Confused- what can the initial biopsy results actually reveal?

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MarieTherese
MarieTherese Member Posts: 85
edited August 2015 in Diagnosed and Waiting for Test Results

Hi All

I had a core needle biopsy on 8/5- they took 5 samples. They actually took more tissue than the size of themass they were looking at

On 8/7 - was told IDC - mass 3x3x11mm

Is there more info that the pathology report can give?

I hear some people getting info about staging or hormone receptor status after a biopsy. Is that just done after excisional biopsy?

I am scheduled to see a surgeon in 3 weeks and shcheduled for a lumpectomy as soon after that. Then it goes to pathology for another week and then they told me they can determine the treatment.

Should I be asking for more info at this point?

Any advice greatly appreciated

MT

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited August 2015

    Pathological staging is done after surgical removal and nodal status is known, the only staging that can be provided prior to surgery is known as "clinical staging" which is a guess based on imaging and biopsy info. It can, and often does, change after surgery due to the limitations of the information prior to surgical removal of the mass and sentinel node biopsy (SNB). Core biopsy information should include hormonal receptor and Her2 status beyond identifying the type of malignancy. Sometimes it takes a few days for the full pathology report to be generated as some labs don't routinely perform these types of tests, they have to be sent out. How long ago was your biopsy done? This additional information sometimes shows up as an addendum report to the original pathology report, but you should obtain a copy of all pathology reports for your own records.

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  • windingshores
    windingshores Member Posts: 704
    edited August 2015

    You will get grade, and estrogen/ progesterone percentages most likely. HER2 takes a little while. If it is equivocal at first they will do further testing (most likely FISH) which can take 2 weeks. Some labs do ki67 (proliferation) but many. I hope that they did not do Oncotype testing on your biopsy. My first hospital did that and it threw a wrench in the works: I had to fight to get it done on the surgical sample later. Oncotype testing takes two weeks. You can check online to see what tests were done. Often pending tests are on there too but sometimes you have to ask the office.

    If they did HER2 and there is any contamination of IDC tissue with DCIS or normal tissue, it will not be reliable. DCIS tissue in there can cause a false positive for HER2. I don't think this happens often but it happened to me.

    Grade can change too. Read up on what constitutes grade and how there can be very small differences between grades sometimes.

    The best pathology will be done after surgery but the post-biopsy tests will give you some idea of what you are dealing with.

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  • MarieTherese
    MarieTherese Member Posts: 85
    edited August 2015

    Ok- so more info may be coming. I had biopsy on 8/5 and my doctor was able to get the DX on 8/7 only because I am going away and they wanted to have a plan in place before I left. I see a surgeon as soon as I get back in 3 weeks, but my doctor told me to call her next week to schedule pre op clearance.

    They told me that hormone receptor could not be determined until after the whole tumor was removed. I would love to know this since it could really change the treatment options as we all know.

    Thanks for the input

    MT

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  • Morwenna
    Morwenna Member Posts: 1,063
    edited August 2015

    Seems to me that a biopsy can only give a snapshot. They only see what they happen to get in the sample taken. I think it gives an inference rather than a definitive diagnosis. I remember the grade, and I think it came back ad ER negative .....

    My diagnosis changed A LOT after the path results from my lumpectomy!

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  • ksusan
    ksusan Member Posts: 4,505
    edited August 2015

    I'll add that some places don't bother with oncotyping if surgery finds a positive node--in that case, they are going to recommend chemo no matter what your oncotype is.

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  • MarieTherese
    MarieTherese Member Posts: 85
    edited August 2015

    thanks- that is scary though. It makes you wonder why they do a biopsy if it really can't give you enough information.

    In my case they were pretty sure based on the US alone so I wish they could have just done it all at once

    MT

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  • queenmomcat
    queenmomcat Member Posts: 3,039
    edited August 2015

    I think the initial biopsy's intended to confirm whether it's cancer, without the need to put the patient under general anesthesia. (Having been through an ovarian cancer scare last year, i much preferred the beesting of a stereotactic biopsy, even through in my case the radiologist was also pretty sure it was breast cancer.)

    But I'm not a doctor, nor do I play one on television. All I know is my BiRads score went from 4 after the mammogram to 6 after the biopsy.

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  • Morwenna
    Morwenna Member Posts: 1,063
    edited August 2015

    Yes, I think Queenmomscat is right. The biopsy CAN give an accurate picture. You can at least confirm the presence of cancer, if not its exact extent and full characteristics, without the need for a general anaesthetic and unnecessary scarring.


    In my own case, most of my cancer was not showing on imaging, and the biopsy was highly suggestive of dcis, with only a suggestion of invasive ductal cancer. It turned out to rather worse than that. Sorry, I did not mean to alarm you, I only meant, well what I said really; that it might not show the full story, but it does confirm that further surgery is necessary.


    I wish you all the best! I am coming up for three years since diagnosis myself btw, and doing really well!!

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  • 614
    614 Member Posts: 851
    edited August 2015


    Dear MarieTherese:

    I replied to your other thread.   Enjoy your vacation.  At least you will be able to go away prior to your surgery. Good luck.

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  • MarieTherese
    MarieTherese Member Posts: 85
    edited August 2015

    614/ thanks

    Morwenna- you did not alarm me, you just helped me better understand what might happen and I appreciate that

    Take Care

    MT

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  • lindab142
    lindab142 Member Posts: 105
    edited August 2015

    I'm newly diagnosed, just Mon (4 days ago). Did any of you get a second opinion before getting surgery?

    My surgeon is ordering an MRI to see more, but first I have to go to PCP Dr. for a physical (because I need to be sedated). I'm feeling pretty panicky, having trouble sleeping (after getting up to pee [I drink water].

    But, I'm determined to think positive and get through this journey as a survivor. In a way, I want it to be done yesterday.

    Do you guys know of resources for good foods to eat and ones to avoid? I have a friend who's a raw diet person, eats lot of soups and veggies. She told me to stop eating sweets and bread. Oy!

    Another challenge is I'm still smoking. Blessing and releasing every cigarette to be a nonsmoker, but it's hard.

    What? Give up cigs and food? At the same time? Are you kidding me?

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  • Partyoffive
    Partyoffive Member Posts: 188
    edited August 2015

    marietherese:when I had my biopsy two years ago-I had a clinical diagnosis of stage 1 my breast tissue surrounding the tumor looked healthy and the dr's were confident that after my mastectomy(I was initially given the option to have a lumpectomy)I would be "all good" based on the limited info they had on my biopsy. I awoke and found out that I had malignant sentinel nodes(in all 11/21) after further scans they found out my cancer had metasticized. I am not the norm most biopsies are way more accurate then mine as the dr explained they r only getting a snapshot of 1/1,000,000 of the whole picture

    I'm not trying to freak anyone out just sharing my experience with the biopsy.

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  • DianaNM
    DianaNM Member Posts: 281
    edited August 2015

    My experience was the opposite, my biopsy path results looked way worse than the lumpectomy results. Biopsy said I had a ki-67 score of 58%, which is Grade 3 and luminal B. Both a Mammaprint and Oncotype test done on the lump were Low Risk, Stage 1A. Onco score is an 8. Kind of weird, but I'll take it!

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