Diagnosed with Invasive Ductal No cancer Found after Mastectomy!

So that all the responses are in one place, I will copy and paste here the answer I provided to Cheryl yesteray when she posted the same information and questions in a different thread:

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Cheryl, the final diagnosis is based on the combined findings of both the biopsy pathology and the surgery pathology. While it's not all that common, it certainly can happen that all the cancer was removed in the biopsy. And if invasive cancer was found in the biopsy, then unfortunately yes, you do have a diagnosis of invasive cancer, even if no invasive cancer was found in the surgical pathology.

Given the different findings between the biopsy and the surgery, a logical next step would be to have the biopsy sample reassessed, to ensure that the finding of invasive cancer was correct. Since your biopsy sample was submitted for the Oncotype analysis, and since the Oncotype analysis would have noted if no invasive cancer was found, this second step has in effect been done. The Oncotype score is the confirmation of the invasive cancer diagnosis.

As for the need for chemo, the question to ask is how much risk reduction benefit you will get from chemo. The TAILORx study that was released last year showed no benefit to chemo for anyone with an Oncotype score up to 25. With a score of 28, this means that there will be some benefit from chemo, but your Oncologist should be able to tell you how much benefit is estimated. In other words, what is your recurrence risk with hormone therapy alone, and how much lower is your recurrence risk if you have chemo and then take hormone therapy? That information can help you decide if chemo is worthwhile for you.

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Perhaps a reassessment of the biopsy sample would be advised, although if the tissue was sent for Oncotype testing, nothing more may be available. Instead, a detailed review of the Oncotype results should confirm whether or not invasive cancer was found in the biopsy sample, which would mean a diagnosis of IDC

Something in your write up caught my attention " but to much inflammation the clip from biopsy not even visible.". Perhaps the biopsy triggered your immune system to respond and that cleaned up the remaining cancer. Spontaneous remission does exist and infection or trauma could trigger it. The high level of inflammation could have been due to this. In any case I would request preparation of a new set of slides from the extracted tissue and send them to an independent pathologist to confirm the original diagnosis. People do make mistakes.