Help understanding my surgical pathology report

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KimD
KimD Member Posts: 30
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

I had a nipple sparing skin sparing mastectomy on May 6. At my post op, my BS said pure DCIS and mentioned the isolated tumor cells.  He said it was only four cells and could have been from my biopsy in October. He never mentioned the close posterior margin.  He just handed me the report as I walked out.  I have an email into his assistant with questions but haven't heard back yet. I typed out what I think are the relevant parts of the pathology report below.

Thanks in advance for all of your help.

My questions are:

Should I have a second pathology opinion to  make sure it is pure DCIS.

If it is Pure DCIS, does the isolated tumor cells have any prognostic significance.

Is there any worry with my close margin?

The report states,"representative portions of the mass for Mammaprint." Does that mean they are doing mammaprint or do the automatically save portions in case mammaprint is requested. Is mammaprint an option with pure DCIS?

The surgical pathology report found

A. One lymph node with isolated tumor cells.  Comment: Threee to 4 single cytokeratin positive cells are seen in the lymph node, associated with giant cells.  AE1/AE3 immunohistochemical stain performed on blocks A1-A3 with adequate control suppots the above diagnosis(technical component performed at Clarient, Inc.).

B. DCIS, High Grade, solid and cribiform type with comedonecrosis, microcalcifications and focal secretory features. . . No invasion Identified.  DCIS is present <.1 cm from the posterior(deep) margin in the lower outer quadrant.

Pathologic TNM stage pTis(DCIS) pN)(i+)(sn)

Size of DCIS 4.5 cm

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Comments

  • Moderators
    Moderators Member Posts: 25,912
    edited May 2013

    Hi Kim,

    While you wait for the ever-helpful advice from others here, you may be interested in checking out the main Breastcancer.org site's pages on Your Diagnosis, which helps walk you through what each piece of your pathology report means.

    Hope this helps!

    --The Mods

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited May 2013

    Here is some info regarding the isolated tumor cells - it is a pdf, so copy and paste in your browser to view it, and it is in support of your BS assertion that this may be from your biopsy.  If they did not find any invasive component, and this is indeed what your pathology report states, there is no apparent explanation for movement of these isolated cells in your SNB.  The posterior margin might be concerning - was there any discussion of a rad consult?  I believe that some people have sent their slides to Dr. Lagios for a second opinion.  Here is some info:

    ajcp.ascpjournals.org/content/113/2/259.full.pdf‎

    http://www.breastcancerconsultdr.com/about_dr_lagios/about_dr_lagios.html

     
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  • KimD
    KimD Member Posts: 30
    edited May 2013

    Thanks Mods and Special K.  I have been trying to do some research both on this site and others.  There seems to be conflicting info as to whether isolated tumor cells mean anything prognostically.That may be because sometimes they are significant and sometimes they are just garbage cells.  I would like to know what the pathologist means by "giant cells." What are they and is it a good or bad thing?

    As to my posterior margin, <.1 cm could be 9mm or <1 mm.  I wish he had been more specific. Dr. Cox never even mentioned the margins.  He only mentioned the ITC in the lymph node and the epidermalysis of my nipple and handed me the pathology report as I walked out the door.  He said he would see me in two months.

    My other confusion is my hormone status.  I was diagnosed by core biopsy in 20011 as being ER+(All tests being 3 or 3%), PR negative.  I then procrastinated and had another core biopsy done in 10/2012 at a different facility.  This time the report came back as ER-, PR+(1%) and Her-2 positive. I don't know how this can be and the BS said that maybe one of the biopsy samples was not tested timely, which could cause different results.   I then had the surgery from the BS who did the first biopsy that found me ER+, PR-. The surgical pathology says:  Ancillary studies(per outside report, slides not reviewed) ER Positive 3%-PR Negative.  Couold this be the test results from my first biopsy or would they test the surgical specimens again? Because the results are exactly the same as my first biopsy and biopsy and tests were done by my current BS and lab.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited May 2013

    KimD - just sent you a PM

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  • Beesie
    Beesie Member Posts: 12,240
    edited May 2013

    Kim, about the posterior margin, .1cm = 1mm   So if the report truly said "DCIS is present <.1 cm from the posterior(deep) margin" ( the "." in front of the "1" being the most critical) then you know that the margin is less than 1mm.  

    Often for clarity a ".1" is written as "0.1" so that there is no confusion. 

     

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  • KimD
    KimD Member Posts: 30
    edited May 2013

    Thanks for answering my question Beesie.  The report says DCIS is present <0.1 CM from the (deep) posterior margin in the lower outer quadrant.

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  • ballet12
    ballet12 Member Posts: 981
    edited May 2013

    Hi KimD,  0.1 CM is 1mm, which is a very narrow margin (not a clean margin).  Sometimes radiation is recommended in that situation, after a mastectomy. 

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  • KimD
    KimD Member Posts: 30
    edited May 2013

    Thanks ballet12.  I guess I misread the decimal at first.  My BS never brought the narrow margin up when he went over my path report findings with me at my 10 day post op appt.  I only noticed the margin issue when I read the report myself after the appt.  I wrote some questions to his assistant to ask him, but haven't heard back.  I have been reading a few threads about close margins and was alarmed the number of times someone had their surgical pathology reviewed and got different results.  Many times pure DCIS was subsequently found by a 2nd or 3rd pathologist to have an invasive component.  Combined with the isolated tumor cells in the lymph node and the high grade comedo, I am confused on what to do next.  I am assuming my breast surgeon is not recommending further treatment as he said he would see me in two months.

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  • deb1973
    deb1973 Member Posts: 96
    edited May 2013

    Hi Kim,

    I also find pathology reports to be more confusing than not. In my experience, you have to do whatever gives you the most peace. I'd also read stories about women whose path was revised on second or third opinion & felt nervous about having such a large area of DCIS (& there was language in the initial biopsy review that said there were factors that were suspicious, but not diagnostic, of invasion) so I got a remote second opinion consult on the final path from MD Anderson. They agreed on most points w/ my caregiver institution but I'm glad I did it & may even have one more level of review b/c, for me personally, that is what it will take to feel comfortable with the integrity of the results.

    p.s. It is good that you are asking your doc for clarification about the narrow margin. As ballet says, some doctors recommend rads on an MX with narrow margins so it will be good for you to get further clarity on what, if any treatment, s/he is recommending.

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