Some advice please?

Sorry--what's "WLE"?

Hi alant:

If she had a biopsy, there should be a detailed pathology report available describing the full findings of the pathologist. In addition to the diagnosis of DCIS, it should include things like the grade, estrogen receptor (ER) and progesterone receptor (PR) status, and comments on whether there are signs of invasion or micro-invasion, the size of the surgical margins (i.e., how close is the DCIS is to the edge of the sample if it was a surgical biopsy), etc. In the US, your wife is entitled to receive a copy, and should immediately request one in order for both of you to be fully informed, before making decisions about surgery.

Your understanding of DCIS is correct. "Ductal Carcinoma in Situ" or DCIS is a non-invasive form of breast cancer that is confined to the ducts. It is by definition a "Stage 0" cancer, or the lowest stage with the best prognosis. However, over time, some of the cells may gain new skills to become "invasive" and break through the wall of the duct. Once they do, the rogue cells are "invasive ductal carcinoma" or "IDC".

Here is a short summary with pictures about DCIS and how it can progress to invasive cancer (breaking through the wall of the duct), from this site. Scroll down a ways to the illustrations to see:

http://www.breastcancer.org/symptoms/types/dcis/di...

A biopsy is just a representative sample of the lesion. There will be an additional pathology assessment of the tissue removed in surgery. In some cases, areas of invasion are found.

If they are now recommending a lumpectomy with concurrent sentinel node biopsy, I have posted on a similar situation discussing the option of doing a lumpectomy, obtaining the pathology, and then doing a sentinel node biopsy only if indicated. Please note that this may not be available in all cases, as explained in more detail here:

https://community.breastcancer.org/forum/68/topic/...

I recommend reading the entire thread at the link above, as other members provided additional views, information and perspective, and then reviewing the pathology report from the biopsy and following up with the surgeon with questions about whether medically she has the option to defer SNB and undergo a second procedure for SNB if invasion is found in the post-surgical pathology, or if not, why not.

If you have doubts about what is being recommended to you and your wife, I encourage you both to please consider obtaining a second opinion, which will include a review of all imaging, the pathology slides (sent overnight), a review of all associated written reports, and an independent recommendation regarding treatment options preferably from a breast surgeon (not a general surgeon).

Don't hesitate to ask more questions if this doesn't address your questions fully.

BarredOwl

I had a wide excision lumpectomy with sentinel node removal July 17th. My surgeon opted for the node/biopsy removal in case the DCIS had invaded out of the duct. The biopsy is never 100% accurate, mine said my DCIS was 0.7 cm with micro invasion absent. My surgical pathology report says the DCIS was 2cms big with invasion. So I agree with your wife's surgeon better to be safe than sorry and do the sentinel node.