Stage 0--->Stage I ~ Need Help Re. Interpreting My Reports

Being a "BC newbie" - wanted to ask collective "eyes" if any light could be shed on my BC results? I apologize for the long post (can you tell I type for a living?). I discovered a small lump in my L breast Feb 18. My PCP ordered a DX mammo Feb 26.

Radiologist MD who did DX mammo noted microcalcifications of interest near small lump cyst (which was B9), and ordered a Sterotactic Needle Core Biopsy - which I had done on March 19, whose Surgical Pathology Report stated:

• L breast, stereotactic needle core biopsy - ductal carcinoma in situ, nuclear grade 3 with comedonecrosis and microcalcifications. E-cadherin immunohistochemical stain is positive supporting the DX.
• Estrogen progresterone receptor (ER/PR) analysis: Estrogen receptor: Positive (>95% of nuclei staining; stain intensity: Strong); Progresterone receptor: Positive (>95% of nuclei staining; stain intensity: Strong). Staining of greater than or equal to 1% of the turmor cells is considered positive.
• Tissue analyzed: In situ carcinoma; Block number: A1; Internal controls: appropriately staining; External controls: appropriately staining; Fixation: Formalin-fixed paraffin embedded tissue. Antibodies:  Estrogen receptor- SP1 Clone & progesterone receptor - 1E2 clone.
• Gross Description: Received in formalin are multiple segments of cylindrical tissue aggregating to 1.5 x 1.3 x 0.3 cm, yellow and of a soft consistency.

My BS ordered an MRI with IV contrast on April 10. Results given to me by BS were that due to "size of area of interest" shown in the MRI now at total area of 9 cm (= 3.5 inches), a lumpectomy I first opted for in my L breast was now "totally out of the question." So, then I made a personal choice of having not only a MX on my L breast, but also a prophylactic MX on my (totally normal and NO BC in) my R breast. Here are the MRI w/IV Path Report data:

• Bilateral enhancement is mild. There is a 9cm x 2cm x 2.3cm area in L breast at 2:00 middle depth & is a known BX positive for malignancy. This shows clumped enhancement & delayed washout type vascular enhancement. Angiographic measurement calculates an estimated volume of approx 4.4cc's of the known DCIS. There are no abnormalities seen in axillary nodes region. Impression: KNOWN BX PROVEN MALIGNANCY.  SUMMARY: Left breast 2:00 moderaltely large area of known DCIS; NO AXILLARY ADENOPATHY. MRI BI-RADS: 6 Known BX proven malignancy.

Being cautioned & told by my medical team that above DX of DCIS/Stage 0 BC could very well change, upon my undergoing removal of Sentinal Lymph Nodes just before my BMX surgery, and final pathology report (produced April 30, 5 days post-BMX surgery) could uncover something very different! In fact, BS gave me Final Pathology Report (April 30) last week (stating only that NO cancer found in lymph nodes; but a very small microinvasion was found within the DCIS), as follows:

Lymph node, L axilla, resection: no tumor seen in 1 lymph node (0/1). L breast, mastectomy: small focus of invasive ductal carciona (1.5mm) arising in a background of extensive ductal carcioma in situ, intermediate grade, solid & cribriform types.

Comment:

Specifiment Laterality: Left. Proecdure type: Mastectomy. Wire localization: absent.

Tumor Size (size of largest invasivce carconoma) - greatest dimension of largest focus of invasion: 1.5mm.

Tumor Focality: single focus of invasive carcinoma.
Extent of Tuomor: Skin: Not involved. Nipple: Not involved: Chest wall: Skeletal muscle is absent not involved by invasive carcinoma.

Margins: Invasive carcinoma; uninvolved; Closest margin: 1cm, to the deep margin.

DCIS: Positive for involvement at the deep margin and radial margin at 1 o'clock.

Lymph-Vascular Invasion: Not identified.

Ductal Carcioma In Situ (DCIS):

DCIS is present; Type: Solid & cribriform type; Nuclear Grade: 2; Neccrosis: focal, small amount.

Lymph Nodes:

Number of sentinel lymph nodes examined: 1.

Total number of lymph nodes examined (sentinel and nonsentinel): 1

Number of lumph nodes with macrometastases (>0.2cm): 0.

Number of lymph nodes with micrometastases (>0.2mm to 0.2cm and/or >200 cells): 0.

Number of lymph nodes with isolated tumor cells (less than or = to 0.2mm and less than or = to 200 cells): 0.

Number of lymph nodes without tumor cells identified: 1

Size of largest metastatic deposit (if present): Not applicable.

Extranodal Invasion: Not applicable

Pathologic Staging (AJCC 7th Edition): pT1 pN0

Estrogen & Progesterone Receptor: Pending

HER2/(ERBB2): Pending

Clinical Data: Carcinoma in situ of breast (233.0)

INTRAOPERATIVE CONSULT DX: Sentinel lymph node, left axillary biopsy: Negative for malignancy. Final diagnosis pending permanent sections.

GROSS DESCRIPTION: Lymph node with attached adipose tissue measuring in aggregate 3.0 x 2.0 x 1.0cm. The lymph node measures 2.5cm in greatest dimension.

The L breast measures 15.0 x 15.0 x 6.0cm, and weighs 645.0 grams. Margins of specimen are marked with black ink. Specimen is serially sectioned; 3 separate possible masses are identified. 1st mass is located at 4:00 location & consists of tan-pink, firm, ill-defined fibrous itissue surrounding an area of hemorrhage measuring 1.2x 1.2 x 0.7cm. This mass extends to within 1.0cm of the deep margin. 2nd possible mass is loated at 3:00 location & is posterior in depth measuring 1.5 x 1.0 x 0.7cm. It also consists of tan-pink, ill-defined, fibrous tissue srurrounding an area of hemorrhage. This mass extends to within 0.5 cm of the posterior margin. 3rd possible mass is located at 1:00 location & is anterior in depth extending to within <0.1cm of radial margin at 1:00. Mass consists of tan-pink firm tissue & measures 1.0 x 0.8 x 0.5cm. Mass rrounds an area of hemorrhage. Xray taken identifying metal clip. Representative sections are submitted as follows: B1-B10 mass 4:00 location totally submitted with adjacent tissue, any ink present is the deep margin, B11-B17 possible mass at the 3:00 location totally submitted with adjacent tissue, any ink present represents the deep margin, B18-B22 possbile mass at 1:00 location totally submitted with adjacent tissue, black ink present represents the radial margin at 1:00, B23-B25 contain sections of remaining breast tissue as follows: B23 lower outer quadrant, B24 lower inner quadrant, B15 upper inner outer quadrant, B26 nipple. The specimen was removed from patient at XXXX hours & placed into formalin at XXXX hrs.

Given the above, I'd appreciate anyone shedding some light as to what the above means. I also hope, since I had a BMX, I can avoid having to do chemo and/or radiation therapy?? (I'd prefer the latter vs. the former!) I think the hardest part of my dealing with BC is test... then waiting for results... another test... waiting for results (and yada, yada...!). Enough to really unsettle you, if you do not have any support system or "relief valve" in place!!

Any input/thoughts? Very much appreciated! Thank you! Right now, I am praying for the day when BS will FINALLY remove these pains-in-the-a** remaining 3 JP drains I've been lugging around me since April 25!! (fingers crossed... I think their collective output is FINALLY slowing down to almost nothing! TG!!!)