Pathology Received-Need Help Understanding

poppy2022

Hi Everyone,

Just received my pathology on MyChart. Can’t talk to the surgeon and need help understanding the size of the invasive component? I’m confused on whether it is 28 mm plus DCIS or 20mm of DCIS and 8mm of invasive?

Your ValueThe localization lumpectomy specimen in part E has been submitted in its entirety for histologic examination. Sections show a 28 mm focus of grade 1 invasive carcinoma with extensive ductal carcinoma in situ (DCIS). DCIS is present in slices 2-6 and in 10 of 25 total blocks. DCIS occupies approximately 20 mm (70%) of the 28 mm mass. A separate second focus of grade 1 invasive carcinoma is identified in slice 10 (block E24), measuring 0.5 mm in maximum dimension. This second focus is located in the anteroinferior aspect of the lumpectomy, at least 8 mm from larger 28 mm mass. No DCIS is identified in the second focus. The intervening breast parenchyma between the larger and smaller tumour foci consists of benign breast tissue. As listed in the synoptic report, all resection margins are negative for invasive carcinoma and DCIS. Invasive carcinoma in the 28 mm mass is present 0.1 mm from the posterior margin at its closest point. Invasive carcinoma is present 0.1 mm from the anterior margin in the second focus at its closest point.
SYNOPTIC REPORT	Your ValueINVASIVE CARCINOMA OF THE BREAST: Resection INVASIVE CARCINOMA OF THE BREAST: COMPLETE EXCISION - All Specimens 8th Edition - Protocol posted: 17/12/2021 SPECIMEN Procedure: Excision (less than total mastectomy) Specimen Laterality: Right TUMOR Tumor Site: Not specified Histologic Type: Invasive carcinoma of no special type (ductal) Histologic Grade (Nottingham Histologic Score): Glandular (Acinar) / Tubular Differentiation: Score 1 Nuclear Pleomorphism: Score 2 Mitotic Rate: Score 1 Overall Grade: Grade 1 (scores of 3, 4 or 5) Tumor Size: Greatest dimension of largest invasive focus (Millimeters): 28 mm Tumor Focality: Multiple foci of invasive carcinoma Number of Foci: 2 Sizes of Individual Foci (Millimeters): 28, 0.5 mm Ductal Carcinoma In Situ (DCIS): Present : Positive for extensive intraductal component (EIC) Size (Extent) of DCIS: Estimated size (extent) of DCIS is at least (Millimeters): 20 mm Number of Blocks with DCIS: 10 Number of Blocks Examined: 25 Architectural Patterns: Cribriform Architectural Patterns: Solid Nuclear Grade: Grade II (intermediate) Lobular Carcinoma In Situ (LCIS): Not identified Lymphovascular Invasion: Not identified Dermal Lymphovascular Invasion: No skin present Microcalcifications: Present in DCIS Microcalcifications: Present in non-neoplastic tissue Treatment Effect in the Breast: No known presurgical therapy MARGINS Margin Status for Invasive Carcinoma: All margins negative for invasive carcinoma Distance from Invasive Carcinoma to Closest Margin: 0.1 mm Closest Margin(s) to Invasive Carcinoma: Anterior Closest Margin(s) to Invasive Carcinoma: Posterior Distance from Invasive Carcinoma to Anterior Margin: 0.1 mm Distance from Invasive Carcinoma to Posterior Margin: 0.1 mm Margin Status for DCIS: All margins negative for DCIS Distance from DCIS to Closest Margin: 0.5 mm Closest Margin(s) to DCIS: Anterior Distance from DCIS to Posterior Margin: 1.2 mm REGIONAL LYMPH NODES Regional Lymph Node Status: : All regional lymph nodes negative for tumor Total Number of Lymph Nodes Examined (sentinel and non-sentinel): 7 Number of Sentinel Nodes Examined: 7 PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing physician's responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report. TNM Descriptors: m (multiple foci of invasive carcinoma) pT Category: pT2 pN Category: pN0

Meow13

It doesn't sound too bad 8 mm of invasive ductile cancer looks like grade 1. The DCIS non invasive about 2 cm.

No node involvement really good. Overall a good early catch. Doesn't say anything about receptor status, estrogen or progesterone receptors or her2 status.

