Pathology Report, Restaged?

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Irishlove
Irishlove Member Posts: 82
edited June 2019 in Diagnosed and Waiting for Test Results

I wonder if you were restaged after biopsy showed one stage and final pathology showed another stage?

Having read posts about the difficulties in pathology based on a small tumor sample, versus the final path report after a lumpectomy or mastectomy, I suppose it's not out of the question. Wondering how common this is? Would a vaccuum assisted biopsy have made a difference?

Has anyone been restaged from a higher stage to a lower stage? In my case, I went from IDC, stage 1A, to Encapsulated Papillary Carcinoma, stage 0! I know I'm very, very lucky. But I also know that I may have opted out of a mastectomy had I known. It's too late to change anything. I struggled with mental health anxiety, that lead me to a PMX 2 1/2 months after first MX. The final pathology showed benign but precancerous papillomatosis (did no show on mammo, mri or ultrasound). I did have very dense breast tissue.

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

    Restaging happens quite a bit. It's Clinical Stage, based on imaging and biopsy, vs. Pathological Stage, based on the pathology of the cancer as seen under the microscope after complete surgical removal.

    I know that preliminary clinical diagnoses of DCIS (based on a biopsy) are restaged to invasive cancer about 20% of the time.

    And a tumor that appears large on imaging could end up being smaller once the pathology is done, or a portion of the tumor could be DCIS (which doesn't count towards the size/staging of an invasive cancer) so it's possible for an invasive cancer to go down in Stage from clinical to pathological.

    I admit that I don't understand however how a Stage I clinical diagnosis could become Stage 0, or at least not if the clinical diagnosis was based on a biopsy in which invasive cancer was found. The final pathological staging always incorporates the pathology finding from all biopsies and surgeries, so any invasive cancer found in the biopsy would still be included in the final Pathological Staging.

    Was your preliminary diagnosis based on a biopsy or just imaging? And if there was a biopsy that found invasive cancer, when the results from surgery came back showing no invasive cancer, was the biopsy sample re-examined to confirm that the preliminary diagnosis was an error? I could see something like that happening, although it would be quite unusual

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  • AliceBastable
    AliceBastable Member Posts: 3,461
    edited June 2019

    Is there a chance the invasive cancer cells were removed with the biopsy sample, leaving just the Stage 0 tissue?

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  • Irishlove
    Irishlove Member Posts: 82
    edited August 2019

    Beesie, The first staging was based on a biopsy. The pathology report was updated/corrected after the mastectomy. Curious had mentioned in a prior posting that Papillary Carcinoma is a rather rare b.c. and it's important to have second pathology opinions. In my case the slides were first viewed by a local Pathologist and automatically reviewed by Wake Forest Cancer Center Pathology Dept.

    AliceBastab, My guess was similar to your idea. The fine needle biopsy pulled the carcinoma cells but not the encapsulated wall (is it called collagen?). With EPC being a rare b.c., perhaps it's possible the local pathologist has not viewed this type of b.c. in the past.


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

    AliceBastable, that's been known to happen, particularly with DCIS-Mi. The biopsy pulls up the tiny invasive cancer and then nothing but DCIS is found in the surgical pathology. It also sometimes happens that a biopsy needle retrieves either DCIS or IDC, and then nothing is found in the surgical pathology - it's all benign. In both those situations, the final Staging will be based on what was found in the biopsy sample. Back when I was diagnosed 13 years ago, I had that happen, although my biopsy was an excisional biopsy so it wasn't as much of a fluke to find the small invasive cancer then, with nothing but DCIS being found later in my MX surgical pathology.

    Irishlove, was the biopsy tissue also re-checked by the Wake Forest pathology department? If a closer look uncovered just a tiny bit of the encapsulated wall and/or showed papillary cells identical to those found during surgery, that would confirm the misdiagnosis from the biopsy.

    I have to admit that in all my years here, while I've often seen staging change from the clinical diagnosis to the pathological diagnosis, I can't recall a single case that went from Stage I invasive cancer down to Stage 0 non-invasive cancer.

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  • Irishlove
    Irishlove Member Posts: 82
    edited August 2019

    Beesie, Yes the first slides were reviewed by the outside pathologists, along with the final sections. I rec'd a "Corrected" Report. I am still astonished by this development.

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

    Yes, astonishing, but great news. And excellent that the biopsy slides were rechecked by Wake Forest. This is one case where being one in a million is a really good thing!

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  • obsolete
    obsolete Member Posts: 466
    edited June 2019

    Does anybody have any knowledge or reference material which would state what % of actual breast mastectomy tissue gets examined by pathology labs, on average?

    I'm curious because the OP had a Papillary Carcinoma, which I had been told by multiple MD's is not usually visible on imaging (MRI, ultrasound, 3D) on Papillary lesions under 5mm in size because of it's usual cystic composition. Thank you.

    "Gross evaluation of tissue for breast cancer remains a challenge especially in large mastectomy specimens. In the routine gross laboratory, the mastectomy specimen is inked and serially sectioned perpendicularly to its long axis at roughly 1-cm intervals. Subsequent tissue examination for breast carcinoma is carried out by taking into consideration the available clinical and radiographic information. While assessment of larger lesions poses no difficulty, finding small or nonpalpable lesions and microclip sites is often problematic. In addition, obtaining complete slices of uniform tissue thickness with intact specimen margins (to determine the exact distance from lesion to margins) is not always feasible owing to the inherent parenchymal characteristics of large fatty specimens. Consequently, a high tissue volume may need to be submitted for microscopic evaluation that is neither time efficient nor cost-efficient to the pathology laboratory."

    "Therapeutic decision-making and prognostication of patients depend heavily on the status of breast carcinoma biomarkers."

    https://www.archivesofpathology.org/doi/pdf/10.585...


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  • Irishlove
    Irishlove Member Posts: 82
    edited August 2019

    I can't answer your question, but my tumor was 1.5 cm, behind the nipple and palpable. It was found during a routine mammo and was also quite visible on the ultrasound.

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