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Bookpusher
Bookpusher Member Posts: 75
edited July 2021 in Just Diagnosed

These are the results of my biopsy:

FINAL DIAGNOSIS:

Breast, "right", stereotactic biopsy:
High-grade DCIS with comedonecrosis.
Intraductal papilloma.
Microcalcifications identified.

Ancillary Studies
Estrogen Receptor (ER) Status
Low Positive (1-10% of cells with nuclear positivity)
Specify percentage of cells with nuclear positivity:
2%
Average intensity of staining: Very Weak

Progesterone Receptor (PgR) Status
Negative (less than 1%)
Internal control cells present and stain as expected


Methods
Fixative: Formalin
Estrogen Receptor:
Food and Drug Administration (FDA) cleared: Leica
Primary Antibody: 6F11

Progesterone Receptor:
Food and Drug Administration (FDA) cleared: Leica
Primary Antibody: 16

Cold Ischemia and Fixation Times Meet the Requirements Specified in the
Latest Version of the ASCO/CAP Guidelines: Yes

Comment(s): This case was discussed with Dr. Fraley on 7/6/21 at 9:05
am and presented at the intradepartmental consensus conference.

The cancer in this sample has a low level (1%-10%) of ER expression by
immunohistochemistry. There are limited data on the overall benefit of
endocrine therapies for patients with low level (1%-10%) ER expression,
but they currently suggest possible benefit, so patients are considered
eligible for endocrine treatm
ent. There are data that suggest invasive
cancers with these results are heterogeneous in both behavior and
biology and often have gene expression profiles more similar to
ER-negative cancers (Allison et al J Clin Oncol 2019).


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  • Redcanoe
    Redcanoe Member Posts: 131
    edited July 2021

    well, if this is the whole report, it sounds like the diagnosis is DCIS, which is good news because it means the cancer is confined to the duct and is not invasive yet. I would definitely get some clarification if there was any invasive cancer found in the biopsy. I would guess that the next step for you is surgery and then you will get more information from that pathology to make any sort of decision going forward.

    I'm sorry you are here. Hopefully others who know more about DCIS will pop in.

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  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited July 2021

    Hi!

    Sounds like your DCIS is more-or-less ER-/PR-. That means that hormonal therapy would not be as beneficial for you as someone with a higher % of ER+ cancer. However, it sounds like they still think you might be eligible for it. Also, if they find invasive cancer during surgery, I wouldn't be surprised if chemo might be considered because chemo is always recommended for triple negative cancer (ER-/PR-/HER2-) or ER-/PR-/HER2+ cancer.

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  • Beesie
    Beesie Member Posts: 12,240
    edited July 2021

    Just to clarify ElaineTherese's post, chemo is NEVER given for pure DCIS.

    In approx. 20% of cases where DCIS is found in a biopsy, some invasive cancer is found in the finally pathology. Most often (about 70%-80% of the time), the amount of invasive cancer is very small, either a microinvasion (1mm) or something just slightly larger. Chemo is recommended with triple negative invasive cancer, but usually only if the tumor is above 5mm in size or if there is nodal involvement.

    So with a preliminary diagnosis of DCIS, it's possible that you could end up with a final diagnosis that requires chemo, but there's probably only about a 5% chance of that happening.




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  • cgifford7
    cgifford7 Member Posts: 27
    edited July 2021

    Hi - As mentioned, DCIS is not invasive. The two options presented to me were lumpectomy followed by radiation or mastectomy. In my case my surgeon went on to explain that because of the size of the DCIS (5 cm) and the size of my breasts (very small), a lumpectomy would leave me with very little breast tissue so realistically I have to have a mastectomy. Most women, though, have the option to choose either and it comes down to personal preference. My surgery is tomorrow and am having a double mastectomy with tissue expanders placed. If nothing new is found in the pathology after surgery, that may well be the extent of my treatment. I will have to have a second surgery to exchange the tissue expanders for implants, but no radiation or chemo (again, assuming no invasion is found during surgery).

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  • Bookpusher
    Bookpusher Member Posts: 75
    edited July 2021

    Thanks so much. I cannot see the HER2, can any of you?


    This is also stated in the report:

    There are data that suggest invasive
    cancers with these results are heterogeneous in both behavior and biology and often have gene expression profiles more similar to ER-negative cancers (Allison et al J Clin Oncol 2019).

    This statement scares me, as does the high grade DCIS.

    I am on overload. Do you think this is triple negative cancer?

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  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited July 2021

    Hi!

    They usually don't test DCIS for overexpression of the HER protein. However, if the pathology from the surgery shows invasive cancer, they will test the invasive portion to see whether it is HER+ or HER-. Whether or not it is triple negative DCIS doesn't matter if there is no invasive component.

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  • LivinLife
    LivinLife Member Posts: 1,332
    edited July 2021

    Your results are so similar to what mine were.... including the basically negative ER and PR, mine were 2% and 5% respectively so I chose no hormone therapy - concerned the side effects/toxicity would be worse than any benefit. My onc was hesitant about that the first time we talked and now totally in agreement. Hopefully you are able to seek options for a team you are comfortable with. I initially had a local surgeon appointment, etc. though then a second opinion 4 hours away. I went with the 2nd opinion for surgeon and onc..... Best to you and keep us updated please!

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