Biopsy Report

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softheart45
softheart45 Member Posts: 5
edited August 2016 in IDC (Invasive Ductal Carcinoma)

Hello,

Last Tuesday I found out I have IDC. I see a surgeon tomorrow. I have my Biopsy report & I was wondering if someone could explain more on my results. Any thoughts?

Thanks!

BREAST PROGNOSTIC MARKERS:
Beaker Case #: S16-045455

A) RIGHT BREAST, 11 O'CLOCK, ZONE 2: INVASIVE CARCINOMA
ESTROGEN RECEPTOR: POSITIVE (98% of tumor nuclei; Strong staining)
PROGESTERONE RECEPTOR: POSITIVE (97% of tumor nuclei; Strong staining)
HER2 BY IMMUNOHISTOCHEMISTRY: NEGATIVE FOR HER2 OVER-EXPRESSION
(1+ staining)

B) LEFT BREAST, 11 O'CLOCK, ZONE 3: INVASIVE CARCINOMA
ESTROGEN RECEPTOR: POSITIVE (99% of tumor nuclei; Strong staining)
PROGESTERONE RECEPTOR: POSITIVE (54% of tumor nuclei; Strong staining)
HER2 BY IMMUNOHISTOCHEMISTRY: NEGATIVE FOR HER2 OVER-EXPRESSION
(1+ staining)

MATERIALS AND METHODS, AND REFERENCE RANGES:
- Adequate number of tumor cells present on re-cut H&E stain from block A1 and B1.
- Internal control staining for hormone receptors is absent and external control
staining is within normal limits on A1 and B1.
- This specimen was placed in formalin within
1 hour of removal from patient, and
fixed in 10% neutral buffered formalin for a minimum of six hours, not to exceed
Seventy-two hours.

TESTING INFORMATION FOR HORMONE RECEPTOR ANALYSIS:
Estrogen and progesterone receptor proteins (ER and PgR) are assayed by immunohistochemistry with quantitative microscopy, following tissue fixation in 10% neutral buffered formalin. Tissue sections are incubated with an ER rabbit monoclonal antibody (Neomarkers clone SP1; polymer detection system), and a PgR mouse monoclonal antibody (DAKO clone PG636; polymer detection system). A positive control is run with each sample.

Image analysis method: Slides interpreted qualitatively using the Aperio Imaging System.

ASCO/CAP consensus guidelines for ER analysis of tumor:
- Positive: 1% or greater tumor nuclei positive
- Negative: 0-0.9% of tumor nuclei showing staining
- Average staining intensity = Negative, Weak, Intermediate, Strong

TESTING INFORMATION FOR HER2
OVEREXPRESSION BY IMMUNOHISTOCHEMISTRY (IHC):
HER2 analysis by IHC is performed on invasive breast cancer sections following tissue fixation in 10% neutral buffered formalin. Tissue sections are stained using the FDA-approed Ventana Pathway HER2 (4B5) primary antibody (rabbit monoclonal HER2Neu antibody and Ventana polymer detection kit, with Ventana BenchMark ULTRA automated slide stainer). Control tissue is stained in parallel. Evaluation is performed using manual IHC morphometry.

FDA guidelines for HER2 over-expression via IHC:
- Positive: Score 3+: More than 10% of invasive tumor cells must
exhibit strong, complete, uniform circumferential membranous
staining.
- Equivocal: Score 2+: Weak or moderate heterogeneous complete
membrane staining in greater than 10% of cells, or, strong,
complete, uniform circumferential membranous staining in less
than or equal to 10% of tumor cells
- Negative: Score 0-1+: No staining (0), or weak, incomplete
membrane
staining (1+) in any percentage of cells


DISCLAIMER:
Per ASCO/CAP guidelines, these test results are valid for non-decalcified paraffin embedded specimens fixed in 10% neutral buffered formalin between 6 and 72 hours.

REFERENCES:
PMID:9504686, 24099077, 21960707, 20194857 and 21502545
AMENDMENTThis report is issued to clarify that the left breast biopsy is specimen B (not A as originally recorded). The diagnoses remain unchanged.
Final DiagnosisA) RIGHT BREAST, 11:00, ZONE 2, ULTRASOUND-GUIDED CORE BIOPSY:
1. Invasive ductal carcinoma
a. Nottingham grade: II of III; Nottingham score: 7 of 9
b. Angio-lymphatic invasion: Absent
c. Associated DCIS: Absent (atypical ductal hyperplasia/ADH is present)
2. Estrogen and progesterone receptor immunohistochemistry, and HER2
analysis are pending on block A1 and will be reported in an addendum

B) LEFT BREAST, 11:00, ZONE 3, ULTRASOUND-GUIDED CORE BIOPSY:
1. Invasive ductal carcinoma
a. Nottingham grade: I of III; Nottingham score: 5 of 9
b. Angio-lymphatic invasion: Absent
c. Associated DCIS: Present
d. Subtype: Cribriform
e. Grade of DCIS: 2 of 3
2. Estrogen and progesterone receptor immunohistochemistry, and HER2
analysis are pending on block B1 and will be reported in an addendum
COMMENTThese are image-guided breast biopsies. The pathologic findings should be correlated with radiologic and clinical findings prior to treatment decisions.

Case seen in consultation with Dr. Nelson.
Clinical InformationSite A) Right breast irregular mass with spiculated margin. Total area: 1.1 x 0.9 x 0.8 cm. Right, 11 o'clock, zone 2.

Site B) Left breast irregular mass with spiculated margin. Total area: 0.6 x 0.6 x 0.4 cm. Left, 11 o'clock, zone 3
Gross DescriptionA) Labeled "right breast US core biopsy" are four fibrofatty core needle fragments of soft tissue ranging 0.3 to 1 cm length, 0.1 to 0.2 cm diameter. The cores are inked BLACK. The specimen is submitted in toto in one cassette.

