BREAST CANCER EXPERT FORUM
DCIS, Sentinel node biopsy? Time of treatment

DCIS, Sentinel node biopsy? Time of treatment

I am a 48 year old Caucasian female who was diagnosed with DCIS 12/16/09.  

Clinical history:  6X6 mm lesion

Procedure was a stereotatic biopsy with an 8 gauge biopsy needle using a vacuum assisted device.  

The pathology report:  Microscopic:  Sections show ductal carcinoma in situ.  There is a single focus in one core which measures 4 to 5 mm in greatest dimension consisting of numerous closely spaced large ducts.  These ducts are dilated and filled with cribriform proliferation of epithelial cells showing moderate nuclear grade.  Central comedonecrosis is seen which is associated with microcalcification.  A stromal response is seen around a single involved duct.  While microinvasion cannot be entirely excluded, I believe that this focus most likely represents a stromal response to a ruptured duct.

Elsewhere in the breast biopsy material are several foci of lobular carcinoma in situ and a single focus of atypical intraductal hyperplasia.

Conclusion:  Left breast, stereotatic core needle biopsies of lesion at 1:00 location (biopsy procedure said 2:00).  Ductal carcinoma in situ; multifocal lobular carcinoma in situ and single focus of atypical intraductal hyperplasia.

Histological type:  Cribriform
Nuclear grade: 2
Necrosis:  Present
Calcifications:  Present associated with DCIS
Estrogen Receptors:  Positive for estrogen receptor.
No palpable mass and no mass seen on mammogram.

I have a lumpectomy scheduled for March 24th.  

1)I have the procedure scheduled for 3/24 for multiple reasons.  Is this within an acceptable time range of doing the treatment given the diagnosis and pathology?  

2)Would Sentinel node biopsy be recommended or over treatment?

3)If just the lumpectomy would be preformed would there be any reason there couldn't be a sentinel node biopsy done later if something else showed up in the pathology of the lumpectomy?

4)Is the pathology report clear and complete or would a second opinion be recommended or necessary?

Thank you.
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Dear Sunday999:   The purpose for sentinel node biopsy is to determine if there is any spread to a lymph node.  If there is any invasive cancer, this procedure would be recommended.  In this sample, there is some question about one spot that the pathologist thinks is more likely not invasion.  You should discuss this with your surgeon in terms of whether a sentinel node biopsy would be appropriate for your situation given what remains in the breast and degree of concern in the sample.  A sentinel node biopsy is done at the time of surgery and is not generally done after the fact.  While these things are generally not emergent, in terms of timing, no one can guarantee that a specific interval of time is "safe."  This question is best discussed with your surgeon who can speak to your situation and your reasons for the date you selected.  
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