Inconsistent Pathology Reports

At least one second opinion. I'm going out of state to Loyola Medical Center for a second opinion on the original path slide. They will only accept the original slides. Many pathologists have differing opinions about the diagnosis. I find it odd the patient never gets to meet or talk to the pathologist who's opinion sets the stage for treatment. Actually, many years ago, in 1994, I was able to talk to the pathologist. He explained everything about the cells (I had DCIS and LCIS). Said they may never metastasize I actually had no treatment and for 17 years nothing happened. Last Oct. 2010 they found a 12mm section of DCIS, non invasive. I knew I had it, so I was not surprised. I may choose a different course of treatment this time.

nothing wrong with a second opinion especially when the first opinions raise questions.  If they are telling you to do rads, they usually want to start within 6 weeks of lumpectomy so start finding your second-third-fourth opinions now.  good luck.

It's actually not unusual at all to have two pathology reports that say something different.  Breast cancer is usually a mix of a lot of different conditions so it's not surprising that one sample would include only certain conditions and another sample would include others.  My stereotactic biopsy had only ADH and some fibrocystic conditions.  My first surgery pathology had a microinvasion of IDC, grade 3 DCIS with comedonecrosis, every other type of DCIS (solid, papilllary, micro-papillary, etc.), plus ADH and a bunch more fibrocystic conditions.  My final surgery pathology had grade 3 and grade 2 DCIS and fewer different types of DCIS and fibrocystic conditions.

It is true that normally staging and treatment is based on the pathology report from the larger sample, which is usually the report that's available after surgery.  But this 2nd pathology report does not negate what was found in the first sample and documented in the first pathology report.  If the conditions noted are different and the first report included only lesser conditions (as in my case, where it showed only ADH), then the first report can be ignored.  But if the first report included a more serious condition (as in your case), then it cannot be ignored. In your case it sounds as though a microinvasion was found in the tissue sample from the stereotactic biopsy.  If this was the only microinvasion that you had (which would not be that strange - I had only one 1mm microinvasion in over 7cm of DCIS), then it's not inconsistent that your pathology report after your lumpectomy would note only the presence of DCIS.  But just because you didn't have a second microinvasion doesn't mean that the first one wasn't there.

If you are going to have any sample re-read, I would suggest getting the stereotactic biopsy sample done, in order to confirm whether or not a microinvasion really was present.  If there was a microinvasion, then from a treatment standpoint, the only change would be that you would need to have a sentinel node biopsy, if you have not already had one.  Any amount of invasive cancer dictates the need to have your nodes checked.  Other than that, your treatment will be the same as it would be if you had pure DCIS.  I say that from experience, and from reading the posts of dozens of women who've come through here who've had microinvasions. Of course, as you noted, the presence of a microinvasion would change your stage to Stage I and along with that, it would mean that you have a very slight (about 1% or less) risk of mets.  This is a risk that those with pure DCIS don't face and that's the reason for the change in staging from Stage 0 to Stage I for those of us who have microinvasions.

it was my understanding that they don't treat DCIS with microinvasion differently from plain old DCIS. So even if the pathology is a little different it's not like you'd get a different treatment.