Reading Path Report and Not Sure of My Decision Now

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takeitfor4
takeitfor4 Member Posts: 4
edited June 2014 in IDC (Invasive Ductal Carcinoma)
Reading Path Report and Not Sure of My Decision Now
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  • takeitfor4
    takeitfor4 Member Posts: 4
    edited August 2013

    Hi All,

    I just met w/ one of my docs re: Results from ONCOTypeDX as well as my path report.  She was very pro Rad w/Tamoxifen and reviewed my numbers with me.  Here's what I know:

    ONCOType # is 10, I am Stage 1b, Grade 2 w/ 0/6 nodes and ER/PR+, HER2-, and nuclear grade 2.  We discussed the benefits of chemo vs. Rad w/Tamoxifen and based on my numbers, she recommended the latter.  I agreed and came home with a copy of my path report and the ONCOType report.

    Here's my worries:  I originally was told my tumor was "Well Differentiated" (before surgery), but noticed the path report shows it was actually "Moderately Differentiated (Score: 6)".  Also, before removal, my tumor was estimated to be around 7mm in size (IDC), but post op, its actually 1.8 x 0.9 x 0.9cm.  I also noticed that the report says microcalcifications were present and location listed as Atypical Lobular Hyperplasia.

    Am I making mountains out of mole hills? Are all these notations actually minor in the scheme of what is the best treatment?  What do you folks think?  At a minimum, I think I'm going to be making a phone call on these details, but it would be helpful to understand other's experiences too.

    Your insights are appreciated.  Thank God for this site!

    Linda

    p.s. - Forgot to mention....I am 52 yrs. old and perimenopausal.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited August 2013

    Sorry to hear about your diagnosis. With regard to the final pathology report mentioning Grade 2 vs the initial diagnosis of Grade 1, please remember that the pathologist's opinion is very subjective. Opinions can vary. Likewise, the Oncotype DX score which measures various genetic markers of your tumor is probably a better indicator of how aggressive your tumor is. With a low score of 10, it appears that the risks of chemo outweigh the benefits and the chance of distant recurrence is low. You tumor has very favorable traits. And despite being larger than you first was told, it's still small and early stage. If you are not sure about a treatment plan, request a second opinion.



    Good luck!

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited August 2013

    My genetic MD said that grade IS subjective to the pathologist. I think there is even a chart on Genomic Health's website that show that local pathologist are often more conservative than those at national institutions when the same speciman is sent for a second opinion. He said that  oncotype trumps grade, no doubt, and there is even some talk that oncotype trumps size. To me your stats look like pretty good news. I know it is tough that the size was larger than they originally thought. To this day I still pick apart every piece of my path report looking for answers that probably will never be found. That is a natural tendency.

    It is all so so scary right now, but it will get easier over time. Hugs to you!

    ALH, ADH. high risk family, preventive bilateral mx on 2.21.12 that turned out not to be preventive.
    Dx 2/24/2012, IDC, 1cm, Stage Ia, Grade 2, 0/1 nodes, ER+/PR+, HER2-Surgery 02/21/2012 Prophylactic Mastectomy (Both); Reconstruction: Tissue expander placement (Both)Surgery 03/11/2012 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Surgery 07/22/2012 Reconstruction: Breast implants (permanent) (Both)Hormonal Therapy 04/10/2013 Tamoxifen

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  • coraleliz
    coraleliz Member Posts: 1,523
    edited August 2013

    The way the size difference was explained to me is that when you are standing(during a mamogram) your breast hangs one way. When you have an ultrasound, you are lying on your back & your breast hangs a different way. During a MRI, you lay on your stomach & your breast hangs a different way. The tumors are somewhat pliable & this accounts for the difference. I often wonder if sometimes the person reading these(since it's subjective) might be overly opromistic. I got variations from just under 1cm to just over 2cm & on final path it was 1.6cm.

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