Some help interpreting path report?

Kerri_Oz · October 2017

Can someone please help me with interpreting my pathology report? I know what the ALH/LCIS means (as much as I can at this point, anyway), but can't makes heads nor tails of all the other terms. I've tried googling, but it's just confusing me more. I feel reassured that it says there are "benign" changes, but I don't see LCIS as completely benign, so what else is in there that is concerning despite not actually being "cancer"? This is what it says:

Clinical: Right breast 2 0'clock, 50mm, widespread calcification, 4cm from nipple. Tabar 3. Stereo guided vacuum assisted core biopsy plus clip. The radiologist has identified calcifications in the core samples.

Macroscopic: Multiple pieces of yellow fibrofatty tissues measuring up to 15mm in maximum extent. (mp/2b/nr)

Microscopic: Sections show cores of fibroadipose breast tissue in which there are benign breast changes. Foci of cystic change, columnar cell change, epithelial hyperplasia, sclerosing adenosis and fibrosis of the stroma are present. Abundant lumian and stromal cancifications are present. There is an incidental focus of ALH/LCIS. There is no DCIS or invasive malignancy.

Thanks

GreenEyes81 · October 2017

Hi Kerri, this is the place to make your post! I am sorry, but I don't have any words to help as I am not familar with this partifular finding. I know when I started I felt like I was trying to take a collage course over night. Someone will be along soon and have more info I am sure.

Is there is anything about ER or PR, Hers2? Grade? In the pathology report?

Take a deep breath, you can do this. Strength will come where you never knew you had it. Hugs.

Kerri_Oz · October 2017

GreenEyes - thanks. No, nothing about anything except what I've put here. I only got like a summary report, not the whole thing.

windingshores · October 2017

https://community.breastcancer.org/forum/83/topics/746104

Wildplaces · October 2017

Kerri,

Did you get this path report from your GP - I ask because I am on the Gold Coast - and we don't usually hand over pathology to patients without a medical person interpreting it for them.

Having said that, you are right - both ALH/LCIS while not being overt cancer by themselves carry a significantly higher risk of cancer at 5-10 years... . I am assuming you had a mass biopsied?? Did you have any/further imaging ??

If it was me - I would take my breasts, films and my biopsy pathology and get it reviewed by a breast surgeon (not a general surgeon, someone who does lots of breasts) - because it needs to be followed up, and how to best do so, depends on a number of patient factors: age, hormonal status, family history, breast size etc. The simple answer would be MRIs but they are not always easy to get.

I am about to look up where Bunburrry is ... but you have time to get yourself to a reputable breast surgeon and get a proper explanation and follow up plan. Please do not leave it. I find the " incidental" comment on ALH/LCIS a little flippant.

I hope I did not worry you - if you posted this you figured out it needs a good pair of eyes 😊🌷

( I suggested a breast surgeon because they would be the most knowledgeableregarding follow up and biopsy not because I think you need surgery)

Kerri_Oz · October 2017

Thanks, windingshores. There is a load of good info on here.

Wildplaces ... lol - Bunburrry is a major regional centre in south west WA (and it has be rather burrrr lately. the other night went down to 2. what the hell happened to spring??). I did get the report from the GP. The whole finding out about the dx has been a bit of a dog's dinner. I had a sterotactic vacuum assisted core biopsy for microcalcs found on a mammo. When I went back to the breast doctor for results, she said "All clear, all good", but then called later in the day and said the LCIS had been found. No follow up appointment or anything. I went to see my GP this morning and he wasn't there, so I just saw another doc at the practice and he printed out and gave me the report, and referred me for an ultrasound, which I've got booked for tomorrow. There are 2 breast surgeons here, but only one does reconstructions, so he's the one I've been to see and who I have been referred back to, but that was all before we knew about the LCIS. I've been looking at getting the girls lopped off and rebuilt for a while now due to other risk factors, but once the calcs were found on the mammo, the surgeon refused to even talk about anything until I'd had the core biopsy. I'm expecting (and totally dreading) that he'll now insist on an excisional biopsy. I'd like a bit of an interpretation of the biopsy report before I go and see him, and will definitely be taking the report and the discs with the images with me when I do get an appointment. Forewarned is forearmed and all that stuff.

