Pathology results - help interpreting

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MEM127
MEM127 Member Posts: 27
edited December 2020 in Just Diagnosed

Hi - New here. I just got my pathology results today and would love some help interpreting (explaining?) my results. I think I understand the basic gist - there were two lesions adjacent to each other. One slightly larger (16 x 12 x 14 mm) and another (10 x 8 x 9). As I understand it, the first is DCIS and the smaller is a high risk lesion which is generally seen when there is cancer present. Official report below. My questions - 1. What does this mean (nice and broad, LOL). 2. I assume I am looking at a lumpectomy, but would they take both lesions, or just the DCIS? 3. Am I likely to have radiation and/or some other additional treatment after the lumpectomy? I know this is all guessing until I meet with the surgeon, but I'd like an idea of what's ahead. I appreciate your help! (If it adds to the analysis, I am 52, no history of breast cancer in my family, peri-menopausal, and have had 4 kids).

FINAL PATHOLOGIC DIAGNOSIS:

A. RIGHT BREAST, 2:00, CORE BIOPSIES FOR A NON-PALPABLE MASS LESION:
Ductal carcinoma in situ; see NOTE.
Atypical apocrine adenosis.

NOTE:DCIS is nuclear grade 3 of 3, apocrine and cribriform types with
comedonecrosis, and involves a complex sclerosing and papillary lesion with
associated microcalcifications.

Immunostains for myoepithelial cells (calponin/pankeratin, p63/pankeratin,
smooth muscle myosin) reveal an intact layer. No definite invasion identified.


B. RIGHT BREAST, 2:00, CORE BIOPSIES FOR A NON-PALPABLE MASS LESION:
Complex sclerosing lesion; see NOTE.

NOTE: Immunostains for myoepithelial cells (calponin/pankeratin, p63/pankeratin,
smooth muscle myosin) reveal a complete layer, consistent with the diagnosis.

Note: ER ASSAY BY IMMUNOHISTOCHEMISTRY:

SPECIMEN ADEQUACY: The specimen is adequate for evaluation.

ER RESULT, DCIS: NEGATIVE
Percent positive: <1%
Average staining intensity: weak

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  • Beesie
    Beesie Member Posts: 12,240
    edited December 2020

    Hi MEM, welcome!

    To your questions:

    1. What does this mean (nice and broad, LOL). Your preliminary diagnosis is DCIS. No diagnosis is ever good, but DCIS is as good as it gets. This is a non-invasive condition, considered Stage 0 breast cancer but by some definitions is a pre-cancer. This is hopefully your final diagnosis but in about 20% of cases where DCIS is found in a needle biopsy, the diagnosis is upgraded to invasive cancer once the final surgical pathology is in.

    2. I assume I am looking at a lumpectomy, but would they take both lesions, or just the DCIS? I don't know. Some atypical lesions are always surgically removed, to ensure that no DCIS or invasive cancer is mixed in. That applies to ADH and ALH (atypical ductal/lobular hyperplasia). I believe that usually atypical apocrine adenosis is not surgically removed, because it is lower risk. But perhaps since you have the DCIS and will be having the lumpectomy anyway, the surgeon may opt to be conservative and remove the atypical apocrine adenosis as well.

    3. Am I likely to have radiation and/or some other additional treatment after the lumpectomy? Yes, radiation will be recommended. That's the norm after a lumpectomy. Since it appears that your DCIS is ER- (or close to that), it's unlikely that endocrine therapy (anti-hormone therapy, 5 or 10 years of a daily pill) will be recommended.

    Not something you asked, but with a preliminary diagnosis of DCIS, you will not need to have a sentinel node biopsy at the time of your lumpectomy, which is a good thing. And HER2 is not relevant to a DCIS diagnosis (you will see HER2 discussed a lot for those with invasive cancer). You can read up on the reasons why, and other things DCIS, here:

    Topic: A layperson's guide to DCIS https://community.breastcancer.org/forum/68/topics...



    Hope that helps!



