Recurrence results question

Hi Sopho, so sorry that your diagnosis brings you here, but you are not alone. I can empathize with your frustrations & disappointments because I'd been down that same road. Given your rare dx presentation, your best resource might just prove to be your Pathologist. I would suggest that you call & visit them to get more detailed clarification on your pathology or independently seek a 2nd opinion on your pathology (which is what I had done...it actually took 4 pathology opinions to straighten out my mess).

What size and where was your IDC lesion located in proximity to your papillary tumor? At the outside of your papillary tumor's wall? Any IDC cell infiltration(s) entrapped within the papillary wall itself? What grade was the IDC? Mitosis value of IDC? Have you viewed your slides? Any LVI (lymph-vascular) invasion seen? Any isolated malignant cells or clusters observed in your nodes?

The answers to these questions from your pathologist might help determine the infiltration & proliferation tendencies....which is what had been explained to me by Breast Pathologists with whom I had consulted? (I also had conventional IDC cells mixed into a good size invasive & solid papillary tumor.)

Papillary tumors are usually described with a variant of "invasive" or "encapsulated" or "intracystic" or "intraductual" or "solid". And as such can be any of the molecular subtypes (Luminal A or Luminal B or TN or HER2+, etc.), so you may wish to quiz your Breast Pathologist on this also. Please consult with Breast Pathologist experts in your situation, as rarer Papillary with invasive components can get pretty complicated.

And Papillary Carcinoma can be invasive or occur in multiples, so it's important to drill down a little deeper into your pathology. Some Papillary can spread regionally. Wishing you the best....

Hi Sopho, please feel entitled to speak freely to any professional directly who consulted on your case. Most pathologists are more than happy to speak by phone or even give a tour of their lab and walk you thru your pathology slides. The pathologists had been very receptive to my questions, except one lab insisted that I speak only with the Director or Pathology on questions.

Regarding your unusually low genome assay recurrence risk of "0", your lab was responsible for submitting that block or slide(s) which presented the most aggressive cells. If your lab possibly messed up, you may be possibly be entitled to a repeat assay, so you may wish to consider consulting with your hospital's patient advocacy or customer service dept. to obtain a credit for the costs of your original genome assay or obtain a repeat assay at no cost to you. (Me too.) However, I would speak with your Pathologist directly first.

That's good news that your papillary tumor was entirely encapsulated, meaning the papillary tumor was enclosed within a duct inside a capsule.

Regarding your need for follow-up surgery, were your tumor's margin(s) dirty with only DCIS or also dirty with more IDC micro-invasions & papillary cells? Knowing this answer might help you to decide on which type of further surgery.

DCIS, IDC and papillary tumors can present with different grades within the same breast. You should have been given grade values for each subtype of cancer, which may help you to decide on your final surgical plan. I would also press the pathologist for the molecular type (Luminal A or Luminal B, for example). Luminal A tumors are much less aggressive and are often lower risk for recurrence.

If you have a copy of your pathology report, look for the name of the pathologist who signed your report and please give them a phone call or schedule a phone consult in advance with the department clerk. Good luck.

I called up the pathology department directly, said I wanted the pathology sent for a second opinion and why. Chief of staff called me back and said he would be happy to pull my slides and take another look. So helpful. I never did send it for another opinion. Also member Beesie had a similar diagnosis to you re:microinvasion. Her posts are incredibly knowledgeable.