Please help me, ladies

Hi Percy, Happy New Year (I hope!)

I wish I could help with those big real life things like unemployment and money.  It's tough enough to go through what you are going through when those issues aren't also pressing.  I also wish that Kaiser was more helpful to you.  I think it's great that you are consulting with Dr. Lagios. I have read that his consultations with you by phone are really thorough, and I'm sure he will answer all that he can, from whatever he gleans from the pathology (including size of the lesion, margins, etc.) It's probably a real microinvasion, so rads is important.

As I have said, I had major cosmetic changes to the breast from all of the surgeries (including three prior to the three lumpectomies).  The radiation actually IMPROVED the breast.  It did not get any smaller.  It filled out a little bit over time.  The skin is baby soft (you actually lose the tiny hairs on the breast that you can't even see). Just do it!  It'll be OK.  We'll be here holding your hand (as well as those on the rads threads, if you care to join them).

Percy, when you say "Do realize it's probably a real micro, but need to understand WHY, biologically" are you looking for the answer as to which immunostaining tests were done to confirm that this is an area of invasive cancer and not just displaced DCIS cells, or are you looking for the reason why you would develop a microinvasion when you had such a small area of non-aggressive DCIS?

To be honest, I don't think you will ever get the answer to the second question because this is something that just isn't understood yet within medical science.  I talked to this a bit in one of my earlier posts in one of your other threads:

One of the big mysteries is why some DCIS converts almost immediately
to become IDC and develops
from that point on as IDC, while other DCIS develops and spreads within
the ducts as DCIS
and never becomes invasive, or perhaps just a small amount of cancer
breaks through the duct after many years and a microinvasion develops.

Approx.
90% of IDC starts as DCIS. In most cases of
IDC, whatever the grade, some amount of DCIS is also found. Usually the
DCIS is the same grade, but not always. Most often when the diagnosis is
IDC, what's found is just a
very small amount of DCIS mixed in with a much larger amount of IDC. So
in
these cases it would appear that the DCIS broke through the duct to
become IDC very early on, and at that point the DCIS stopped developing
within the ducts and only the IDC cells continued to multiply and
spread. Percy, this might be what would have happened in your case, had
your cancer not been caught when it was.

Then there are cases
like mine, where a
very aggressive DCIS spreads throughout the ductal
system for years, and at some point in just one area a small amount of
the DCIS breaks through the duct wall and becomes IDC. Once my
microinvasion developed, if I hadn't had surgery, would I have developed
a lot more IDC? Or would my cancer have continued to develop as DCIS,
as it likely had for years, with just that one tiny microinvasion?

So
those are two completely different models that both result in a
diagnosis that includes a combination of both DCIS and IDC. Both start
as DCIS, but in one case the IDC takes over almost immediately and
becomes dominant, and in the other case the DCIS always remains
dominant. When a biopsy diagnosis is DCIS, we assume it's the second
scenario. But sometimes it's not; sometimes it turns out to be a case
of IDC with just a small amount of DCIS. If your cancer had not been
caught when it was, how would it have developed? Would it have become
predominantly IDC, or would it have remained predominantly DCIS? I don't
think there is any way to know.

As for the first question, that is something that Dr. Lagios hopefully can answer for you.  There are specific immunostains that are done to try to determine if cells are microinvasive or DCIS.  Here is some of the information on this that I provided in my previous posts:

• See the discussion of In Situ v. Microinvasion near the bottom of this web page: Immunohistochemistry in Breast Pathology

• 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

.

Have you seen these diagrams from the breastcancer.org site? You can
see how a microinvasion just breaks through the cell wall. So what they are looking for is both the cells on the outside of the duct, and the breaks or gaps in the duct wall - and that I believe is what some of the immunostaining aims to find.  http://www.breastcancer.org/pictures/types/dcis/dcis_range

As for the SNB, here is a copy of part of the explanation of the SNB procedure that I provided previously: 

• 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.

.

Although many of the articles about SNBs say that the injections are done at the tumor site, that's not actually necessary and that's why SNBs can easily be done after a lumpectomy surgery has already removed the tumor. I had four injections done around my nipple; this is how it's commonly done.  I then lay for about 15 minutes with my arm raised under a scanner (I believe it's called a gamma scanner; the process is called lymphoscintigraphy) and I was able to watch on a computer screen as the four injections each started off heading in different directions in my breast and then each turned and began to snake their way toward my underarm nodes.  Before reaching the nodes, all 4 injection streams joined together.  So I knew before I went into surgery that I clearly had one or more sentinel nodes.  Sometimes those injections don't all join up and it means that there is no clear sentinel node; in those cases more nodes need to be removed. My surgeon had warned me about that, but it only happens in only a small percent of cases.  Most SNBs are successful in highlighting the sentinel node(s), usually anywhere for 1 to 4 nodes (but sometimes even 6 or 7). 

As for your liver situation, hopefully the ultrasound is all that is necessary and no biopsy is necessary. That's the problem with MRIs or any general scanning (CTs, PETs, etc.) - they tend to find all sorts of things that you might prefer not be found.  My last breast MRI found spots on my spine - spots that had the appearance of spinal mets.  The few weeks that it took to get that cleared up were not fun at all but fortunately I didn't need any more testing or biopsies - just a more expert analysis of my imaging by my oncologist and a radiologist who specializes in spinal mets. 

Lastly, you have a lot of threads going and it's
getting hard to keep track of where we discussed what; I had to do a lot of digging to find the info that I'd previous provided and wanted to refer to here.  So as a suggestion, it
might be easier going forward to stick with one or two primary threads
so that we can continue the discussions with references back to earlier
posts in the same thread.

Good luck with the liver ultrasound!!

Love the graphic

Well 'Crap!' to the liver ultrasound results.  I can appreciate why you are getting scared... I've been there (except that it was my spine not my liver)!  The one thing I can tell you from all my years on this board is that lots of non-significant garbage in the liver shows up on MRIs so hopefully that's what it is in your case.

When I was going through the possible spine mets thing, I was pretty scared for about the first 48 hours and at that point, I talked myself down.  I reminded myself that with a microinvasion, I had at most a 1% chance of developing mets - so yes, it was possible but highly unlikely.  And whatever it was, it was.  Worrying wasn't going to change it.  So why drive myself nuts over something that had a 1% chance of happening and that I couldn't do anything about anyway?  Once I gave myself that little talking to, I was fine.  Of course it remained in the back of my mind the whole time until it was resolved, but I really did stop worrying and I become quite calm about it. 

Interesting that your surgeon is interested in Dr. Lagios' opinion.
That's good because it means she'll be receptive to whatever he says.
That's often not the case with the primary surgeon.

Good luck with the CT scan!  Did you get any idea of how quickly it will be scheduled?

Hi Percy,  Sorry you have to go for the liver CT.  I hope that can be scheduled soon, so that you can get resolution on it.  I like Beesie's reasoning, that there is only 1 percent change of metastasis from bc with the microinvasion.  At the same time, it would be impossible to get it out of one's mind until the issue is resolved.  I am very happy to hear that the surgeon will be open to Dr. Lagios's views on the snb.  So, now, you have to be ready to decide what you would do with the information if Lagios says "yes" to snb or "no" to snb.  That's the really hard part. I gather that you've been leaning toward doing it, because it's the "standard of care" for microinvasion, and you'd worry, forever, if you didn't do it.  I hope you can get these things out of the way, move on to radiation, and return to some semblance of normal life.