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Breast Cancer (Expert Forum)
Are multiple stereotactic biopsies warrented, as well as Sentiel Node Biopsy?
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Are multiple stereotactic biopsies warrented, as well as Sentiel Node Biopsy?
by kiksav, Aug 05, 2003 12:00AM
My wife was diagnosed with (DCIS, cribriform and solid types with focal comedonecrosis, nuclear grade2)associated with microcalcifications and colonization of lobules. No invasive carcinoma.(This directly off pathology report) 2 questions. 3 areas of calcifications were detected by mamagraphy, approx. 3 1/2 inches apart. Surgeon biopsied 1 site. He states that all three will be identical.(Large dense breasts) Radiologist made the comment that after the excision of all of these sites, it may be determined that 1 or 2 may not be DCIS. Seems like a hard way to find out!! Should we push for another stereotactic biopsy? Surgeon also seems adament about doing a Sentinal Node Biopsy. I understand that no harm can come from this, yet it appears that this surgeon has pioneered a sub areola injection site technique and this test is contra indicated for DCIS (non Invasive)She doesn't need to be part of a study. I don't need to risk my wife being under general any longer than necessary as well as the small chance of an anafalactic (Sorry for the spelling) reaction. This will be disfiguring enough and do not see the reason for her breast to be blue for up to 6 months!! She is not too thrilled about a needle in her areola region.(this done while she is awake) Thanks for the help!
Doctor's Answer
by CCF-RN,MSN-rf, Aug 05, 2003 12:00AM
Dear kiksav: If there are three areas of calcifications, there is no way to know what all three are with only one biopsy. The biopsy tells you what is in one area. If this area is DCIS, it does not mean that the others are (or are not). If they are DCIS, a mastectomy might be recommended rather than lumpectomy since that would mean multiple focuses. In any case, in DCIS, there is generally no reason to check lymph nodes. Lymph nodes should be evaluated if there is ANY invasive component.
Member Comments (6)
by surgeon, Aug 05, 2003 12:00AM
In my opinion, the more important question is how is the breast going to be treated? DCIS is virtually 100% curable; however, when it has comedonecrosis and other features you mentioned, there's a higher recurrance rate within the breast. At minimum it would be recommended that the area be widely excised to clear margins, followed by radiation. Some would suggest considering simple mastectomy. If, when the final surgical excision of whatever is going to be removed is done, and if no invasive component was found, node biopsy isn't clearly indicated.
by kiksav, Aug 05, 2003 12:00AM
To: Surgeon
A wide excision is planned with radiation and Tamoxofin. I guess my question still is are the other 2 calcification sites most probably DCIS? I just want to make sure we are not removing healthy tissue. In regards to the SNB, can the decision to to this be made on the spot? If not do they have to go back in again at a later time to do the SNB?
by surgeon, Aug 06, 2003 12:00AM
It's hard to review all the tissue during surgery. The entire specimen needs to be examined in detail. With DCIS, the rapid technique of examination during surgery may not give enough detail. So, the scenario is most likely one in which the excision is done, and the final report will have to wait. If invasion is found, then a second operation to do the node sampling would be necessary. It's too bad to have to go through it twice; but that's how it is with DCIS.
by surgeon, Aug 06, 2003 12:00AM
It's hard to review all the tissue during surgery. The entire specimen needs to be examined in detail. With DCIS, the rapid technique of examination during surgery may not give enough detail. So, the scenario is most likely one in which the excision is done, and the final report will have to wait. If invasion is found, then a second operation to do the node sampling would be necessary. It's too bad to have to go through it twice; but that's how it is with DCIS. Again, the issue is whether limited treatment of the breast is adequate; it might well be that if breast preservation is what your wife wants, then the other areas need to be sampled as well.
by kiksav, Aug 06, 2003 12:00AM
To: Surgeon
On 8/5/03 we had a second opinion. This Surgeon wants to do a wire/needle biopsy of all three sites, then remove only the sites that show as DCIS (or worse) Sentinel Node Biopsy will not be done unless any invasive carcinoma is detected. Obviously safe margins are our big hope. As you stated, my wife and I are trying to save the breast. This surgeon feels that if he has to remove any more than 30% from any quadrant, a masdectomy will be required. As of now the DCIS site and the other two calcification sites are in the upper left (3 o'clock) quadrant of the left breast. Your replies to my questions have led us to get a second opinion. We are very relieved that this surgeon wants to biopsy all the sites in question before removing the tissue. Any final thoughts or suggestions that you may have will be appreciated. Thanks again!!!! More people should be made aware of your web site.!!
