Grading for IDC

Microscopic analysis showed minimal tubule formation, marked nuclear pleomorphism & a brisk mitotic count.  I'm having a lumpectomy followed by radiation.  I mentioned my concern about the biopsy, the surgeon said it wasn't that important, wait for the surgical pathology of whole tumor.  That doesn't sound fully truthful to me, I need to get a better idea if chemo is in my future.  The tumor is 1/2", do not expect node involvement, surgeon said probably stage 1, but that doesn't address the aggressiveness of the tumor itself.  Any thoughts?

[CCF-RN,MSN-rf]

Dear Calth:  The decision to use chemotherapy (or not) is, in fact, based on the whole picture.  Once the lumpectomy is completed, you will have more information including the actual size of the involved tumor, margins, the grade, invasion, node involvement (if these are being checked), hormone receptor status and her2neu status.  Once all the information is available, treatment recommendations can begin to be made.

[sparkle246]

You won't know the grade until they test it.  I was stage 1, node negative, 1.3cm tumor, grade 3, er/pr+.  typically, women who are premenopaual have higher grade tumors, but I have seen older women with high grade and young women with low grade tumors. The good thing about high grade tumors, is that they respond well to chemo.

Hope this helps.

Karen

[Calth]

Thanks for the information and for responding so quickly. I am 53 and premenopausal at this point, sort of a mixed bag.  In any case, I still don't understand why the biopsy path report isn't a fairly accurate indicator of tumor grade.  I don't look forward to chemo but am not afraid of it and don't understand why it wasn't put forward as likely.  I'm a former CCRN about to take a refresher course to return to work - if I am likely to need chemo I must change the date of my classes right away.

[sparkle246]

Calth,

I would wait until you receive your final pathology to make any major decisions.  You may not need chemo.  I did do everything possible eventhough it was considered early stage disease.  I did dose dense chemo, radiation, Herceptin (for one year until June, '06) and Aromasin (estrogen blocker, pill) for 5 - 10 year.  

Do you know how big the tumor is?  Have they told you the grade yet?  When I got my biopsy report back, my tumor was a grade 2-3 but when the final pathology came back from my lumpectomy, it was grade 3.  

I am sure the nurse that answeres the questions here will get back to you soon.  A really good board to go to for information is, Breastcancer.org.  Lots of really smart women who are dealing with breast cancer.

Good luck,

Karen

[healthcareguerilla]

Given your concerns, have you had another pathologist review the biopsy slides - perhaps a pathologist from another institution?