Radiation following excisional biopsy?

[mt boobs]

Right breast has 2 masses in close proximity(both small) An excisional biopsy/lumpectomy will be performed. What is the difference between an excisional biopsy & a lumpectomy? I have read that lumpectomy without radiation is not a good treatment choice. But one of the surgeons I have spoken with says if I have "clear margins" following the lumpectomy, radiation will not be needed. And what about Sentinel Node Analysis? Should that procedure be performed at the same time? Or am I really confused - does the excisional biopsy provide the "definitive pathology" and the lumpectomy is the treatment for it IF cancer is found.  

Pathology: Needle core biopsy on one mass: First report reads:Changes suggesting DUCTAL carcinoma in situ, question invasive carcinoma. Outside consult pending." The second report on same tisue (from outside consult) reads: "It is our opinion that this in situ carcinoma is of LOBULAR rather than ductal type. E-cadherin performed shows lack of cytoplasmic membrane staining within the central portion of these expanded acini. Difficult to say if invasive. Based on imaging finding that there is a mass, open biopsy strongly recommended."

Path.from mammotone on second mass reads: Extensive atypical lobular hyperplasia involving multiple lobular units & adenosis w/associated microcalcifications involving multiple cores. Largest focus 6mm. Comment: extensive adenosis & sclerotic foci w/entrapped ductal structures suggests involvement of sclerosed micropapilloma or complex sclerosing lesion.Density of the process indicates it may be localized."

Thank you!

[CCF-RN,MSN-rf]

Dear mt boobs:  An excisional biopsy is technically the same as a lumpectomy, although an excisional biopsy is intended for biopsy.  IF the lump is malignant, the margins (edges) will be examined.  If the margins are positive, then additional lumpectomy or mastectomy (depending on tumor and choice) is required.  If the margins are clean (negative), then no lumpectomy is needed.  However, in either case, the lymph nodes should be checked either by axillary node dissection or by sentinel lymph node biopsy (depending on the specific pathology of the tumor).  If the lump is malignant and lumpectomy is done, radiation therapy is recommended.  IF the lump is benign - no additional procedure is needed.  Excisional biopsy will provide definitive pathology.

[surgeon]

lobular carcinoma in situ is a controversial animal: many think it's more of a marker for cancer risk than it is actually cancer. So if in removing it, no invasive cancer is found, and if the entity is lobular rather than ductal, then simple excision alone would generally be felt to be adequate. As to the difference between excisional biopsy and lumpectomy, it's largely semantic: if the excisional biopsy removes all the tumor and the margins are adequately clear, then it's a lumpectomy. If a core, or other type of biopsy, has established a diagnosis of cancer already, then there's really no difference between excisional biopsy and lumptectomy: the goal is total removal the the tumor with clear margins. When a biopsy is equivocal due to partial sampling, then one might call the surgery to remove it all to get complete sampling "excisional biopsy." In most cases, where there is reason to be pretty suspicious of cancer, the excision would be done widely enough to be a complete lumpectomy. It may not, especially in the case of  insitu carcinoma, to tell immediately in the OR whether there's any invasion. Node sampling is generally done only when there is invasive cancer -- so some women have to wait til the final pathology report, because when sampling shows insitu (non-invasive) carcinoma, then it may be necessary to go through many slices in a time-consuming way to see if there's any invasive component. Make sense?

[surgeon]

I should have added that in your case, the exact nature of the lumps is so far unclear. Some things can look like cancer on a sample and turn out not to be. The difference, as I said above, between ductal carcinoma in situ and lobular carcinoma in situ if significant: the former usually requires additional treatment of the breast if it's extensive, the latter usually doesn't. Invasive, whether lobular or ductal, requires treatment of the whole breast.

[mt boobs]

Thanks to both of you for your prompt and informative responses! I feel I have a much better understanding of "the process" of excisional biopsy/lumpectomy. I'm so glad I found this "forum" for questions and answers. Everything I have read is clear and concise. Keep up the good work! And many thanks!!