Pathology during surgery questions

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Sms15
Sms15 Member Posts: 2
edited April 2019 in Surgery - Before, During, and After

I had a partial mastectomy for DCIS on 3/19/19.i was wondering what the standard protocol is for the examination and reporting of pathology of the tumor? Survivor friends have told me their pathology was done immediately on their tumors while they were in the operating room. I waited 10 days for my pathology report to find ou I need to undergo more surgery because a 3mm Sage 1 tumor was found with the DCIS.

I had a mammogram, an ultrasound, and a 3D mammogram. Why was this not discovered? Why was the pathology not done while I was on the table? Shouldn’t checking the lymph nodes have been done when they found the Stage 1?

I’m very upset. This second surgery to me seems like it shouldn’t have been necessary.

Thanks,

SmS

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  • Beesie
    Beesie Member Posts: 12,240
    edited April 2019

    It's not uncommon for the surgical pathology to differ from the imaging. Imaging is imprecise and unfortunately sometimes misses things. Many women end up with a final diagnosis that is different from the preliminary clinical diagnosis. And approximately 20% of women diagnosed with DCIS from a needle biopsy end up having some invasive cancer as well, once the final pathology is done. Invasive cancer this small is rarely distinguishable from the DCIS on the imaging.

    During your surgery, there was no way that the surgeon could have known that the breast tissue that was removed included 3mm of invasive cancer mixed in with the DCIS. It would not have been visible to the naked eye and it could have been anywhere within the removed tissue. As for sending the breast tissue to pathology for a check under the microscope while you were in surgery, this is not standard practice and to my knowledge is never done for the whole tumor but is only sometimes done as a way to quickly assess the surgical margins or the sentinel node. Even in those cases, the pathology review is done quickly and a more thorough assessment is done later, so an "all clear" result during surgery might turn out to not be clear after the second more comprehensive review is done.

    I appreciate your frustration, but your situation is not unusual and your expectations, based on what you've been told by your friends, unfortunately were not realistic. About 25% of women who have a lumpectomy require a second surgery, for one reason or another (eg. surgical margins, lymph nodes).

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  • gb2115
    gb2115 Member Posts: 1,894
    edited April 2019

    So correct me if I'm wrong...you had a surprise IDC tumor found in tissue from your DCIS surgery, and they need to go back in for margins on that plus to check the lymph nodes?

    Yeah...3 mm is tiny. Probably easy to miss on the imaging and beesie is right that they aren't usually doing full pathology in the OR. They are taking appropriate action based on what they found and it really doesn't sound like you are getting poor care. Thank goodness they found it in the tissue sample they got, rather than it be lurking somewhere else! Have they discussed any plans to do MRI to take a closer look at everything else?


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