Interpreting the Biopsy Report

Hi Seebee~  Your pathhologists looks at the cells in your specimen to see whether they are invasive or not. Here's is a page that kind of shows what they look for:  http://www.breastcancer.org/symptoms/path_report/the_cancer/invasive.jsp

As for yours, they are saying that there is Invasive Lobular Carcinoma and that it appears to have an area in, around or near it of Lobular Carcinoma In Situ. I don't believe this is uncommon.  Cancer starts within the cells and then moves to the outside of them, thus the invasive part. They invade the breast, outside the lobular where they began. I hope this makes sense.

The girls are right--it's very common to have LCIS along with ILC. The funny thing about LCIS, though, is that the medical community can't agree on whether it's truly an in situ cancer like DCIS, or if it's just a marker of increased risk for invasive cancer, either ILC or IDC. The majority of oncs take the latter view--that LCIS is not an in situ cancer that then progresses to invasive.

Seabee

My tumor's biopsy was all ILC, but on final pathology after my lumpectomy, there was a small LCIS component indicated on one edge. So I'm thinking that if that portion had been included in the original biopsy, it would've read as yours did.

Remember that all of this stuff is analyzed on the cell level - much cancer and certainly ILC isn't visible to the naked eye. So that "little" 1 cm by .1 cm piece contains a whole lot of cells that have different features that the pathologist uses to identify what they are.

The bad news is that if the diagnosis is Invasive Lobular Carcinoma, it's got to be removed. The good news is that if that LCIS is "part of" the mass that has been identified as LCIS, it'll end up coming out with the tumor, so there won't be that worry about whether it's a pre-cancer or not - it won't matter. My surgeon said the bit of LCIS in mine was just part of the tumor mass and not anything unusual or separate

Good luck to you! As you deal with this diagnosis and make decisions, it can be a little wild. My ILC diagnosis initially freaked me out completely, and then I calmed down and took it one step at a time. I had a lumpectomy and sentinel node biopsy, and now I'm doing radiation. My Oncotype DX test score indicated I'd likely not benefit from chemotherapy, so it wasn't offered.

I hope all goes well.

Coleen

 Seabee, pages 1 and 2 of this transcript might be slightly helpful:

 http://www.lbbc.org/data/transcript-file/LBBCdcislcis06.pdf

And this might help a bit, too:

http://www.cbcrp.org/RESEARCH/PageGrant.asp?grant_id=1836

Sorry I can't post live links with my browser. 

Seabee, I totally agree with you--why do they ignore the subtypes, especially the ones that appear to progress? I'm in a pickle b/c I have both pleomorphic ILC and pleomorphic LCIS. I can't imagine that the LCIS didn't morph into ILC in my case. At first the surgeon, onc and tumor board all said I had to have bilat mast b/c of the pleomorphic subtype. Then I saw another onc who said the subtype didn't matter--in fact, he didn't even differentiate ILC from IDC in terms of treatment. Then tumor board et al decided I was more at risk for mets than a new primary, and thus should just have a lumpectomy. It was enough to make one's head spin.

At any rate, I opted for a lumpectomy b/c I was not at a time/place in my life last year to be able to go through major surgery (bilat mast/reconstruction), but I second guess my decision every day. I figure at the first sign of a local recurrence or new primary, then the girls have got to go. But in the meantime, it's very frustrating to have the docs not all be in agreement on how to handle LCIS, especially pleomorphic LCIS. If they don't really understand it, how are we supposed to make informed decisions?

I found this discussion interesting because I work in a lab with a pathologist.  My initial sympton with my ILC was bleeding from the nipple.  Since I had the blood sample, I decided to make a slide and look at it.  I could see the small tumor cells in a 3-D configuration.  I looked in some of our reference books and found balls of breast cancer cells that looked like  what I had.  The stomach cancer cells were very similar also.  After my mastectomy my path report said extensive LCIS with pagetoid spread and six areas of ILC.  Pagetoid spread means that the LCIS was in the ducts and spreading toward the nipple.  There's something called a basement membrane at the outside edge of the lobule or duct that is where the duct or lobule stops.  If the cancer cells go through that membrane and outside of the lobule or duct they are called invasive.  The cells look the same for LCIS and ILC, it just depends on whether they have grown through the basement membrane and out into the other breast tissue or not.  ILC cells tend to be smaller and more normal looking than IDC and have to be identified through special stains.  My pathologist said that they have to be really careful when looking in the lymph nodes for the ILC because it is easier to miss.  The frozen sections that they did during surgery showed my lymph nodes to be clear, but the more careful testing done later showed isolated tumor cells in the first node.  I am not a cytotech, so I've had to learn what I was looking at as I went along.  All of this information is from my personal experience and understanding and study.  If I am wrong about any of this I apologize,but I think this is correct.  gandl

Thanks for that input, gandl. That was very interesting. And a touch disconcerting. I'm sure my PLCIS turned into PILC, also, and some days I think I'm completely insane for not having a bilat mast. But for whatever reason, I just can't bring myself to do it until backed into a corner medically.

I thought it was really interesting that you said the cells you looked at also resembled stomach cancer cells, since women with a mutation of the e-cahedrin gene CDH1 that causes familial gastric cancer are at a higher risk for ILC.