Risk Assessment: Shouldn't ALL Tissues Count?

Alpineartist
Alpineartist Member Posts: 53
edited June 2014 in DCIS (Ductal Carcinoma In Situ)
Friends, if this question has been previously posted, sorry, and please lead me there. Otherwise, here it is.

In risk assessment, we generally use wide excision tumor size and grade as primary metrics, correct?

But often, there's a previous biopsy also. Shouldn't biopsy tissue be considered somehow in prognostics? 

If biopsy tissue is of higher grade or significant size, but is left out of risk assessment, could it cause one to underestimate?

Thanks for your input.

Kay
· Share on FacebookShare on Twitter

Comments

  • redsox
    redsox Member Posts: 523
    edited September 2013

    The final path report should incorporate results of all prior biopsies and breast surgeries for the final grade and size. Sometimes it is not possible to get a precise and accurate total size because they cannot reconstruct exactly how the tumor segments fit together, especially if the first surgical procedure was not expected to find cancer.

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

    I agree with redsox. One's final diagnosis should be based on a combination of what was found in all of the biopsies and surgeries.

    A microinvasion of IDC was found in the pathology from my excisional biopsy.  My final and more significant surgery, my MX, found only DCIS. However my final diagnosis was Stage I DCIS-Mi, thanks to that microinvasion that was found in the biospy.

    · Share on FacebookShare on Twitter
  • Annette47
    Annette47 Member Posts: 957
    edited September 2013

    Just to agree with Beesie - I'm also Stage 1A due to the microinvasion that was found along with the small area of DCIS on my stereotactic biopsy, even though the lumpectomy found nothing (it was all removed by the biopsy).

    · Share on FacebookShare on Twitter
  • Alpineartist
    Alpineartist Member Posts: 53
    edited September 2013

    Thanks, ladies. How was it that you learned all this?
    Is it standard pathology procedure to take into account a patient's previous paths, and render a report based on all info?

    · Share on FacebookShare on Twitter
  • redsox
    redsox Member Posts: 523
    edited September 2013

    There are standards for what should be included in the path report and how the specimen should be prepared. The standards depend on the diagnosis or expected diagnosis so they differ for a cancer diagnosis vs. an expected benign result. For cancer the final path report should incorporate all earlier findings.



    I had a big head start when I was diagnosed because I have worked in cancer research for a long time. Some things I knew -- like the answer to your question because I knew we always look for the final path report. If it is done right that is the only one you need.

    · Share on FacebookShare on Twitter
  • Alpineartist
    Alpineartist Member Posts: 53
    edited October 2013

    Interesting. So, Redsox, how would you interpret final path on the following:

    Biopsy:  5mm grade 2

    Surgery: 6mm grade 1

    · Share on FacebookShare on Twitter
  • redsox
    redsox Member Posts: 523
    edited October 2013

    That looks like a report of each sample separately the biopsy info included in the final path report. Different sections of the tumor can have different grades so you have a combination of grade 1 and 2. 

    · Share on FacebookShare on Twitter
  • Alpineartist
    Alpineartist Member Posts: 53
    edited October 2013

    I see. -And the size? 11 mm?

    · Share on FacebookShare on Twitter
  • redsox
    redsox Member Posts: 523
    edited October 2013

    The maximum tumor size would be 11 mm and that is how most doctors would describe it. It might be less depending on the relative orientation of the two specimens.

    · Share on FacebookShare on Twitter
  • Alpineartist
    Alpineartist Member Posts: 53
    edited October 2013

    Interesting. -Not sure that's how mine was done. I'll have to ask. I did make contact with Genomic Health, who did my oncotyping. For their purposes, they ask for one sample that is most representative of tumor genetics, as selected by one's local pathologist. In my case it was the surgery sample. I can't help but wonder if the biopsy sample wasn't more representative, especially if it was indeed of a slightly higher grade. 

    On second thought, why fuss with what was done in the past - my onc is not very available anyway. I've contacted Dr Lagios for his opinon. According to his literature, all samples are considered in his final path report. (A phone call confirms this.) He is directly available to patients and very affordable, in my opinion, for the quality of care.  I'd like to see if he agress that the first sample is grade 2, then get his expert take on my omitting radiotherapy for now. -A little extra assurance can't hurt. (In case you'd like to know my story, here it is.) 
    Thank you, ladies (in particular Redsox) for your help. A great weekend to all!


    · Share on FacebookShare on Twitter
  • Alpineartist
    Alpineartist Member Posts: 53
    edited October 2013


    Update: Dr Lagios did downgrade my biopsy sample to low grade also, based on the absence of necrosis. He absolutely agrees that I should wait on radiotherapy, and advises that I omit Tamoxifen and other such drugs. After our 45-minute phone consult, I couldn't be more happy that I used his services, and couldn't recommend him more. If it is all right to post a link to his page, here it is. Thanks again for all your help, ladies.


    Blessings and health to you,


    Kay

    · Share on FacebookShare on Twitter

Categories