They did see 2 foci, 2 tumors that could be a little more complicated but I wouldn't worry too much I had 2 tumors the were later found to be separate.

poppy2022

Thank you so much for your quick reply! The earlier biopsy stated 100% ER and 100% PR and HER negative. I had a palpable lump for years that mammogram didn’t locate and US stated probably benign. Followed up every year and this last April they finally biopsied at a new clinic. Lots of concern that it was left for so long and the overall size varied drastically on imaging. That’s why I was a little concerned with the pathology. Also took almost 3 weeks to receive. Does staging include the DCIS, or only the invasive component

Meow13

I would think they are leaving it up to the oncologist to stage either 1 or 2. Usually DCIS alone is considered stage 0.

Looks like they will probably suggest tamoxifen or AI drugs, given the hormone status. I was considered stage 1 because my ilc tumor (1 cm) and dlc tumor (1cm) were considered separate occurrences with 95% confidence.

As far as the excision, do you know if they plan more surgery? The margins look tight to me, good to discuss it with your doctor. Good luck to you, I am now on my 11th year no cancer. I did 4 years AI treatment after a simple mastectomy and DIEP reconstruction. I was 95% er and 0% pr her2 negative.

poppy2022

11 years is amazing! I was diagnosed in April, didn’t have the lumpectomy until the end of July and path report almost three weeks later. The anxiety of waiting was the worst part of it all. The surgeon said she went right to the chest wall when she removed the lump. I asked her about the margins prior to receiving the report and she said they would radiate rather than do a reincision. But now that the report is in I will find out her thoughts. Again, congrats on 11 years and your very helpful advice

Meow13

Are you a candidate for internal radiation, with it being close to the chest wall? I have a friend who did that, I guess it saves the skin and is more convenient.

poppy2022

No idea. So far I have only worked with the surgeon. They don’t refer you to the oncologist or radiation clinic until you receive the pathology. I will definitely ask about that.

Meow13

good luck poppy

poppy2022

just spoke with the oncologist, haven’t had my follow up with the surgeon. She is stating that the invasive part is 28mm plus another focus of DCIS. I’m confused as the way the pathology report words it it seems like the 28mm is 20mm of DCIS. “Your ValueThe localization lumpectomy specimen in part E has been submitted in its entirety for histologic examination. Sections show a 28 mm focus of grade 1 invasive carcinoma with extensive ductal carcinoma in situ (DCIS). DCIS is present in slices 2-6 and in 10 of 25 total blocks. DCIS occupies approximately 20 mm (70%) of the 28 mm mass.“ Any help would be appreciated. They are requesting oncotype to determine chemo.

Quietgirl

not to make it sound simple but you can for example have a gray hair on your head growing right next to a non gray hair. As compared to a hair that is bleached blonde on the end and has a gray root. So in this case it sounds like the doctor is saying you have this 28mm long mass of invasive and next to it there is 20 mm section of DCIS (because to call it dcis it can’t be broken open it in theory is completely enclosed. Does that make sense? I’m not even sure the section is one length of DCIS because notice has it says it’s in slice 2-6 and in 10 of 25 blocks so it doesn’t necessarily mean it’s one duct or a continuous strand. I don’t know that helps.

poppy2022

Any help is greatly appreciated! I think the part that confuses me is that they say at least 20mm of the 28mm mass is DCIS. Yet the oncologist said that the full 28mm is IDC and there must be another mass of 20 mm DCIS. Contradicts the report. Her response wasn’t very confident and it’s making me question the whole thing,

obsolete

Hi Poppy, you're wise to follow your instincts & question everything. You may also contact pathologists directly to obtain clarification.

Had you already been given a pre-operative MRI for surgical planning? Tumor #2 was found a distance of 8mm from tumor #1. It's disturbing a palpable lump grew in your breast for years & went misdiagnosed.

0.1mm margins are very tight, as Meow commented. In mastectomies, surgeons can scrape the chest wall. You could also seek a 2nd opinion at a cancer center on those close margins.

Your invasive tumor characteristics are quite favorable (grade-1, low mitosis) 100% ER/PR, so Oncotype probably will not indicate chemo. Please continue to advocate for yourself, especially before radiation begins, if this is the treatment path you choose. Best wishes.

poppy2022

Thank you so much! I did have a MRI that identified 2 areas of concern, the other area was biopsied and confirmed benign breast tissue. Left breast a few cysts. I also had a Cat scan that was clear and a bone scan that were clear. Genetic testing showed a Chek mutation of unknown significance, so being treated as no genetic risk. No family history of breast or ovarian cancers. And I’m 46 years old.

This board is the only thing carrying me through right now. Trying to get answers from the medical staff is so frustrating! I’ve asked a friend whose wife is affiliated with a large cancer Center to take a look and provide an opinion as well. I’ll keep everyone posted.