Please Help me understand my sister's biopsy pathology report

Karenna16 · April 2016

Hello. My sister got the results of her initial biopsy via telephone on 4/22/16 from her family doctor. I posted in the 'Just Diagnosed' thread. My sister has some learning disabilities. She was not able to articulate to me what the doctor had told her She is 52 and she lives with her 14 year old son.

She was told that an appointment would be made for her to see a specialist. I planned on going with her to the appointment.....but I was at work Monday (yesterday) when she was told to come in at 2:15pm. We thought this appointment would be later in the week.

She came home from her appointment and I was waiting for her at her apartment. She went alone to the appointment. She shared all the paperwork with me and showed me all the gifts she was given. Books....one called, 'There's No Place Like Hope'. She received tote bags and handmade pillows, herbal tea, pens, wig catalogs, and a folder filled with lots of wonderful resources for BC patients. Free membership for the YMCA.....I'm sure most of you are very familiar with all this.

I read the pathology report from her biopsy.

It says:

Well differentiated invasive Ductal carcinoma. Fibrocystic changes including Ductal ectasia and sclerosing adenosis focal columnar cell change

Tumor Type: Invasive Ductal

Invasive Carcinoma Overall Grade 1

Glandular (acinar)/tubular differentiation score 2

Nuclear Pleomorphism Score 1

Motic Rate 1

In Situ Component: present. Nuclear Grade: Low. Necrosis- No

Architectural Pattern: Papillary

Micro calcification within tumor- Absent

AngloLymphatic Invasion: Not detected

Estrogen receptor done on block A1 -Positive

Average Intensity of staining: Strong

Progesterone Receptor Negative

Internal controls present and PR positive (as expected)

HER2 Negative (score 1+)

2.5 x 2.0 x 0.1 cm yellow cylindrical tissue

My sister said that they will be scheduling her for surgery within a month's time. She will not have to stay overnight. She will then have chemo/radiation and hormone treatment.

Basically this is all that she was able to tell me.

My sister does have some liver damage

If anyone can explain or help me understand the biopsy results, I would appreciate it immensely.

Thank you in advance.

Bless all of you

Hopeful82014 · April 2016

Karenna, first let me say how sorry I am about your sister's diagnosis. It sounds as though you are a huge support to her and that this will impact your life heavily, too.

I can't help you with all the details (a few - below) but would suggest that if at all possible you establish a strong working relationship with the nurse navigator (s) at your sister's treatment center. She should be able to answer just about every question that arises - including checking with you scheduling if you want to accompany your sister (a really good idea), making sure her liver issues are conveyed to her MDs, etc. You should be able to just call her, although you may have to have your sister sign a HIPPA release.

What I see looking at the path. report is that your sister's cancer is not too aggressive, based on the Grade 1 designation. It's early stage, smaller, and not thought to have spread to her nodes, based on the Stage 1 designation. The replication rate is low. This is all good news.

She is ER+, PR+ and HER2 negative - those are favorable characteristics.

Depending on other factors, she may be able to opt for lumpectomy and radiation followed by either Tamoxifen or an Aromatase Inhibitor (AI) for a minimum of 5 years. Bear in mind that the biopsy is somewhat preliminary information - the final, surgical pathology may reveal somewhat differing information.

There is a section on the main BCO site (not the discussion boards) on understanding your pathology report that addresses the surgical path. report rather than the biopsy report but you may find it helpful. There are also many articles which address the various factors and treatment protocols that you and your sister may want to read together.

I'm not a pro by any means and I'm sure someone will come along shortly to expand on this. In the meantime, I wish both of you the best. None of this is easy but there is a great community here to help you through it. You may also want to reach out to support groups at her treatment facility - check with the nurse navigators and social workers in the cancer care unit for plenty of specific recommendations. Take care.

SpecialK · April 2016

Karenna - so sorry to hear of your sister's diagnosis, this is very hard on family, and it sounds like there have already been some challenges with your sister's health. Your sister's pathology shows that she has the most common breast cancer type, hormonal receptor and Her2 status. This is a good thing because this type of cancer is well understood and there are therapies available. The notation of no LVI (angiolymphatic invasion) is a good thing, and it looks like "clinical staging" is stage 1, but pathological staging is not done until after the mass is removed and nodal status is determined. Hopeful explained things very well above, but I wanted to add that chemo tends to work better on rapidly dividing cells, and your sister's tumor appears to be somewhat indolent, so chemo may not be an effective tool in treatment. Because she is ER+ she would be eligible for an Oncotype Dx test. This is a genetic assay test of the removed tumor sample to determine whether there is benefit in adding chemo to hormonal therapy, which is more of a given in treatment of ER+ patients. If you can, I would ask about this - and encourage you to see if you can gain access to her oncologist and medical records so that you have a more clear path to information. I would want to be very sure that chemo is necessary because chemotherapeutic agents are notoriously hard on the liver, and you have indicated that there is already an issue. Wishing you, your sister, and your family the best, hang in there!

Please Help me understand my sister's biopsy pathology report

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