Path Lab report 0 (zero) cancer

JWe

UK based. I had lumpectomy using wire-guided wide excision & node biopsy. The 4.7mm lump was star shaped, visible on mammograms. The Pathology report following surgery stated no cancer cells at all found.

Before the operation, my diagnosis from 2x samplings of the lump was Invasive Ductal Carcinoma, stage 2.

I am finding it very hard to believe they got either the right lump site (my surgery cut is on the outer aeriola which surprised me, as different to pre-op discussions with consultant, who is different person to the surgeon) or the report is correct.

I had only 6x weeks of Letrozole pre op, which the surgeon is saying that's why all the cancer cells have gone. Really? Anyone know if this is possible?

Beesie

4.7mm is very small - less than a quarter of a inch.

Do you have a copy of the biopsy pathology report? The report should indicate the exact amount of cancer that was removed during the biopsy. Since you had 2 cores taken, you may have to add to get to the total, or it might be summed up for you in the report write-up.

In the surgical pathology, were there any abnormal cells at all? Cancerous masses often are a combination of cancer cells plus other high risk or fibrocystic conditions. The size on imaging doesn't always reflect a mass that is 100% cancer cells, so that's another possibility.

Do you know if a clip was placed at the location of the biopsy during the biopsy? That would be normal procedure. If so, the question would be whether the clip was found and removed during the surgery.

Lastly, if you remain uncomfortable, I would suggest that as soon as feasible (given that you just had surgery on the breast), you have a mammogram to see if the area of concern is still there.

Side note: Stage cannot be determined from a biopsy so I'm guessing that what your biopsy found was IDC, grade 2.

Let us know what you find as you dig into this more.

JWe

Yes it was very small. It was a star-shaped small lump found on a regular mammogram. It could not be found by examination nor ultrasound. It was on an MRI though.

A clip was placed, but not near the areola where the surgical incision is. It was higher in the breast, maybe they move.

I have a copy of the surgical path report as I have asked for that (we don't get reports unless we request them).
Pathology shows no cancer at all; zero in all slices quote: 'full regression'.

I will ask for the biopsy path report and hopefully will get that in a week or so. That is a great idea, thank you for your helpful reply.

I will ask for a mammogram when things settle down pain-wise. If they refuse, I will look at paying private for one if that is possible. I only have 'stage 2' in a pre-op letter from the Consultant, (not the one who did the surgery) no grade is mentioned in any letter or report.

Many thanks and hopefully I will find out more soon as I speak to the Consultant on 31st.

Beesie

Making the surgical cut near the areola is a common surgical technique that minimizes the appearance of scarring - having the incision there doesn't mean that the tissue was removed from exactly that location. The incision is just the route into the breast. When you had the wire placement, was the wire put in where you believe that the cancer was? The surgeon would have entered the breast through the incision and removed the tissue where the wire was located.

Does the surgical pathology note whether the clip was removed? If not, then the question will be whether the clip shows up when you have another mammogram.

With very small tumors, it certainly can happen that the entire tumor is removed during the biopsy.

Having "stage 2" noted in your pre-op letter makes no sense. Staging is based on the final size of the tumor based on tissue removed during all biopsies and surgeries, plus the nodal status. So staging can't be done from a biopsy alone. In any case, a 4.7mm tumor would not be stage 2.

I hope you get the answers you need when you speak to the consultant on the 31st.