The specimen was removed from the patient at 3:55 PM on 7/26/2016. The specimen was placed in 10% neutral buffered formalin at 3:55 on 7/26/2016. The specimen was fixed in formalin for a minimum of 6 hours and not longer than 72 hours.

B) Labeled "left breast US core biopsy" are four fibrofatty core needle fragments of soft tissue ranging 0.4-0.7 cm length, 0.1-0.2 cm diameter. The cores are inked BLUE. The specimen is submitted in toto in one cassette.

The specimen was removed from the patient at 4:05 PM on 7/26/2016. The specimen was placed in 10% neutral buffered formalin at 4:05 on 7/26/2016. The specimen was fixed in formalin for a minimum of 6 hours and not longer than 72 hours.

TRB:llg 7/26/2016
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Comments

  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited August 2016

    Hi softheart.So sorry about the diagnosis. It shows that you have invasive cancer in both the right and left breast. Both tumors are small and ER/PR pos and her2 neg which is the most common kind of breast cancer. One side is grade 2, and one side is grade 1. This link can help explain things better.http://www.breastcancer.org/symptoms/diagnosis

    I'm sure this is all a shock to you. I'm glad you found us. Hang in there. As the days unfold the dx will become less frightening. Gentle hug.

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  • softheart45
    softheart45 Member Posts: 5
    edited August 2016

    Thank you! I understand all of that, but I'm not clear on the other findings. The margins etc...I also don't know what stage I am...just trying to learn everything,...


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  • SpecialK
    SpecialK Member Posts: 16,486
    edited August 2016

    softheart - you can only be given a clinical stage right now, true staging does not happen until after surgery. Based on size, and assuming you are node negative, you would be clinically stage 1A, but that can change after surgery and Sentinel Lymph Node Biopsy (SNB) testing. Imaging can provide a measurement of your tumor(s), but depending on the imaging modality your tumor may be larger, or smaller, when removed in its entirety at surgery and this can change the staging as well. Here is BCO's staging info:

    http://www.breastcancer.org/symptoms/diagnosis/staging

    The margin comment is describing shape, not a surgical margin since the tumor has not been removed, so is not of concern with regard to biopsy. The first half of your report concerns the imaging description, size, location, etc., your hormonal receptors, Her2 status, the testing methods and standards used to determine those two things. It actually looks like the addendum that is referred to in the later part of the report, which said it is pending. As farmerlucy indicated above, both tumors are IDC, the most common type of invasive breast cancer, with ER+/PR+/Her2-, which is also the most common arrangement of receptors and Her2 status. The tumor in your right breast is grade II, with no LVI ( lymph vascular invasion - not having it is a good thing), is IDC with no DCIS, and is about a sq 1cm in size. The left breast is both IDC grade I, and DCIS which is grade II, no LVI, and is about a sq half centimeter in size. Other than surgically removing the DCIS, the IDC in the left breast is what will drive treatment decisions. The remainder of the report describes how the specimens were submitted to the lab and prepared.

    Just an FYI - since this is a publicly searchable site you might want to remove your name from the report in your header for privacy.

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  • softheart45
    softheart45 Member Posts: 5
    edited August 2016

    Thank you so much! This is quite helpful....Thanks for taking the time to write this...:)

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  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited August 2016

    Claudette, sorry you have to be here, but welcome to the sorority nobody wants to pledge. The good news is that your tumors are apparently tiny and not aggressive. As SpecialK notes, you can’t know the exact stage until surgery (which will reveal actual size and any lymph node involvement); but if nothing changes on the surgical pathology (and you get clear margins and all negative nodes) you’d be Stage IA in both breasts (even though DCIS is Stage 0, the invasive tumor is the one that will determine treatment going forward). That the IDC in your L breast is only grade 1 is very favorable. I’m sure your surgeon will discuss with you whether you want to do bilateral lumpectomies or mastectomies (given the small tumor sizes and favorable hormonal/HER2 profiles, I’d go with the least invasive surgery possible, especially with the location of the R tumor on the upper outer quadrant--you can always dig deeper or do mastectomy later, but you can’t undo a mastectomy). I was told that the risk of recurrence was very low with either option, and overall survival exactly the same--and decided I’d rather get lumpectomy & radiation and keep my breasts for now. Only you can know what would and wouldn’t give you peace of mind. I note that the report doesn’t mention your age, which might affect your priorities.

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  • softheart45
    softheart45 Member Posts: 5
    edited August 2016

    Thanks for the info...:) I'm 53 & also, I am a quadriplegic (SCI) for 35 years.


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  • Englishmummy
    Englishmummy Member Posts: 337
    edited August 2016

    Claudette - this is devastating for you I understand, we all do. I was also diagnosed with bilateral BC, similar pathology to you, last year at age 41.

    Please take a peek at this thread: https://community.breastcancer.org/forum/109/topic...

    it is not super active but if you want to chat, it will light up quick! It will also help you see you are most definitely not alone as there are a number of us on there, but also scattered throughout the boards. This place is a wonderful draw of hope and strength, use it as you need.

    Hugs, Laura x

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  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited August 2016

    Claudette, you do have quite a few challenges--not the least of which might be your ability to do daily radiation treatments. Best of luck in your consultation with your surgeon tomorrow. As we say here on bco, “we’re in your pocket” for this.

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  • softheart45
    softheart45 Member Posts: 5
    edited August 2016

    Thank you everyone for your replies. It was quite a shock to learn I have breast cancer. I'm anxious to see the surgeon and hopefully get on the questions answered. You guys have really been helpful and I feel better after Reading all of the replies. Thank you again and I Will post

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