DCIS - MRI RESULTS

diad · January 2016

Non-invasive DCIS in the right breast was confirmed following a biopsy. The Surgical Oncologist ordered a MRI. The MRI says: "There is an area of non‐mass enhancement in the anterior breast measuring
approximately 3.7 x 3.8 x 3.8 cm." Is this a really large area and, if so, does that mean anything in terms of whether it ever might become invasive?

Moderators · January 2016

Hi diad, and welcome to BCO. As we are not medical experts, we suggest that you ask your doctor about that. What are they suggesting in terms of a treatment? Are they providing additional information?

CAMommy · January 2016

hi,

The bigger the area the greater the risk of included invasive, however I had a large 5+ cm area with no invasive. Other people have small areas and do get invasive. DCIS is a funny thing that they don't really understand completely.

I found waiting for my lumpectomy results to be the absolute hardest part of this whole thing.

BarredOwl · January 2016

I'd ask if the results of the MRI are concordant with prior imaging, or do these findings indicate either a larger or additional srea of concern, and if so, what are the implications (if any) for continued surveillance, additional biopsy, or surgical planning.

Good luck.

BarredOwl

BLinthedesert · January 2016

My MRI highlighted a much larger area than the ultrasound/mammogram did - so much so that the radiologist at the MRI center said, "the area is so large that cosmosis after lumpectomy is likely to be unacceptable and MTX might be a better option". My surgeon told me that MRI often shows a larger area than is actually involved. He let me make the decision, and I decided to proceed with lumpectomy, and wait to see what the margins looked like. Margins were great -- only ADH, no DCIS and no IDC. For me, MRI was a little "too" sensitive size-wize.

Best luck to you, I know this is such a difficult time.

Amstar15 · January 2016

This is what happened with my wife. She had DCIS for about two years that ended up getting bigger in size (area wise) and she did develop a cancerous tumor as well as non cancerous tumor in the middle of her DCIS in her right breast. The DCIS was so large that the cosmetic look of her breast after going in and removing all of the DCIS wouldn't of left much of breast. Her breast surgeon also stated that when it comes to a lumpectomy to treat DCIS -- he looks at this this -- DCIS is like chocolate chips within a chocolate chip cookie. To expect him to go in and get all of the various chocolate chip pieces during a lumpectomy is not feasible.. there are always small small chips that may not be taken out --- so to him a mastectomy is the way to go.. especially when the area is large such as it was for my wife's case.

Whatever you choose best of luck and let us know

BarredOwl · January 2016

Hi:

The advice that Amstar's wife received makes sense based on the extensive DCIS relative to the size of the her breast. She likely had additional imaging findings showing scattered disease. I had a similar situation (multifocal DCIS spanning 5 cm in a small B cup). However, many women on these boards receive lumpectomy plus radiation even for 5 centimeters of DCIS or larger.

As far as the chocolate chip cookie analogy, this would only apply in specific cases, such as where imaging shows multiple areas of suspicious calcifications and/or biopsies show multiple areas disease, and given the particular geometry, the disease cannot be adequately addressed by lumpectomy with a reasonable chance of obtaining clear margins and a cosmetically satisfactory outcome. Again, in many cases of DCIS, lumpectomy is an available and excellent option.

As noted in Beesie's famous posts, and confirmed by subsequent studies, lumpectomy plus radiation is as good or better in terms of overall survival as mastectomy.

For more information, please see Beesie's posts:

A layperson's guide to DCIS (scroll up to the top of the page for the original post):

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

Lumpectomy vs Mastectomy Considerations (scroll up a bit to Beesie's post of Jun 20, 2013 12:00PM)

https://community.breastcancer.org/forum/91/topic/...

BarredOwl

BarredOwl · January 2016

Diad:

Are you planning on surgery soon? As Beesie explains in her Layperson's Guide post (see link in my previous post), with a diagnosis of DCIS made by limited biopsy, one does not have a complete picture of what is in there until after surgery and pathology of the surgically removed tissue is completed. In roughly around ~20% of cases, some invasive disease may be found after surgery, although the invasive disease tends to be small and so is early stage.

DCIS is seen as a precursor of invasive disease. Thus, clinical factors like a large area of DCIS, higher grade, and palpable lesions may be associated with an increased likelihood of finding some invasive disease, but this is not always the case and it is not possible to reliably predict from such factors exactly which particular patients will be found to have invasive disease on surgery or which would develop invasive disease, if left untreated. This is why surgery is done.

Keep us posted.

BarredOwl

Age 52 at diagnosis - Bilateral breast cancer - Stage IA IDC - BRCA negative;

Bilateral mastectomy and SNB without reconstruction 9/2013

Dx Right: ER+PR+ DCIS (5+ cm) with IDC (1.5 mm) and micro-invasion < 1 mm; Grade 2 (IDC); 0/4 nodes.

Dx Left: ER+PR+ DCIS (5+ cm); Grade 2 (majority) and grade 3; isolated tumor cells in 1/1 nodes (pN0i+(sn)).

DCIS - MRI RESULTS

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