Wildplaces · October 2017

Ok Kerri

you have done your homework.

The trouble with DCIS ( which you do not have) or LCIS is that it is hard to assess both for margins and follow up...it is non invasive, it just does not show up that well in scans.
It would be a fair question if they propose an excisional biopsy to ask what is your risk of not getting all of it?
See looking at the report I am not sure what they would excise - ?? the 0.5 cm lesion...but the ALH/LCIS, when they called incidental - I am wondering if they meant is not associated with the 0.5cm lesion but in the surroundings? You will need to clarify that. In which case which bit does he take out??

My understanding is that the risk is something like 4fold over 10 years - you need to check that - so if the general population risk is 1/8 - the numbers are getting highish.

So yes my personal view (skewed by my 4cm plus cancer) is to do more rather than less.

I hate the thought of unclear margins/ take backs etc.
It is a tough conversation to have and being clear on what YOU want (🙄 I know...) works best. My mother was diagnosed with breast cancer a year before me - she had a 2.4cm mass, no nodes and choose a mastectomy and level 2 axillary clearance (12 nodes out) - she has some scarring issues from a wound that did not heal initially but no lymphoedema. I had a mastectomy and axillary clearance from get go - called as "excessive" surgery by some colleagues, oddly not the surgeon who after we discussed it said - a bit old fashioned perhaps, but as good of an operation as any. For me it was the right choice - my tumour was bigger then reported on imaging and node positive.

I have told you my story - (and I want to be clear the above surgery was done on a definitive diagnosis of Stage 2 cancer) - to say it is ok to ask for what you want provided you have all the information regarding a procedure and risks, you have time to consider and someone runs you through ALL your options.

Wishing you well,
😊

Kerri_Oz · October 2017

Wildplaces - yep, I'm trying to get all my homework done. The amount of info is a bit overwhelming, and sorting thru it to find what might be relevant to me is a big job. I think what the incidental means is sort of like a "happened to" type thing, as in they went looking for DCIS in the sample and just happened to find LCIS whilst testing for the DCIS. I imagine the area they would excise would be the calcifications, as that's where the LCIS was found. The problem with LCIS is that it is often multifocal and bilateral, so clear margins are not a consideration. The aim is to see if there is something more sinister lurking within the LCIS, which there is around 20-25% of the time. 1 in 4-5 chance of something nasty - not odds I like at all.

I've just been and had an ultrasound and apparently I have very complicated breast (a nightmare, to quote the sonographer [said jokingly, but seriously at the same time]). They are dense and messy. The ultrasound turned up an area in each breast they would recommend core biopsies on. The biopsy I already had was at 2 o'çlock on my right breast, and now there's a lesion at 11 o'çlock on my right breast and one at 3 o'clock on my left breast they want to suck out and look at. My boobs just seem to be the gift that keeps on giving at the moment. Rather than have the extra biopsies right away, I am going for surgical review, which was already in the pipelines anyway.

It seems every test I have just totally reinforces my thoughts that a BMX is the best (and maybe only) way forward for me.

That's rough with both your mum and you going through that so close together. Mind you, if I do get a cancer dx now, it will be the same sort of thing for my mum and I. She had a mastectomy for IDC about 4 months ago, with clear nodes. Are you both clear now? Do you plan on reconstruction? Do you have to be hypervigilant with your right breast from now on?

Wildplaces · October 2017

hi Kerri,

I am not the right person to go through these options with you because I am an anaesthetist, I work with both breast cancer and reconstruction and I PERSONALLY lean towards definitive surgery (not necessarily supported by what is being published today - research and literature). I know how weird that sounds....

Yep, we are both good - thank you - on AI inhibitors.

