onkell, I had a microinvasion along with extensive high grade DCIS.  About 10% - 20% of women who have DCIS have microinvasions.

In most cases, there's only one change to the treatment plan caused by the microinvasion.  Many women who have DCIS, particularly if they have a lumpectomy, don't have their lymph nodes checked.  But once a microinvasion has been found, it's important to check the nodes.  The likelihood of having lymph node invasion from a microinvasion is small - only about 10% - but it needs to be checked out.  So if your mother hasn't had a sentinel node biopsy (SNB), then that probably will be done at the time of her next surgery.

Other than that, assuming that there is no invasion into the lymph nodes, the microinvasion should have no effect on her treatment plan.  After a lumpectomy for DCIS, your mother probably would require radiation regardless of whether or not the microinvasion is there.  If your mother's BC is ER+, Tamoxifen will probably be discussed as part of the treatment plan, whether or not the microinvasion is there.   Chemo is never required for pure DCIS and is rarely discussed for invasive tumors that are less than 5mm in size, so having a microinvasion should not add chemo into the treatment plan.

The only other change resulting from the microinvasion is that your mother's cancer is no longer DCIS Stage 0.  With a microinvasion, she moves up to Stage 1 (T1mic).  With that comes a very small future risk of distant recurrence.  Since DCIS is non-invasive, distance recurrence (i.e. outside of the breast) is technically not possible because the cancer cells were all removed while they were completely contained within the milk ducts of the breast.   However with any amount of invasive cancer, even the tiniest amount, there is a very slight risk that a cancer cell might have escaped out of the breast prior to the surgery.  So distant recurrence is a possibility, although the risk is very small (maybe 1%?) and a drug like Tamoxifen would be effective at reducing this risk even further.  It's not something that's likely to happen, it's not something to worry about, but it is something to be aware of. 

Hope that helps.

onkell,

Staging is based on 3 factors: 

• T for tumor
• N for nodes
• M for metastisis

In your mother's case, the tumor is T1mic, which as you know means that she has a microinvasion of IDC. 

The pNx means that the nodes can't be assessed - probably because none have been surgically removed yet.  Once your mother's nodes are checked, this will be changed.  Hopefully the result will be pN0, meaning no cancer found in the nodes.

The pMx means that there is no assessment of metastases.  This is unlikely to change since most often for women who have DCIS or very early stage 1 BC, although blood tests and chest xrays may be done, additional body scans (CT scan, bone scan) to check for mets are not considered necessary.  If your mother's nodes are clear, the pMx might be left as is and your mother would still be considered Stage 1 even with the gap in information.   The pM0 (no metastisis) would be assumed.  

Mary,

Yup, the "is" in pTis means "in situ".  In your case, because you had DCIS, you didn't have your nodes checked or any body scans to check for mets.  So you are Stage 0 with the assumption of no node involvement (Nx) and the assumption of no mets (Mx).  Although Stage 0 is usually listed as pTis, pN0, pM0, in fact most DCIS women don't have those other tests so your designation is probably more common.

Cheers!

Beesie,

My situation is a little different, and I am hoping you can provide some of your expertise -- while I climb the walls waiting for my doctor's office to re-open after the holiday.

After a stereotactic biopsy, I was diagnosed with DCIS. I had a double mastectomy 7/25/13 with no sentinel node biopsy. On 8/8/13, I followed up with my surgeon who said my pathology report came back all clear and I was good to go. I was in his office on 11/26 (for another matter) and asked for a copy of the pathology report and found that 3 days after we met the path report had been amended. When staging the cancer, the found a micro-invasion.

So, here we are 4 months later, BMX is completed as is TRAM reconstruction. What can be done to know if the cancer spread?

Amended Path Results: DCIS, High Nuclear Grade in Upper Outer Quadrant, focus of microinvasion is identified, no DCIS at margins. And, then there is this note which makes me hopeful that maybe it's not as bad as I am fearing: The focus of micro-invasion is only identified in the additional level cut for the receptor status evaluation.

Thoughts? Thanks in advance. I am new to this board and have received quite an education reading your posts!

KLB

Thank you, Linda. I have followed you're advice

Bessie,

Thank you for your dedication to education and support. You're posts are amazing!

I haven't spoke to my doctor yet as I just read the amended report lastnight and today is Thanksgiving in the good ole US of A. I am not sure if is office will be open tomorrow but I will be calling! And, I have already sent two emails to his coordinator. Waiting is difficult -- I haven't even told my husband about. Beesie, you and Linda1966 are literally the first to know.

So, hopefully this is the information you're looking for:

Amended Final Anatomic Staging

• Pt1mi Tumor less than or equal to 1 mm in greatest dimension
• pN0 No regional lymph node metastasis histologically (i.e., non greater than 0.2 mm), no examination for isolatated tumor cells (ITC)

Other noteworthy statements in the report:

• The focus of microinvasion is only identified in the additional level cut for the receptor status evaluation.
• Within the soft tissue closest to the suture denoting the location of the axilla there is a single possible lymph node measuring 1.5 cm in greatest dimension. (My interpretation is that while there may have been 1 lymph node in the tissue, it probably would have been a miracle if that was the sentinel node).

I will follow up on the other post. This one is a head scratcher... I wouldn't want to remove all those lymph nodes without certainty of getting the 'right' one. I guess I was hoping something like an MRI or PET scan could get the job done.

I am guessing hormone therapy is a possible change in my treatment. I have two separate scores for ER: 2+ 51% of microinvasive carcinoma and 3+ positive in >90% of DCIS. I don't like the idea of a rogue High Grade cell running rogue, but at least I am ER+...

Time to hurry up and wait!

Thanks again!

klb

I had a double mastectomy. I really hope ALND is not part of the discussion... : )

Klb,

Now I'm really confused. I don't see how the pathology report can state "pN0 No regional lymph node metastasis histologically (i.e., non greater than 0.2 mm), no examination for isolatated tumor cells (ITC)" if you did not have a sentinel node biopsy involving the removal and pathological analysis of regional lymph nodes.

"pN0" means that pathologically there is no evidence of invasion - the "p" is used in front of the "N0" only when referring to a pathological sample. Also the fact that the word "histologically" was used indicates that this was an examination under a microscope. The fact that the single lymph node was found within the breast tissue doesn't seem to explain this since the report states "there is a single possible lymph node measuring 1.5 cm in greatest dimension" - and that certainly doesn't sound as though it was this lymph node that was analysed and found to have no evidence of invasion. If it was, the report should stating and that and it likely wouldn't say that it was a "possible lymph node".

More questions for your surgeon.

aklb- wondering if you recall if you signed consent for a sentinel node bx? Its possible they did it with methelyne blue dye while you were under anesthesia versus a nuclear med injection before you went in. If you were having a planned sentinel node bx there would be separately labeled specimens for each node (typically 1-3)

Reading this it appears that the micro invasion is in the section of the specimen that they did the er/pr/her2neu on. In my case that specimen was not from my surgery- it was from the core bx

Secondly- you had a mastectomy which is a large amount of tissue removed and they usually will mark with suture and label each area

- what this is saying to me is that there is a part of the specimen that includes a possible lymph node in it. My sense is this was not taken out necessarily "on purpose" but part of the overall dissection of the breast tissue during your surgery and it came along with it.

I am not sure why you are thinking you need an entire axillary node dissection- did they say that to you? Sentinel node bx can be done with fewer nodes removed based on where the contrast (nuclear medicine or dye) goes first.