Confused about final pathology

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Mebechamp
Mebechamp Member Posts: 17
edited July 2019 in Surgery - Before, During, and After

Hi all, we just got final patho from a lumpectomy and are confused, about 2 things.

Adter the needle biopsy last month, the diagnosis was dcis with invasive carcinoma found. But now the final patho from lumpectomy says there is dcis ("extensive within the sample") and "NO definitive invasive carcinoma is found within the sample. The pathologic diagnosis is based on previous biopsy which included a .3cm focus of invasive carcinoma."

Was the original biopsy wrong? Does this mean she technically only had DCIS the whole time(only as in singularly, not "only" as in I'm downplaying in situ cancer as a diagnosis)? Would it change any views on treatment from here out?

Second thing is that I saw the patho report and one margin was <1mm to inked border. The other border explicitly said "negative margin." I thought the standard to be considered clean was 2mm but her doc said she was fine. Can anyone clarify this? I didn't see the report until after her appointment and now I'm questioning things....mostly if they took enough to say that under a mm is a clear margin.



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

    No, the biopsy was not wrong. But it appears that the biopsy pulled up all the invasive cancer that was present. This has been known to happen in situations where only a small amount of invasive cancer is present. Not common, but not unusual either.

    The final diagnosis is based on the combination of all the pathology samples, so it incorporates what was found in the biopsy and in the surgery. Therefore the staging is Stage IA, with a T1a 3mm invasive tumor. The DCIS, as a less serious condition, is not relevant to the staging, although of course it needs to be surgically removed, as it was.

    If you are uncomfortable with the diagnosis, you could ask for the biopsy tissue to be reassessed, or send it elsewhere to be checked. It's possible there was an error, but unlikely. 3mm is a tiny tumor, but not so small that it would be incorrectly assessed by a Pathologist. Pathologists regularly find invasive tumors as small as 1mm or even 0.5mm.

    So if the biopsy did find invasive cancer, then the diagnosis is invasive cancer, even if the surgery only found DCIS.


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  • Mebechamp
    Mebechamp Member Posts: 17
    edited July 2019

    Thank you. That is great to know about the retesting or sending to another lab. I may suggest it. She never did go for a second opinion after diagnosis since she loved the first doc so much, and now she is so excited that her lumpectomy looks great that she is downplaying the need for the Tamoxofen (which she is dreading far more than radiation). She even asked if I thought she still needed radiation today based on the patho report. I gave an emphatic yes based on recurrence of DCIS that is only surgically treated, especially as an invasive area DID exist regardless of the more current reading. Im just trying to reign it all in, the information, the feeling like she might knee-jerk trying to change some important part of treatment, the cold feet for the next phase. Again, we have to talk to radiation and onco docs. I'm sure they will clear some things up.


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