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  • MEM127
    MEM127 Member Posts: 27
    edited December 2020

    Thank you Beesie! This is very helpful.I'm grateful to have found this early. Also pleased to have found this site.

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  • Moderators
    Moderators Member Posts: 25,912
    edited December 2020

    Welcome, MEM127! We're sorry you find yourself here, but we're glad you joined our community and reached out for help. In addition to the helpful response you got from Beesie, we hope you get more clarity when you meet with your doctor to discuss the results and possible treatment options. Please keep us posted!

    The Mods

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  • LivinLife
    LivinLife Member Posts: 1,332
    edited December 2020

    Welcome MEM! While I've learned a lot on this site I also don't know quite a bit as well. I will comment some on the medical part of things though generally leave that to others who have much more knowledge. DCIS is technically not cancer b/c the cells, while cancer cells, cannot live outside the milk ducts as they are. At the same time these cells are cancer cells and can evolve into invasive cancer. I had the Grade 3 (expansive) comdeo necrosis too. My understanding of that is a fast/aggressive growing pre-invasive cancer (learned that on this site) where the cancer cells are reproducing so fast the cancer cells are dying and building up in the ducts. That being said DCIS tends to grow very slowly. All of my breast cancer-related docs - from Cleveland Clinic nonetheless - call my DCIS cancer. In fact only one local doc (and I have many) did not call it cancer. It is a fine though important distinction. I think I first heard Beesie, on this site, talk about "pre-invasive cancer" as another way to think about it. That is the label I use because it makes so much sense, esp. with Grade 3 and comedo necrosis being the most serious type of DCIS. In my case they expected to find invasion b/c the area was initially large. Thankfully there was none.

    The "sclerosing" areas I've heard and seen different things. I think that may depend on the treating doc, surgeon, MO, etc. I've known some people who had areas like that removed based on recommendation and others who were told that wasn't necessary - I just don't know enough about these kinds of things...

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  • MEM127
    MEM127 Member Posts: 27
    edited December 2020

    Thanks for this additional info. I am having an MRI on Saturday and meet the surgeon on Monday. She’s affiliated with Mass General and my local hospital so I should be in good hands (literally). I’m happy they are moving the appointments along so quickly. I like to know what the game plan is. I have zero patience!

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  • LivinLife
    LivinLife Member Posts: 1,332
    edited December 2020

    Please let us know how that goes. Things move fast at times and they will move slow (or seem to) at others so work some on developing that patience lol Look up mindfulness, guided imagery or yoga postures (not a routine if you haven't done that before - it's not difficult to injure yourself - not the goal....).

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  • MEM127
    MEM127 Member Posts: 27
    edited December 2020

    Back again - hope everyone enjoyed their holidays as well as possible given everything else plus Covid! So, I met with the surgeon last week and had an MRI which revealed "very busy breasts." My husband is calling me an over-achiever. I'm scheduled for an MRI biopsy on Thursday, and then we'll figure out next steps. I'd appreciate some input on the latest results - basically, they found some new stuff on the left breast, and more stuff on the right. I'm going to guess the odds are that at least some of this is cancerous, maybe more DCIS or something just starting to be invasive? I was preparing for a lumpectomy and radiation, but now wondering if I am more likely looking at a mastectomy. I'm barely over an A cup as it is. The original pathology from the ultrasound biopsy is in the first post above, DCIS, under 2 cm, Grade 3, with comedonecrosis, and a nearby complex sclerosing lesion.

    FINDINGS:

    Left Breast:

    Review of the dynamic contrast-enhanced series shows two adjacent focal non-mass enhancement measuring 4 mm in the upper inner quadrant at posterior depth (postcontrast axial image 69 and sagittal image 138 and 141). There is associated medium initial and washout delay phase kinetics.

