Post neo-adjuvant chemo breast MRI report

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HeatherBLocklear
HeatherBLocklear Member Posts: 1,370
edited June 2014 in Managing Side Effects of Breast Cancer and Its Treatment

Hi all,

I am tentatively happy with the following report, and hope you will confirm that it is indeed a good one. I will include only the conclusions, not the entire report. I would like to add that this MRI was done on day three after my last chemo; is it unreasonable to hope that the remaining lesion might be even smaller now than it was then?  

I would also VERY MUCH appreciate an interpretation of No. 2 below. Those of you who have followed my story know that a grossly enlarged axillary lymph node is what finally convinced me to return home from my mission abroad to be evaluated. That is when I was diagnosed with a grad 3, stage III triple negative invasive ductal carcinoma. That blasted lymph node has also been the slowest to respond to chemotherapy.

"IMPRESSION:

1.) Residual 1.5 cm area of mild to moderate intensity nodular enhancement in the upper lateral posterior aspect of the left breast at the site of the previous neoplasm. One focal 8 mm area medially in this region has slightly greater intesnity enhancement. As judged from the size of the neoplasm on the images from February 2008 (7cm +), this would represent an excellent response. A small amount of focal residue neoplasm probably remains. No other suspicious areas of enhancement are identified in the left breast.

2.) No left axillary nodal enlargement with slight asymmetrical prominence of several Level I lypmph nodes.

3.) Probably begnign well circumscribed subcentimeter enhancing nodular structure in the upper aspect of the right breast. In light of the known left-sided history, recommend attempted targeted ultrasonography of this area for futher evaluation. If no nodule is identified, recommend six-month interval follow-up examination with ME imaging to assess stability."

Thanks to the usual experts for helping me interpret this report. I am hoping and praying it is as positive as it seems to me (my BS was too busy to talk to me today; his office faxed the report instead).

In high hopes,

Annie

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  • LisaSDCA
    LisaSDCA Member Posts: 2,230
    edited August 2008

    Okay - I'll give this a shot:

    1: Right off the bat, the report refers to a site of a previous neoplasm. Not the neoplasm, a former neoplasm. This is indeed good, nay, an "excellent response". This bit of editorializing is rare in an MRI report - usually it's just there or not there. Again, this bodes well. Little bits of 'residue' may remain - the ashes of what you have burned to DUST!

    2: That grossly enlarged node is no longer. Nil. Non-extant. None of them are enlarged. A few are randomly tweaked as though you had been recently under an immune stressor - say, chemo?

    3. Moving on, it is noted that you have a well-defined, perfectly normal-looking node area  of less than a centimenter on the other side that is picking up a bit of resonance. In another patient we wouldn't even note it. Given your history, we'll mention it, suggest an ultrasound to confirm that it is normal structure, and follow-up in the normal 6 month's time.

    Yes, Annie, I would say you could reasonably hope for that magical Pathologic Complete Response when they go in there lookin'! I'll sure be hoping for that for you!

    Lisa

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  • otter
    otter Member Posts: 6,099
    edited August 2008

    Annie, I tried writing a reply earlier this evening, but I got all tangled up with statement #2.  Lisa got it right--I'm glad she posted before I came back here for another try.

    Yes, you had a fantastic response to neoadjuvant chemo.  Your primary tumor is shrunken like a raisin.  Wow--from 7+ cm down to 1.5 cm! (More about that in a minute.)  The very-much-enlarged axillary node is no longer enlarged.  That's terrific, too.  There is some "asymmetry" of nodes at "Level I" (lateral side of the breast, below the armpit).  I struck out on the meaning of the phrase "slight asymmetrical prominence."  I am guessing it means some of the nodes are more noticeable than others, but that is honestly just a guess.  In any case, it must be better than the gross enlargement you had before.

    OK, about that residual 1.5 cm mass.  I'm thinking that may be sort of an advantage, for your surgeon.  I've always wondered what happens when a surgeon goes in to remove a lump after neoadjuvant chemo and can't find the lump anymore.  At least yours can still be detected.  That way, they will know they have it out, and they should be able to get a good idea of the margins of healthy tissue around the tumor.  So, if you need to think of something positive about still having some tumor tissue there, that's what you can think.

    Lisa said it best, though.  We will do a happy dance with you.  I read that your surgery will be in about 10 days.  I have my 6-month post-surgery exam and follow-up mammogram, as well as a 3-month follow-up with my onco, on Aug. 18th.  Maybe we can celebrate together, later that week.

    otter 

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  • AnnNYC
    AnnNYC Member Posts: 4,484
    edited August 2008

    Annie, it sounds like a great report to me -- from 7 to 1.5 cm, and "no left axillary nodal enlargement" -- sounds pretty good!!! 

    Hugs,

    Ann

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  • NancyD
    NancyD Member Posts: 3,562
    edited August 2008

    Annie, sounds good to me, too. Get in there for surgery ASAP, now...don't let that cancer have a chance to grow again. I wish I had scheduled mine for the soonest possible date after my last neoadjuvnat chemo, but I put it off a couple of weeks for family stuff and, well, it was there where they thought it was almost gone, per the CT/PET/MRI reports from seven weeks before. I still had a good response, just not the final path report that I wanted (bumped me up to IIIa because there was a fourth node).

