Scan after lumpectomy?

Lexicoe
Lexicoe Member Posts: 66
edited March 2017 in ILC (Invasive Lobular Carcinoma)

Hi all,

My Oncotype just came back a 10 yesterday, so I don't have to do chemotherapy, which I'm happy about. But after reading these boards, that makes me more concerned about the fact that I had a lumpectomy with close margins on the deep side--it seems like so many ILCs opted for a mastectomy and then the pathologist found cancer cells found in the supposedly "clean" breast.

Question #1--Should I insist on a scan now? It seems like the time to do one would be before radiation, so if they do find something--they can remove it first? And maybe radiate at the same time?

Question #2--If yes, I've decided to move my treatment to some of the many great doctors back home here in Charleston--the only appointment I've made so far is with a RO, two weeks from now. Would I ask her for the MRI scan? Or do you usually have a BS or MO do that? (I have people in mind for those, but haven't made appointments yet.)

Thanks!

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  • Lexicoe
    Lexicoe Member Posts: 66
    edited March 2017

    I shortened the question, so hopefully someone will answer now, I hope...

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  • jojo9999
    jojo9999 Member Posts: 202
    edited March 2017

    Did you have an MRI at the time of diagnosis? My pre-surgery MRI was very accurate - the pathology from mastectomy showed the amount of cancer was very close to what the MRI indicated. Sorry can't be of help - I had to have a mastectomy because it was multifocal, and too spreadout for a LX. But I also had a low oncoscore (4) like you.


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  • Lexicoe
    Lexicoe Member Posts: 66
    edited March 2017

    Jojo,

    No, I didn't. I asked about whether I should get an MRI before surgery and the BS said I didn't need one--that she'd "be shocked" if any other problem areas showed up.

    But the more I read about ILC, the more I wonder if she was treating it like IDC. Especially since she never even mentioned a mastectomy as something to consider.

    I'm going to call tomorrow for an appt with a new MO, and this is one of the first things I plan to ask him about!

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  • jojo9999
    jojo9999 Member Posts: 202
    edited March 2017

    Did you have an MRI at the time of diagnosis? My pre-surgery MRI was very accurate - the pathology from mastectomy showed the amount of cancer was very close to what the MRI indicated. Sorry can't be of help - I had to have a mastectomy because it was multifocal, and too spreadout for a LX. But I also had a low oncoscore (4) like you.


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  • jojo9999
    jojo9999 Member Posts: 202
    edited March 2017

    I am no expert, but I think that a MRI is an important part of the testing, especially for ILC. When it comes to diagnosing ILC, most radiologists will admit that it is very different from IDC. Does your surgeon do only breast cancer? I would think that you could easily make the case for a MRI. I was treated at a research hospital (NCCN designated hospital) and I believe MRI is standard practice for most cases at my hospital.

    Spend some time reading through the ILC forum - lots of good information, especially concerning differences between ILC and IDC. Good luck with the new MO

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  • Lexicoe
    Lexicoe Member Posts: 66
    edited March 2017

    Jojo,

    Thank you! She does only do breast cancer and is affiliated with Duke, which I think is NCCN. And aside from her bedside manner, she has been fine.

    But yes, thankfully, there's tons of good info on here that I've been reading! And that has made me question her comments--and whether I should just switch to a surgeon closer to where I am now.

    Ironically, there is a teaching hospital that is NCCN here in Charleston but I've gotten about 2 dozen local breast cancer doc recommendations and 95% of them have been affiliated with the other hospital in town. Not what I expected at all!

    Tracy

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  • jojo9999
    jojo9999 Member Posts: 202
    edited March 2017

    here is an article from 2015 about the use of MRI for ILC. The authors of this article are from Duke. I would really push to get the MRI. Are they wanting to excise again given the close margins? Given your size and the ITC I would think more imaging would be in order.

    https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-015-0605-0

    Here is the conclusion

    Conclusion

    Lobular cancers continue to pose a specific challenge for radiographic detection. The previous discussion has highlighted that those imaging modalities reliant on contrast resolution are particularly limited by the less cohesive growth pattern of ILC. Thus, mammography and US imaging have a lower ability to discern ILC from the background density of normal breast parenchyma. Evidence evaluating the value of MRI for detection and diagnosis of ILC are emerging and provide support that MRI may be of increased utility compared with standard mammography or US. Newer technologies such as tomosynthesis and MBI are in active development and may be useful adjuncts to mammography and US, particularly for future surgical treatment planning. Together with a clinical commitment to maintain a high level of vigilance in patients presenting with nonspecific findings, continued advances in imaging will improve the ability to provide the best outcomes for women who present with lobular cancers.

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  • Lexicoe
    Lexicoe Member Posts: 66
    edited March 2017

    Thank you, Jojo! I've printed it off to show the doctor in case he questions why I'm asking for one!

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