Question about biopsy

digger · July 2010

I have a question about the results of my DCIS pathology, and I hope someone here can shed some light for me.

After I had felt a large mass on my left breast, a gynecologist (who was filling in for my other doctor who was on medical leave) sent me for a diagnostic mammogram and ultrasound. It had been about 14 months since my last normal mammogram, and apparently I was supposed to be getting ultrasounds because of my extremely dense breasts, but my previous gyn never said anything to me, so it was never done. The mammogram and ultrasound identified two areas of highly suspicious calcifications which covered more than 3.5 cm of my already very small breast (an A cup, if that).

I had a core needle biopsy which, according to the report, resulted in six slides for analysis (so that means 6 sampes, I guess?). The pathologist then reported that all six biopsy samples showed nuclear grade 2, solid type with comedonecrosis. The samples were highly estrogen receptive (95%).

I decided to go to Sloan Kettering for a second opinion (as all of the above had taken place at my local community hospital), and I was told I needed a mastectomy because of the size of the DCIS and the smallness of my breast (essentially, I would have been left almost nothing of the my breast). I know that MSK really tries to do lumpectomies whenever possible, so if they were suggesting a mastectomy, I knew it probably had to be done. I had also brought my slides and all the radiological records with me for their review.

So, here's the question...sorry for the long introduction of it all! In looking at my mastectomy pathology report from Sloan, I see that my DCIS in the left breast tissue was indeed nuclear grade 2 and with, what they call, "moderate necrosis." But, it also says the DCIS has solid, cribiform and papillary types which, according to my research, is the most benign type. So, what happened to the comedo cells? Were they all taken out during the initial biopsy samples? Is "moderate necrosis" saying the same thing as comedo?

The reason I ask this question is because, since the mastectomy and then every time I read another article about DCIS and overtreatment (the New York Times seems to like to have an article almost every week in the science section...), I second guess myself on whether I should have let them take my breast. But I keep going back to the comedonecrosis, and it makes me feel a little better, because I know that's the more aggressive of the DCIS. So what happened to the comedo? Anyone know? Am I just overanalyzing myself to death?

Thanks for anyone's input.

lymphtherapist · July 2010

My story is that the stereotactic biopsy came back with DCIS grade 2. I opted for wide excision. The path came back without evidence fo malignancy, just ADH. The initial needle biopsy removed the DCIS

CandDsMom · July 2010

I believe that solid type DCIS is just another name for comedo type DCIS. From my understanding this type of DCIS by either name is higher risk. I think that both mean that the DCIS is filling up the entire duct (versus cribriform DCIS where it "skips around" - almost in a lacy or swiss cheese pattern or papillary which is more fern like in its spread.)

In the solid/comedo form the necrosis happens b/c the DCIS cells outgrow their blood supply and die, leaving an accumulation of material that is cheesy and pus-like (hence the name comedo - similar to comedone which is what a pimple is called).

Hope this helps!

sweatyspice · July 2010

Most of all, I think you had no choice.

As I understand it, and it was certainly true in my case, many DCIS cases have a combination of cell types (solid, papillary, cribiform, etc). Is "moderate necrosis" the same as "comedo necrosis"? I'm not sure, but I'd think it probably is - and even if it's not, there's still evidence of necrosis which, moderate or comedo, can't be a good thing.

Probably most importantly in my opinion - you had a large area of confirmed DCIS in a small breast. What else were you going to do? A lumpectomy probably wouldn't have been cosmetically reasonable, and your only other choice would have been not to treat it and instead watch it for progression - maybe change your diet and add some supplements and wait and see if it continued to spread or if it became invasive (which would mean repeated biopsies). Could you have handled that emotionally? My guess is probably not. And who knows if you'd have been able to find a Dr willing to go along with that kind of plan.

I think it's crap that we have to deal with such barbaric treatments for such a mini level of disease, but we're also forced to deal with the current level of knowledge in medicine.

At this point in the evolution of medicine, I don't think you could reasonably have made any other decision. It sucks, completely, but I think you did what you had to do. Period.

Beesie · July 2010

digger, all I will say is "Ditto to everything sweatyspice said".

digger · July 2010

I just want to thank everyone who responded to this question. Your responses literally made me cry with relief, that I think I did the right thing. It just seems every time there's an article about DCIS in the press, along with all the controversy surrounding it, then I doubt my agreeing to take my breast off. I am still in such pain with both shoulders and arms from the surgery (mx on one side, lift and augment on the other side for symmetry), and I constantly doubt myself and just want to tear these implants out of my body.

This sounds so childish, but a year and half out now from the original mx, all I think about is how I want my life and my body back the way it used to be. In many ways, I think it was easier right after the surgery, because I was focusing on that. Now, I'm realizing that I have to live like this for the rest of my life, and I don't want to live with this pain.

Question about biopsy

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