Pathology Report

My wife was diagnosed with BC in April-04. Biopsy found (1) small area of IDC; 2 smaller areas of DCIS; ER/PR +; HER2 +. Mastectomy/Tram-Flap performed on left breast. Surgery and reconstruction went well. First pathology report came back(1)node positive and non-invasive cancer. This obvious contradiction caused the surgeon to order another path. report. The second report came back showing and .8cm invasive tumor with "margins to the deep resection." The surgeon stated that "there was not much tissue left for the second path report and it was hard to tell how far the original blue dye had blead into the tissue. Unfortunately, we have to assume this is a positive margin". My wife just finished 8 cycles of dose dense AC+T. She handled the treatment extremely well and is doing great. We have an appointment with the radiation oncologist next tuesday. Our concern is that the need for radiation is based on a "positive margin" from a suspect second pathology report. Any comments or advice would be appreciated. Also, is the reconstructed tissue at a higher risk of damage from radiation then normal tissue.

[CCF-RN,MSN-rf]

Dear Barks:  Radiation therapy may be indicated if the deep surgical margin is truly positive.  As such, your wife may benefit from having all the slides reviewed by a second pathologist.  Often, situations like this will involve a team approach between the radiation therapist, pathologist, surgeon, and oncologist who can discuss all the issues and pros and cons.  There is a higher risk of complications from radiating reconstructed tissue but this may be outweighed by the benefit if the margin is truly positive.