Post-lumpectomy measurements & metal clip questions

Options
kittenpaws37
kittenpaws37 Member Posts: 36
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

Can someone help me wrap my head around the measurements on my post-lumpectomy pathology report?

It states the entire tissue specimen to be 11.1cm x 8cm x 1.3cm. 

I got out a ruler to check this out and was amazed at the large size these measurements seem to indicate...considering i only have a 2 inch wide incision and not that large of a contour remaining. The actual lumpectomy came back clear/benign with the .7cm DCIS lesion no longer in the tissue. So the numbers refer to the whole of the tissue removed. I spoke to my surgeon on the phone and she sort of explained it but all i heard that i understood was the word "radial"....which makes sense because I was told it'd be a circular type of thing coming out from what she drew in our first appointments.  I really do need to go back to Geometry class though...bc I cant for the life of me figure out how these measurements were taken out of my breast. Can someone help me see this better?

I also have a question about the metal clip that is put in during the biopsy to mark the spot.  It is supposedly removed during the lumpectomy and Ive been told mine was, but it states in my pathology report that "no metal clip has been identified". The surgeon said that the tissue is x-ray'd before going down to pathology to ensure the clip is in the tissue thats been removed, and that it definitely was in there but its so small that sometimes it is not found during dissection. The RO showed me some mammo films of where the clip was in relation to the wire localization and it was indeed at the tip of the wire, so by all account, it was removed with the tissue.

Does this all sound ok to you? Has this happened to anyone else? I wont feel relieved until the next mammo shows its no longer in me. But I also have to take confidence that they got the right area which having seen both before and localization area , it seems to be the case.

· Share on FacebookShare on Twitter

Comments

  • Annette47
    Annette47 Member Posts: 957
    edited April 2013

    Not sure I can help you see it better as I wondered the same thing!  I have a 3 inch scar, and had 7x7.5x3cm area taken out, so different shape but if I've done my math correctly an even bigger volume than you was removed but it's not apparent to the naked eye.   I still have some fluid and swelling in there (aggravated by rads) so can't say if when all is said and done that breast will end up smaller than it was, but there certainly isn't a huge divot or anything.   

    They did report my metal clip on the pathology so can't help you there.  I would assume if they x-rayed it after removal and it was there, then they did remove it.   From what I understand they don't actually examine every single part of the removed tissue - they section it and look at the sections, so I'm guessing they could theoretically miss the clip.     Women who get biopsies that turn out negative keep the clips and it doesn't seem to hurt them - I'd be more concerned that they didn't remove the right area than that there are negative repercussions from not removing the clip, but I really doubt that happened.

    Sorry I can't explain HOW they could take such huge chunk out of us without causing more deformity, but at least I can assure that they seem to do it on a regular basis.

    · Share on FacebookShare on Twitter
  • Beesie
    Beesie Member Posts: 12,240
    edited April 2013

    What the surgeon is supposed to do is take out the metal clip and a reasonable amount of breast tissue that surrounds it.  If your clip was placed right where your biopsy sample was taken, i.e. right at the heart of the small area of DCIS, and if that was the center of the area of breast tissue removed by your surgeon, then, 1) the clip certainly should have been removed and 2) you have good surgical margins. 1cm is normally considered to be an "ideal" margin but most often 1cm is not achieved; it sounds as though your smallest margin might be around 0.65 cm - not ideal but still very good - and you have other margins that are as large as 5.5 cm. 

    I think you should feel pretty comfortable with this but I agree that your next mammo will be important too, just to confirm that the clip is gone.  Honestly, with such a large area of breast tissue removed, I find it hard to believe that the right area wouldn't have been taken out.  That would be malpractice. 

    · Share on FacebookShare on Twitter
  • kittenpaws37
    kittenpaws37 Member Posts: 36
    edited April 2013

    Hi ladies :)

    Thanks, ok,i feel better about the large area being taken out without it appearing so to the naked eye. Im glad Im not the only one who has noticed this.

    While gathering materials for a second opinion on radiation treatment, I actually was able to receive copies of the mammo films from the day of surgery including the ones that show the wire localization and where the clip was in relation to it. I was looking at them and I see the clip along side the wire.  There is one film with a rectangular box with numbers and letters on the edges and when i measured it, it does correlate with the dimensions inthe pathology report.  Its amazing such a large rectangle could be cut out. The clip was indeed in the middle of the specimen rectangle box thing, so I feel assured it was the right area. It is a large area so yeah, hard to miss it.  I guess the depth is the 1.8cm ( not 1.3cm -sorry that was a typo in my original post)...which means the margin is a bit larger. There was no mass found in the lumpectomy so as I understood it, there was no margin or the margins were the entire specimen? There was no mass to measure against. Bessie, how are you deducing the 5.5cm margin??  Clue me in lol  :)

    · Share on FacebookShare on Twitter

Categories