Biopsy dx and final path dx different and confusing.

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chef127
chef127 Member Posts: 891
edited June 2014 in Mixed Type Breast Cancer

My biopsy report Dx came back as IDC 4-5 cm. The final path report after surgery came back as DCIS w/ microcalcifications of IDC and skin involvement. The DCIS area was in my breast for many years and was tested as B9 25 yeas ago. I am confussed about the final Dx. Should I assume that the tumor was MOSTLY DCIS that turned cancerous with the microcal or was the entire 4.5cm tumor IDC? I have based all of tx decisions on the fact that most of the tumor was DCIS and not the IDC. I refused chemo, doing 7 weeks of rads w 10 boosts, and I'm on the fence w the AI's. I had a PMX and got clean margins but the skin removed showed cancer cells, hence the rads. I'm treating this like a Lumpectomy only. I fear that I am undertreating because of the IDC. Am I being nieve?

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  • barbe1958
    barbe1958 Member Posts: 19,757
    edited February 2012

    It's very common for the pathology to come back different once the surgeon actually removes the tissue. Until then, they can only give their best educated guess. You might want to find out how much of the cancer was the IDC portion. It could have just been a tiny bit, then rads make sense. If the whole tumour was mostly IDC then I think they'd push you on the chemo. I don't think you are naive as you are questioning, which is good. We don't get any homework on this kind of life issue so we learn as we go.

    Someone else will post with a similiar diagnosis to help you. Good luck, sweetie!

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  • Beesie
    Beesie Member Posts: 12,240
    edited February 2012

    There are two types of staging - clinical staging, which is based on an assessment of the films and a biopsy sample, and pathological staging, which is based on the actual pathology of the tumor when analysed under a microscope. Usually pathological staging trumps clinical staging, although there may be elements of the clinical staging that are incorporated in the final stage assessment and treatment decisions.  

    Was your initial biopsy report based on a core needle biopsy?  If so, then the only thing certain was whatever was found in the small amount of tissue removed by the needle. Everything else was speculative based on your films.  In other words, they took what they found in the small sample, looked at your films, and made some assumptions and drew some conclusions based on that.  If the small needle sample removed mostly IDC, they would assume that the entire area of cancer was IDC - even though it might not be.  On the other hand, if the small needle sample had removed only DCIS, they would have assumed that your diagnosis was DCIS.  So if the initial diagnosis was based on only a small sample from a needle biopsy, then your final pathology report will be more accurate and more relevant.  

    However, if you had an excisional (i.e. surgical) biopsy initially, or a vacumn needle biopsy that removed a significant amount of breast tissue, then the information from both reports would have to be considered to determine your diagnosis, staging and treatment.  

    All that said, from the description of what was found in your final pathology report, I'm not sure that the amount of DCIS vs. IDC is all that relevant.  Having a positive node and having cancer cells found on the skin automatically moves you to at least Stage II, even if the size of the IDC was very small.  So with those other factors, the DCIS really becomes irrelevant.  Treatment is always based on the most serious of the conditions and in your case, that's the positive node and possibly the cancer on the skin.  Was the cancer found on your skin judged to be a spread to the skin or was it thought that these were cancer cells that might have been left there by the surgical tools?  

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  • chef127
    chef127 Member Posts: 891
    edited February 2012

    Beesie,

    Thank You for the in depth explanation. It clears it up for me somewhat. It was a core needle biopsy and I am assuming the DCIS was not biopsied. The tumor was removed via Co2 Laser, the dissection removed the tumor while simultaniosly sealing peripheral blood vessels and lymphatic's reducing blood loss and the possibility of spreading diseased cancer cells during the dissection. The surgeon did tell me that he lased and scraped the skin area before closing it up, the tumor bed was also lased and cleaaned up, without the possibility of spread. but...... it is questionable for me. so I am doing the rads.

    As far as the nodes go, I had a biopsy done which found cancer cells, but the final path report says no lymphovascular invasion.  How can I have a positive node at biopsy and negative nodes when they were removed? did he only remove the neg nodes? and is there a pooitive node still lurking?????? 

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