Re-excision post lumpectomy for LCIS
Hi. There doesn't seem to be a lot of activity on this forum, but I thought I'd throw a quick question out here. Has anyone had to have a re-excision after Lumpectomy for classic LCIS? If so, what wasyour outcome? My surgeon (who is awesome & I totally trust) has scheduled me for a re-excision due to having positive margins. I'm all for it & understand why. But I'm wondering about a possible upgrade?
Comments
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Hi LoveT, I was in the same predicament, just had my second surgery last Thursday - because margins were not clear the first round - and because they found microinvasion they checked my sentinel lymph node - I am now awaitng those results. So depends on what they find - I started at simple DCIS stage 0 - now up to Stage 1. I found the second surgery was very easy - on me. Makes me wonder if they even did anything. I will take it as a good sign - they knew where to go and did what they had to do. In and Out.
Good luck with it.
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I have not, but if the pathologist found ONLY spots of CLASSIC LCIS and/or ALH in your lumpectomy specimens, AND there are no other 'suspicious' spots on your mammogram/MRI/ultrasound, then I don't understand why (s)he wants to re-excise. Why? Because most classic LCIS is multifocal (meaning it occurs in more than 1 spot in a breast) and much is bilateral (meaning it occurs in both breasts). They know this because prior to about 1990, they routinely did bilateral mastectomies on LCIS women, and they could look at the mastectomy specimens. (They didn't discover pleomorphic LCIS until roughly the late 1990s.) Most lumpectomies remove enough tissue to make a good specimen that the pathologist can read more easily.
So, most classic LCIS (and nothing worse - in other words no pleomorphic LCIS, no DCIS and no invasive breast cancer) women have multiple spots of LCIS. The only way you can RELIABLY diagnose LCIS is by looking at a tissue specimen under the microscope. Much/most LCIS is diagnosed as an incidental finding when they find some suspicious finding on mammograms/ultrasound/MRI. Some/most LCIS is found not AT the suspicious spot, but adjacent to it. So you cannot reliably remove 'all the LCIS' in a woman, because you can't tell where the LCIS is without removing the tissue and looking at it under the microscope. Even if you have bilateral mastectomies, there is still some breast tissue left behind.
If an LCIS woman later gets invasive breast cancer, this invasive breast cancer often is found in a place in the breast that looked totally normal under imaging (mammogram/ultrasound/MRI). So you can't reliably tell what tissue is LCIS without removing it.
If you ONLY had a core biopsy, then they often do re-excise the area to be more sure that there is nothing worse than LCIS in the area. Because the sample is much smaller, the friction of the core biopsy needle can distort the tissue, making it more difficult to accurately diagnose the tissue.
When a core biopsy shows classic LCIS (and nothing worse such as pleomorphic LCIS, DCIS or invasive breast cancer), then they often excise the area. They do that because they want to be more sure there is nothing worse going on in the area. Its not to remove the classic LCIS, but to make sure there isn't pleomorphic LCIS, DCIS, or invasive breast cancer in the area nearby. Roughly 20% of the LCIS core biopsies are upgraded to something else such as DCIS or invasive breast cancer.
Best wishes that you have 'nothing worse' than classic LCIS.
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I agree with Leaf - I figure they could stick a needle randomly in either of my breasts and have a good chance of coming back with a piece of LCIS.
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Wow! Thank you ladies for the response! Very much appreciated! I apologize because I feel I may have left a few pertinent things out of my original post (it's been a long 2 months.) my core needle biospy showed classic LCIS with radial scar. The post lumpectomy path report suggests extensive LCIS with extensive sclerosing adenosis. LCIS is @ the anterior-inferior & posterior-lateral margins. He did give me a choice between re-excision or MRI/Mammo screenings every 6 mos. And if all is clear with re-excision, I can go on with yearly mammos. I know that MRI will throw me back into this 2 month loop every year, so I'm hoping the surgery will give me the "good to go for now" result. I am just worried about an upgrade with the next excision because he told me only 20% of cases need it. Once again, thank you ladies!
YazMar74-thank you for the info about how easy the surgery was! Sending wishes your way for answers & good outcome!
Leaf - Thank you for such a detailed explanation of classic LCIS & excision!
MelissaDallas- Thank you for always popping up on threads & making sense of all of this stuff! -
I am puzzled - my LCIS DID show up on mammo. How can this be? Everything I've read says it's an incidental finding only picked up when something else is being investigated. But in my case I had a cyst show up on one breast on a mammo and then what the radiologist described as a 'flicker' on the other breast and ultrasound, biopsy and removal confirmed that it was LCIS (and nothing else). It was 9mm. Perhaps LCIS shows up if it's a particular size, or in a particular part of the beast. Anyone know?
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I am puzzled - my LCIS DID show up on mammo. How can this be? Everything I've read says it's an incidental finding only picked up when something else is being investigated. But in my case I had a cyst show up on one breast on a mammo and then what the radiologist described as a 'flicker' on the other breast and ultrasound, biopsy and removal confirmed that it was LCIS (and nothing else). It was 9mm. Perhaps LCIS shows up if it's a particular size, or in a particular part of the beast. Anyone know?
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Were there other findings on your pathology report? Mine was found because sclerosing adenosis showed on my mammogram.
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No nothing showed, only LCIS. I had two pathologists in different centres look at the tissue and both said the same.
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Classic LCIS *usually* is an incidental finding. *Something* has to trigger a breast biopsy: some palpable lesion or feature on mammogram, ultrasound or MRI, or whatever. They aren't going to biopsy women's breasts with no reason; they wouldn't know what to biopsy.
Some LCIS women here have had things on their mammogram, or palpable masses. The thing is that those features are NOT a reliable feature of LCIS. In other words, if you take all the people with palpable masses, or microcalcifications, or whatever feature on their mammograms, MRI or ultrasounds, only a tiny fraction of those people will have classic LCIS (and nothing worse), and even fewer have pleomorphic LCIS. They often do breast excision after a core biopsy shows classic LCIS to make sure there isn't something worse (such as PLCIS or DCIS or invasive breast cancer) in the area.
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