth taking - of course I'm the only one that can make that decision for myself. Thanks for sharing.

schlip

Well, this might be a new one. My biopsy showed intermediate grade DCIS, HR+/PR+. Had the lumpectomy with no SLNB, and final pathology was still intermediate grade DCIS, HR+/PR+, 2mm(yay!), 5mm+ margins(YAY!).

I was pushing for the Prelude DCISionRT test because I wanted to know what my personal recurrence risk was, with the silly hope I could maybe get out of radiation. After 4 weeks of waiting (results are supposed to take 3-5 days) I find out they ended up having to test my original biopsy, and microinvasion was found that hadn't originally been reported. Their guess was that all the tissue with microinvasion was removed during the biopsy, which is why it wasn't found in the final path report.

I guess now I'm retroactively upgraded to "for real cancer." I'm 10 weeks out from surgery so really need to start radiation soon, but now I'm worried that I didn't get a SLNB. I know lymph involvement with DCIS-MI is still fairly low and the MRI didn't show anything funky, but my "it's no big deal!" attitude has faltered a little as I start thinking about that one lone cancer cell drifting off through my body, leading to Stage IV cancer in the future.

I'll see what the surgeon says (Friday of Labor Day weekend is great timing), but I was not prepared for that news after receiving a pretty decent post-lumpectomy pathology report...

Has something like this happened to anyone else?

Additionally, did anyone not have a SLNB with surgery, but then microinvasion was later found in pathology? What happened then?

At this time I'm still not planning on a mastectomy - going with RT and tamoxifen.

Marinergal

I decided against the SLNB but my pathology from my lumpectomy came back showing small amount of invasive cancer. Second surgery is in a few weeks - my doctor calculated current risk of node involvement at 12% (up from 8% pre-lumpectomy). I have decided to do the node biopsy this time for my peace of mind. Definitely a part of me that questions if I should have done the SLNB with first surgery but hindsight is 20/20, right? If my pathology hadn't shown cancer in the margins I would not be thinking about my original decision.

I was surprised to hear my pathology result even though I'd been told that a second surgery is necessary sometimes (20%). Original diagnosis DCIS with microinvasion. Current diagnosis is 1a.

schlip - I relate to the "it's no big deal" attitude...that's been my attitude since my diagnosis. Definitely feeling a bit more anxious but trying to just see it as a bump on the road.

Hope your appointment today gives you a bit more comfort.

schlip

Marinergal, so it sounds like you had to have a second surgery to get clean margins, is that correct? And if they have to go in again, might as well get that SLNB? What a bummer. Sounds like me, wanting to keep treatment minimal. BUT, you also don't want to mess with cancer. Fingers crossed all goes well for you!

My doctor doesn't have an update, so I won't know more until next week. The hospital I'm being treated at requested the biopsy slide (originally taken at a different place), so they will be taking a look at it themselves to see what's up. It will have been reviewed by three different pathologists!

Marinergal

Hi schlip! Haven't been on the forum in a while. Yes you are correct - I did not have clear margins but now I do! Had second surgery including SLNB on 9/23 and started radiation last week...so far so good but a bit lethargic and some general anxiety that seems to pop up unexpectedly...just breathe.

Hope you are well. Where are you at in your journey? Sending nothing but positive energy your way.

schlip

Marinergal, it must be such a relief to have that second surgery out of the way and the all clear with margins. It was quite a roller coaster for me over these past few months (as I'm sure for anyone in our shoes), but here we are! You've wrapped on surgery and are already on to the next step.

After way too long in limbo (about 7 weeks) I got word that there was NOT microinvasion after all. I finished radiation last week and I'm SO GLAD to be done. I'm a few weeks late in replying, so you're probably close to being done by now, too. Hope the fatigue and lethargy wasn't too bad.

Now I'm just dragging my feet on following up about endocrine therapy. But, hey, the sooner I start, the sooner I'll be done.

I can finally start to imagine that this chapter could be closed, and this will all soon be a distant memory. Hope the rest of your journey with this is uneventful!

wondering44

@Marinergal,

My BS, PS, and MO recommended the SNLB during surgery. I did not want nodes removed for fear of Lymphedema. I did go ahead with it, and the BS removed three nodes in all. All three came back clean on the path report. I do not have Lymphedema, and my arm has a full range of motion without PT. The recovery from the node removal was the worst part for me other than the drain. It hurt a lot! However, I am grateful for the peace of mind from the clean path for the nodes.

Weigh the pros and cons on your list for both choices. Whichever option you choose should be the right one for you.

Wishing you best in your surgery!