    Right Breast:

    Review of the dynamic contrast-enhanced series shows a susceptibility artifact/biopsy marker at the site of biopsy-proven DCIS in the upper inner quadrant at mid to posterior depth with associated extensive regional non-mass enhancement measuring 3.0 x 2.1 x 3.5 cm (AP x TRV x CC). This is best seen on axial postcontrast image 64 and sagittal image 62. The clip artifact is best seen on axial image 72 and sagittal image 57. Another susceptibility artifact/biopsy marker at the site of biopsy-proven complex sclerosing lesion is seen in the slightly upper inner quadrant at posterior depth with associated heterogeneously enhancing focal non-mass enhancement, which appears contiguous to the area of biopsy-proven DCIS measuring 1.4 x 1.5 x 1.8 cm (TRV x AP x CC). There is also associated washout delay phase kinetics. In conglomerate, these areas measure 2.8 x 3.3 x 3.0 cm (TRV x CC x AP).

    In the upper central and upper outer quadrant, there are multiple areas of indeterminate focal non-mass enhancement (axial image 65 through 89), some of which demonstrate washout delay phase kinetics. The most suspicious focal non-mass enhancement is seen in the upper outer quadrant at mid to posterior depth measuring 9 mm (postcontrast axial image 66 and sagittal image 45).

    Miscellaneous findings: none.

    No axillary or internal mammary adenopathy.

    IMPRESSION:

    Left Breast: Two adjacent indeterminate focal non-mass enhancement in the upper inner quadrant. MR guided core biopsy of the more posterior focal non-mass enhancement is recommended given more suspicious morphology. Management of the more anterior focal non-mass enhancement will be dependent on the pathology above.

    Left Assessment: BI-RADS 4B Moderate Suspicion for Malignancy.

    Left Recommendation: Left MRI Breast Biopsy

    Left Recommendations Due Date: To Be Scheduled

    Right Breast:

    1. Biopsy-proven DCIS in the upper inner quadrant with associated extensive regional non-mass enhancement measuring 3.0 x 2.1 x 3.5 cm. Recommend MRI guided core biopsy of the most inferior aspect of the non-mass enhancement to prove extent of disease if desired (axial image 55 and sagittal image 61).

    2. Similar-appearing focal non-mass enhancement with washout kinetics at the site of biopsy-proven complex sclerosing lesion in the upper inner quadrant spanning up to 1.8 cm. This appears contiguous to the area of biopsy-proven DCIS and is suspicious. Consider surgical excision.

    3. Additional areas of indeterminate focal non-mass enhancement is seen in the upper central and upper outer quadrant. MR biopsy is recommended of the most suspicious focal non-mass enhancement in the upper outer quadrant as mentioned above if clinically indicated.

    Right Assessment: BI-RADS 4B Moderate Suspicion for Malignancy.

    Right Recommendation: Right MRI Breast Biopsy

    Right Recommendation Due Date: To Be Scheduled

    OVERALL Assessment: BI-RADS 4B Moderate Suspicion for Malignancy.

    Thanks for your help!

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  • LivinLife
    LivinLife Member Posts: 1,332
    edited December 2020

    The only finding you mentioned I'm willing to speak to is the non mass enhancement (other than the DCIS which you mentioned previously). Initially my diagnostic mammogram showed 3 cm of DCIS (left breast). The subsequent MRI showed just about 5 cm of DCIS and non mass enhancement with recommendation for additional biopsy. The biopsy was unnecessary b/c I already chose to undergo BMX. Upon final surgery pathology the area of DCIS turned out to be 1.5 or 1.2 cm still Grade 3 with expansive comedo necrosis. The other 3+ cm was full of all kinds of benign and precancerous stuff - I could not believe the number of different things in that area. The surgeon's P.A. said had I not had mastectomy on that side I would have been in for many many call backs and biopsies over time. I had already been going through that on my right side....

    No one can really say what ultimately will be the case for your final pathology until after surgery tho an additional biopsy or biopsies could add to the picture prior to that of course..... you know for sure you at least have the DCIS.... Please let us know how the MRI biopsy goes next week and once you get final results on that....

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  • MEM127
    MEM127 Member Posts: 27
    edited December 2020

    Thanks LivinLife. I’m mentally preparing to hear more DCIS and having to figure out the right surgery for me. Just hoping to steer clear of Covid exposure so nothing gets delayed. These are such tricky times and having college aged kids makes it more challenging!

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