    So, time to get in cleaned out! 

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  • HeatherBLocklear
    HeatherBLocklear Member Posts: 1,370
    edited August 2008

    YIPPEEEE!  I knew it was pretty good, but this is even better than I thought. After I was so discouraged (and my medical team too) by my lack of response to the Taxotere, Tender told me I'd have a better response to the AC, and she was right. Thank God she was right.

    Nancy, I'm having surgery three weeks to the day after my final chemo. That's the earliest they can do me since I've also been on Avastin. My BS doesn't believe in dilly-dally, but told me he wants to get stuff out before it can "conclude the coast is clear and decide to make a come-back," as he put it. As far as the residual tumor is concerned, I'm scheduled for a clip to be placed the day prior to surgery. Can anyone explain how that's done and if it's painful? (You'd think that after eight rounds of chemo, pain wouldn't mean that much to me anymore!)

    Ann, Otter, and Lisa, I guess they'll take out the axillary lymph nodes even if they now show NED, is that right? I dread that, but also think it's probably best. Does it hurt a lot?

    Oh Otter and everyone else -- I am so glad we're coming out on the other side. What a long and terrible journey this BC ordeal is for everyone. At the very least we're getting a bit of a reprieve, and I am so grateful for that. Otter, I'll be looking for word from you on the 18th; not only is it important to know you're doing GREAT, it will also be encouraging as I go in for surgery on Aug. 19. Would anyone like to meet up for Margaritas? I mean this!

    Thanks again -- you guys are fabulous.

    Annie

    PS: Piss on John Edwards. I wish I could kneecap the miserable jerk!

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  • Sassa
    Sassa Member Posts: 1,588
    edited August 2008

    Great news, Annie!!!  I am overjoyed for you.Laughing

    P.S. It isn't the kneecap I would go for. Cool

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  • otter
    otter Member Posts: 6,099
    edited August 2008

    Annie, I've been lagging again because I don't know the answer to your question about removal of lymph nodes.

    If there was clear evidence of tumor cells in an axillary node, the standard of care is to do a full axillary node dissection (ALND).  I think that includes removal of all the axillary nodes the surgeon can find, or at least all the nodes he/she thinks might possibly be at risk of containing mets.  Since you did have a positive node prior to your neoadjuvant chemo, that might dictate a full ALND.  OTOH, you will be having radiation therapy, so maybe they'll consider irradiation of your axillary area to be adequate treatment.

    Does removal of the lymph nodes hurt?  I only had 3 nodes removed--they were the ones identified as "sentinel nodes" at the time of my mast.  I think for many women, the lymph node removal (no matter what the number) causes more discomfort than removal of a breast, much less removal of a lump.  The dissection required to locate and remove lymph nodes in the armpit causes tissue trauma, and it damages nerves, blood vessels, and lymphatic drainage pathways.  A good surgeon tries to minimize the damage, but some of it is inevitable.

    I promise to post or send a pm when I get home on the 18th.  I should have results of my DEXA bone scan, my mammogram (right side only, or someone will suffer bodily harm besides me!), and my discussion with my surgeon and onco about the problems I'm having with swelling of my left arm and chest wall (lymphedema, I fear...).

    Margaritas?  Virtual, or real?  One of my favorite treats during chemo was anything with lime in it.

    otter 

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  • NancyD
    NancyD Member Posts: 3,562
    edited August 2008

    Annie, if there was evidence of cnacer in the nodes before the neoadjuvant chemo, they HAVE to do an ALND to see if it's gone or if it's in any other nodes. They can't go by any CT/PET scans because they are looking for very small pockets of remaining cancer. Single cells, even.

    I don't know if the ten nodes my surgeon removed were all he could find, or what. Considering that some women have twice that amount removed, I'd like to think I still have a few clean ones in there keeping the lymphadema at bay. As far as pain, there's a little more on my ALND side than my prophylactic mx side. The surgeon did not create another opening--used the same one created for the mx--so there's no additional scar.

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  • embmom
    embmom Member Posts: 115
    edited August 2008

    Annie--Congrats on the great report!  We started this journey about the same time and have both had really great outcomes!  I had my surgery on the 25th--single L mx--and the bs found a 1.2cm tumor and of 4 nodes taken all were neg.  The MRI had shown what we thought was a 3cm tumor before sugery.  The tumor before I started was 6cm plus with it actually coming thru the skin.. My question now for the onc on Thurs is whether or not I still need radiation.  The BS said maybe not but said we need to keep to the original plan and that I have to talk to the ONC.  I can't find anything that shows you get rads with no pos. nodes.  Anyway I am extremely thankful for the great response we both have had--things looked a little grim going into this--hopefully others will see the response we've had and be encouraged for themselves.  Hopefully your surgery goes well--it was easy at first but the pain in the underarm and chest area seems to be increasing these last few days instead of going away.  I probably am doing too much--I have been back to work since 4 days after surgery because of some employee issues (they quit--without warning and left me stranded)...but all will be better soon--good luck on your surgery and here's hoping that everything is clear and negative!

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