pleomorphic LCIS biopsy..now negative MRI

kitkit
kitkit Member Posts: 80
edited June 2014 in LCIS (Lobular Carcinoma In Situ)

Hello ladies,

Last night I had MRI after discovery of pleomorphic LCIS during needle biopsy a week ago.  This all began from calcifications on mammogram.

My doctor called at 8:30 this morning to say that the MRI revealed nothing at all.  He says that if there was something invasive it would show up.  How is this possible?  Why wouldn't the LCIS be visible?  If anything, I thought MRIs give false positives.  My surgeon who is doing the lumpectomy in two weeks said he wanted the results of the MRI to help guide him to where he will be cutting.  So now it's giving him no guidance?

I suppose this is all good news, but it seems rather odd.  I guess I am waiting to be elated until I get the biopsy back from the lumpectomy and I have "clean margins" (whatever that means with respect to pleomorphic LCIS) and I'm told to just have frequent monitoring.

What do you'all think?

Thanks.  Kitkit

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  • leaf
    leaf Member Posts: 8,188
    edited February 2010

    LCIS is normally not seen on mammogram, clinical exam, or ultrasound.  Its not reliably found on MRI either.  We don't know how many women with LCIS are walking around with it and don't know they have it. Estimating the incidence of lobular carcinoma in situ (LCIS) of the breast is challenging because it lacks both clinical and mammographic signs and is usually an incidental finding in breast biopsies performed for other reasons http://www.ncbi.nlm.nih.gov/pubmed/12353815 (emphasis mine)  Some people HAVE had LCIS show up on their MRI, but MRI is NOT a reliable way to detect it.

    LCIS is often not found AT the site of an abnormality (mass, calcification, architectural distortion, etc), but ADJACENT to the abnormality.

    Clean margins don't matter (at least in classical LCIS) because the risk is bilateral, even if you only have 1 spot of LCIS in one breast.  When women with (unspecified classic or pleomorphic - presumably classic) LCIS get breast cancer, it often occurs in areas that were previously thought to be NORMAL.  So most of the time, (presumably classic) LCIS is thought to be a risk factor for breast cancer.  In a SMALL number of cases,  presumably classic LCIS is thought to be a nonobligate precursor -meaning the LCIS spot MAY go on to become cancer, but it may not.  In the majority of cases, at least classic LCIS, the LCIS spot is thought NOT to go on to become breast cancer, but it enhances the risk of other breast tissue.

    Edited to add: In pleomorphic LCIS, they may want to get clean margins to get out as much pleomorphic as they can, but I don't think they know how much that decreases the total risk - if the risk of 'action at a distance' still persists like in classic LCIS.

    These are speculations, because of course to really know an area of the breast has LCIS is to biopsy it, so it is removed from the breast.  You can't tell what would have happened to that area if you didn't biopsy it.

    LCIS (whether classical or pleomorphic) is a weird disease.

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  • nash
    nash Member Posts: 2,600
    edited February 2010

    I have had 5 breast MRIs, and my PLCIS has never shown up on any of them.

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  • kitkit
    kitkit Member Posts: 80
    edited February 2010

    but would invasive lobular cancer show up on a MRI?

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  • kitkit
    kitkit Member Posts: 80
    edited February 2010

    one more question:  what is the purpose of ordering a MRI for a patient with pleomorphic LCIS?

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  • nash
    nash Member Posts: 2,600
    edited February 2010

    Yes, my PILC showed up on MRI in all its blazing glory. In fact, MRI is the best imaging technique for invasive lobular--it's very hard to see on mammo and u/s.

    The purpose of ordering an MRI for a PLCIS patient would be to look for possible invasive disease.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited February 2010

    kitkit----I was diagnosed with LCIS from suspicious microcalcifications on mammo about 6.5 years ago and also have family history of ILC (my mom).  I do high risk surviellance of alternating mammos with MRIs every 6 months, breast exams on the opposite 6 months, took tamoxifen for 5 years and now take evista for further preventative measures.  My hope is always that if ILC is there, hopefully it will be detected by the MRI, but ILC is somewhat elusive (they call it "sneaky") and isn't always seen on imaging studies (mammo, US, or MRI).  Did you have a clip inserted during your initial biopsy for the calcifications? The clip (seen on mammo) helps guide the surgeon to the specific spot  to biopsy during the lumpectomy (mine was removed during my wide excisional lumpectomy for LCIS) . I had clear margins, but the bs said it didn't matter as I have classic LCIS which doesn't require them as it is felt to be a bilateral disease (meaning theorectically bilateral mastectomies would be needed in order to "get it all", but actually it isn't medically necessary to remove it all); but that may be different with pleomorphic LCIS--I've read it may need to be treated more like DCIS, requiring clear margins and possibly radiation, but I think this is still very controversial. I have never had any more areas of LCIS identified on my MRIs, but then again I don't really expect to. Praying you get good results soon with no invasive bc found. Feel free to PM me if you'd like.

    anne

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  • IllinoisNancy
    IllinoisNancy Member Posts: 722
    edited February 2010

    HI,

    My Pleomorphic ILC showed up on the mammogram, the ultra sound and the MRI.  It was only 1 cm big but they still saw it on all of the tests.  I don't get it why some of you go undected.  Are some doctors just better at reading these reports??

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited February 2010

    kitkit------the purpose of an MRI for someone with LCIS is to detect any invasive bc.

    Nan---some ILC is seen on imaging (my mom's was found on mammo), unfortunately just not all ILC is.

    anne

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  • kitkit
    kitkit Member Posts: 80
    edited February 2010

    Thank you all for your responses.  Now I feel like I should kinda feel good because nothing invasive was found on the MRI, albeit that they found nothing at all.  On March 11 I will have the lumpectomy, and hopefully we'll all digest the "clear as mud" answers together.

    Kitkit 

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  • leaf
    leaf Member Posts: 8,188
    edited February 2010

    In this 2007 Port study of AH and LCIS women screened with and without MRI, MRI did not pick up ALL of the cancers, but it picked up more of them than without MRI. All of the MRI-detected cancers were in LCIS patients.

    In MRI-screened patients, 55 biopsies were recommended in 46/182 (25%) patients, with 46/55 (84%) biopsies based on MRI findings alone. Cancer was detected in 6/46 (13%) MRI-generated biopsies. None of the six cancers detected on MRI were seen on recent mammogram. All six cancers were detected in five patients (one with bilateral breast cancer) with LCIS; none were detected by MRI in the AH group. Thus, cancer was detected in 5/135 (4%) of patients with LCIS undergoing MRI. The yield of MRI screening overall was cancer detection in 6/46 (13%) biopsies, 5/182 (3%) MRI-screened patients and 5/478 (1%) total MRIs done. In two additional MRI-screened patients, cancer was detected by a palpable mass in one, and on prophylactic surgery in the other and missed by all recent imaging studies. http://www.ncbi.nlm.nih.gov/pubmed/17206485 (emphasis mine)

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