DCIS with positive sentinel node

[cduplaga]

Last week I had a double masctectomy (right breast prophylactic). The lower left breast had multiple areas of calcifications classified as Intermediate Grade DCIS after stereotactic biopsy. A sentinel node biopsy was done on my left side. Frozen section came back positive. 11 more nodes were taken - those 11 all negative.  The sections done on the left breast (including an additional 10 slices requested by my surgeon after the original report) have not shown any areas of invasive cancer, only DCIS. I been advised to have chemo and possibly radiation.

Do I really have invasive cancer and need chemo? What advice can you give me? I am 58, good health, post menopausal, no family history of cancer of any kind.
Thank you.

[Fordeb]

I am interested in this subject matter because my friend, diagnosed with Infiltrative Lobular Carcinoma, had a mastectomy just last week.

Her sentinel node appeared negative (checked twice!) when the frozen section was examined intra-operatively, however her final pathology showed micrometastasis in the sentinel node only (1-2mm).

14 axillary nodes were removed beyond that SN, with 0/14 positive.

How likely is it that there could be a false positive on the sentinel node reading micromets?

She has classical lobular carcinoma, and is estrogen positive at 70%, progesterone positive at 20%, BRCA 1 and 2 negative.

She did have multiple nodules within the breast itself, the largest of which was 3.5 cm.  Tumor was multicentric, across three quadrants.

I would so appreciate your thoughts in this regard, especially as it pertains to chemotherapy.  Chemotherapy is not particularly effective for ILC, but is particularly toxic.  Risk vs. benefit ratio is questionable in my mind.

Your thoughts on this and the likely false positive of the SN would be most gratefully accepted.

Julia

[CCF-RN,MSN-rf]

Dear cduplaga: Yours is a situation which may merit a second pathology opinion by an expert breast cancer pathologist.  There are basically two possibilities: one is that there was an invasive cancer somewhere in the breast but was missed and, although probably small, was able to metastasize to a lymph node OR, alternatively, there was no invasive cancer and the "positive" lymph node was a false positive lymph node (meaning that the cells seen were not truly metastatic breast cancer cells).  The latter possibility is greater if the nodal involvement were microscopic and identified only by special stains called immunohistochemistry (usually performed on sentinel lymph nodes).  The size of the deposit in the lymph node would also be helpful to know as the significance of microscopic deposits less than 0.2mm in the lymph nodes is uncertain.