Micro-invasion and future possibilities

Well, you've certainly put your own spin on the expression "When life gives you lemons, make lemonade!".

Happy Birthday and Merry Christmas to you, Percy!  You deserve to have a wonderful day!

That phone call stuff happens to all of us.  You are guaranteed to get a return call the minute you leave the phone to do something or turn it off.  This has gotta be a truism.  I hope you can reach someone today (it's already 12/24 here on the East coast).

Hi Percy:  Micro-invasion is invasive cancer, but at the earliest possible stage.  Hardly will even affect your treatment or outcome, but once the cells leave the in situ stage (DCIS) they are invasive.  You still have a very very early cancer and your outlook will be excellent. 

Hi Percy, glad to hear you were so hopeful and grateful on your birthday, and that the news from the path report was not any worse.

At least, you now have confirmation from three different places about the microinvasion.  You may not need Dr. Lagios, unless you want further input on the SNB question, which is a tough one. I wish I could help you on that one. 

I hope you continue to enjoy your holidays.

Percy, 

CAM5.2 is a new one for me.

This article suggests that the Calponin and P63 can be used to try to distinguish between invasive and non-invasive cells:  Immunohistochemical distinction of invasive from noninvasive breast lesions: a comparative study of p63 versus calponin and smooth muscle myosin heavy chain

This might be helpful too: Molecular markers for the diagnosis and management of ductal carcinoma in situ    I don't have time right now to try to locate the full article, but it might be helpful in explaining the difference between the stains.  Same thing with this one, although it's a much older article: Detection of stromal invasion in breast cancer: the myoepithelial markers

As for the number of nodes removed during an SNB, it all depends on how many nodes "light up".  The way an SNB works is that injections are made into the breast prior to the surgery. The
injections are either blue dye or radioactive isotopes or both. Several
injections are made, and they are aimed in different directions. The
dye/isotopes then travel through the breast and move to the lymph nodes
under the arm. The nodes that "light up" with the dye and/or isotopes
are the sentinel nodes. It's not that the dye/isotopes light up nodes
that have cancer. They just light up which ever nodes they enter into.

What is not well understood is that sometimes with an SNB, one node
is removed, but often it's 2 or 3 and it could even be up to 6 or 7.
When a sentinel node biopsy is properly done, the surgeon should remove
all of the nodes that 'light up' from the dye or isotope injections.
If only one node lights up, then only one node needs to be removed. But
if 6 nodes light up, then all 6 nodes need to be removed. If the
dye/isotopes were able to travel so quickly from the injection site in
the breast into 6 nodes, then logically if cancer cells were to travel
from the breast to the nodes, the cancer cells could just as easily
move into any one of those 6 nodes (or all 6). So when 6 nodes light
up, the surgeon can't just pick one to remove. Because of the way that
the nodes are bunched, there is no way to know which node was the
first one that the dye (and cancer cells) would have entered. All 6
nodes must be removed.

So basically the theory of an SNB is that the injected dye/isotopes
will follow the same pathways within the breast to the nodes that cancer
cells would have followed. Therefore whichever nodes are entered into
and lit up by the dye/isotopes injections are the nodes that would be
the most likely to have cancer cells, if any cancer had moved from the
breast to the nodes.

Lastly, with regards to Dr. Lagios.  Would it possible to send him an email highlighting your issues/questions (particularly about the SNB in relation to the presence of the microinvasion) and ask if that is something that he would be able to address or whether he sticks to issues specific to DCIS and rads?  There's no point in spending money on his opinion if he doesn't address things like an assessment of the microinvasion and the risk associated with it and therefore the need (or lack of need) for an SNB. But if he does address those things, his opinion could be the very valuable to your decision and peace of mind.

My understanding is that DCIS cells that are misplaced will not be able to survive for long.  So no, they won't have the ability to travel to the nodes.

Usually people who have repeated lumpectomies in a short time frame do so because the doctors were unable to get clear margins the first time, so go back to widen the margins. If your initial lumpectomy achieved clear margins then you should not need further surgery.

Hope that helps!

Hi Leenso, I would have so welcomed the procedure in your hospital, whereby a pathologist immediately stains margins, and presumably examines them under a microscope.  I had the two re-excisions because the margins weren't clean (none were, actually) after the first surgery.  That surgeon didn't even have margins marked or "inked", so when I went for a second opinion and ultimately the two re-excisions at the other hospital, the second surgeon had to go by "feel", resulting in, not one, but two re-excisions in a three week period.  I also asked for wide margins for the third surgery, which I now understand, based on current research, to be unnecessary, but were previous valued as a way to reduce recurrence risk. Best wishes on your recovery and follow-up treatment.