3 diagnoses on same tissue - ALH, DCIS, ADH

[Marty4485]

Routine mammogram showed multiple clustered microcalcifications (more than 20).  I had a biopsy with a diagnosis of ALH.  Was tagged.  Decided to have the lumpectomy to ensure only ALH.  Had wire localization followed by surgery.  Lumpectomy pathology report was DCIS, stage 0, grade 1, no necrosis, cribriform, size .2 cm, clear margins, ER+.  Plan was to do 6 weeks radiation.  But requested second opinion pathology report which came back as ADH, not DCIS.  Breast surgeon says I have three choices - do nothing, tamoxifen or proceed with radiation.  What should I do?  

[Cleveland Clinic]

Dear Marty4485:  It is not unusual to have more than one type of cell in any on specimen.  If there is no question about DCIS, then ADH is a risk factor only.  If it is possible that there is DCIS, then your follow up may be a bit more aggressive.  You may wish to have a tie breaking pathology review - at a major facility and a second oncology opinion following, just to make sure all is clear.

[Marty4485]

Thank you so much!  I will plan to get the "tie-breaker" opinion!