The only reason I did not have a BMX was because I did not want a potential complication with a "healthy breast" to delay chemotherapy. I am planning to have my right breast off early in the New Year. I have chosen not to reconstruct but that is again superpersonal, I am close to 50, have an established family, and you know, short of the inconvenience of occasionally having to stuff my bra with socks, I am not too fussed about it. I may change my mind in the future but I am taking it as it comes. I have always liked me just as I rolled along, clumsy, wide eyed, and small breasted - go figure.

Having said that I think if I only had DCIS or LCIS and needed a mastectomy, I WOULD have reconstructed.

It sounds like you have time to make the right decision for you once you get ALL the information.

Do I miss my breast?? - heck yes, do I regret my decision?? - absolutely not.

Hoping it is all in situ - and that you can have a good long talk to your surgeon.

My only big think to say is TELL HIM (I am assuming) what concerns you, what you want to achieve and what you do not wish for - just tell him calmly and honestly- and then listen to what he has to say.

I think that is hard to do in an office consult.

😊🌷

reflect · October 2017

Hi Kerry,

Sorry you are in this between-tests state--that's hard. I also have "complicated" breasts, and had multiple biopsies (stereotactic, MRI guided, multiples.....) I had an MRI which found (pointed to) another cancer in the same breast. It also looked like something was happening in the other breast but that was just noise. MRIs do give false + results but also see things other tools don't. Maybe with your "messy" breasts an MRI would be helpful. And please have your biopsies done by the most experienced doc you can find--I had a whole round (SEVEN) done which missed their marks.

Best of luck!

Kerri_Oz · October 2017

Wildplaces - clumsy, wide eyed and small breasted sounds adorable to me Reconstruction is a very personal issue, and I totally get why some women decide not to. It's a shame that society makes our identities as women and our sexuality so much about breasts, and kudos to you for being your own person. I get where you're coming from with definitive surgery. I would much prefer to get rid of the problem in one fell swoop, I really don't know if immediate reconstruction will even be an option for me. I have 2 biopsies booked for Tuesday next week. I got some valium from my GP, which will hopefully help with the wracking anxiety I suffer around these sorts of things. I must admit, at this stage, I'm not feeling optimistic. I just have to get through the next few days without going completely around the bend and go have the biopsies, then more waiting. This sux.

Reflect - Thanks. I haven't been offered an MRI yet. Maybe that will be the next step. Having the ultrasound recommended surprised me, and the findings surprised me even more. I got the results today and have several small simple cysts in each breast, as well as a hyperechoic mass in each breast (totally separate from where I've just had for biopsy for calcs that showed up the ALH/LCIS), both of which fill with vocal fremitus (not a good sign at all from what I've read), and with reactive lymph nodes on both sides. The right side mass shows possible vascularity and the left side has a few prominent ducts deep to the nipple. Things are turning out much more complicated than I ever expected, and all so much more frightening. It seems every test I have just turns up something worse. And all of this with nothing unusual felt by the breast doctor or the breast surgeon.

Wildplaces · October 2017

Hey,

I am sorry you are going through this.

Certain breasts are hard to feel lumps in - mine too.

MRI is helpful and a good suggestion - not covered entirely by Medicare/funds even with highly suspicious breasts so the guys especially in the context of cyst, calcification will book ultrasound first.

For your biopsy - easier if the radiologist uses an ultrasonographer as well - they hold the ultrasound probe while the man/woman with the needle do their thing. It's ok to take Valium before the biopsy if you need it - but they should call you to tell you how to prep.

In the majority of cases you can have your expander placed at the time of your surgery - and then about 6 months later get your implants popped in. Even in cases later requiring radiation - the radiation tech can work around expanders.There is also an option with a mastectomy - nipple sparring or not - that will depend on where the buggers are. But in non nipple sparring mastectomies - a plastic surgeon can create a good nipple that can then be tattooed and they look great, although you loose feeling in the area.

You have good recon options - hang tight until you know exactly what you are dealing with.

I won't be too far 😊🌷

Some help interpreting path report?

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