Pathological Report Interpretation

[Jini05]

9 cores of soft tan white yellow hemorrhagic tissue with a combined length of 11.4 cm and measuring 0.2cm in diameter.  Totally submitted in cassettes 1A-1C.

My breast pathological report states that DCIS , High Grade and focuc suspicious for invasive carcinoma with calcifications identified.  Grade of Invasive Carcinoma:  Not identified, Hormones Receptors Ordered: No, Nuclear Score: Grade 3: Marked Variation, Coagulation Necrosis:  1+ Little or none including a few small punctate foci (<10% of coci), Lympathic or Blood Vessel invasion: No, Calcifications:  Yes,  Location: associated with benign breast tissue and DCIS.
Comment: Multiple histological levels have been examined sections show high grade dcis, calcifications are identified. On block 1A there is a focus suspicious for invasice carcinoma with desmoplastic type stroma and inflammation, however definitive features of invasion are not identified.  Immunohistochemical staining for smooth muscle myosin heavy chain and p63 have been performed and non-contributory due to technical issues. Can someone please interpret this report for me?  Please tell me the type of treatments available?

[bluebutterfly2222]

p.s. I found a better description of the Sentinel node biopsy and will send  a private message with a link to it,

[bluebutterfly2222]

I hope this information helps to prepare you these procedures, but I have a feeling that you are more interested in what the experince will be like from the patient's perspective.

Maybe some of our members will add a note about their personal experiences...

Best wishes,
bluebutterfly

[bluebutterfly2222]

And here is a description of the wire localization procedure:

"What to Expect During Your Wire Localization Procedure:
Wire localization is a technique that is used to mark the location of a breast abnormality that is quite small, or that can't be easily found by touch. This procedure ensures greater accuracy for a breast biopsy or lumpectomy. Your surgeon will use the wire as a guide to the tissue that needs to be removed. Since mammograms will be taken first, ask your radiologist if you can use Lidocaine gel to numb your breast before the procedure.
Getting The Right Picture at the Right Place:
Your wire localization will be done in the Radiology Department of the hospital or surgical center where your breast biopsy or lumpectomy is scheduled. Mammograms (or in some cases, ultrasound images) must be taken to show the location of the breast abnormality. You will need to undrape the affected breast, and get into position for a mammogram. Special equipment, such as a paddle-shaped compression device may be used during your mammogram. It may be necessary to take several images, in order to find the exact location of your lump or area of concern.
Preventing Breast Pain:
You will be awake during the placement of the wire, but your breast will be numbed so that you won't feel pain from the needle or the wire. Your radiologist will inject a local anesthetic, to numb your breast before the wire placement. You may feel a small sting from the anesthetic needle, but as the anesthesia takes over, you should not notice any other pain. It is possible to feel pressure or pulling sensations during the wire placement, and some women said that they felt faint or dizzy during the procedure. If you feel anything that is uncomfortable, let your radiologist know right away, so they can help you.
Inserting the Wire:
Now that images have been taken, and your breast has been numbed, your radiologist will use a very fine needle (smaller than is used for a blood draw) to target your breast abnormality. The tip of this needle must rest in the location that your surgeon needs to find, in order to remove the right tissue. A slender wire will be threaded down through the needle and out of its tip, to lodge at the target tissue. The needle will be removed, leaving the wire in place.
Double-Checking the Wire Location:
With the wire in place, you will have another mammogram, to check that the tip of the wire is properly positioned. If the wire is not in the correct place, your radiologist will reposition and re-check it, to ensure accurate placement. When the wire is finally positioned, it will be secured in place with tape or a bandage.
Timing of Your Wire Localization With Other Procedures:
Your wire localization procedure can take about an hour, and is usually scheduled two hours before your biopsy or lumpectomy. When the wire has been properly placed and secured in position, you will be ready for your next procedure. The wire will be removed, along with some breast tissue, during your surgery."

[bluebutterfly2222]

Here is a description of the Sentinel node biopsy procedure:

"Sentinel node biopsy, a relatively new technique to determine whether cancer has spread to the lymph nodes, is  used as an alternative to axillary lymph node dissection. Generally, less tissue is removed by sentinel node biopsy than by axillary lymph dissection. Also, sentinel lymph node biopsy does not appear to cause as many problems with lymphedema as does axillary lymph node dissection.
Before a sentinel node biopsy is done, a nuclear scanning technique called lymphoscintigraphy is used to “map” the drainage pattern of lymphatic fluid from the site where cancer is found. A radioactive material is injected into the area of the breast where the cancer is found and a special camera is then used to take pictures of the lymph nodes. A blue dye may be used during a sentinel node biopsy. The first lymph nodes in the drainage pattern to absorb the radioactive material are called the sentinel nodes. The sentinel nodes are usually the first place where cancers cells may spread. This dye may cause skin discoloration that can last for several days after the procedure. It also causes your urine to be green for 24 hours after the procedure.
Using the information gathered from lymphoscintigraphy, the tissue containing the sentinel nodes is then removed and examined under a microscope for signs of cancer."  

[Jini05]

Thank you bluebutterfly I guess I am all confused and forgot about the thread but thank you for sending me the link.  Thanks again.

Hi Japdip

I hope you are doing fine as for me I am fine.

Went to the surgeon and he told me he would do a lumpectomy and send the tissue he will withdraw to the pathologist for further test.  I will have a wire localization and an injection for the sentinel lymph node on the  morning of the surgery and have the surgery right after.  He has proposed that I do 5 weeks of radiation but this will depend on the pathologist report.

Thank you so much for all your support and I am now thinking of the two procedures that I will have to undergo before the surgery that is the wire localization and the injection for the sentinel lymph node.  Can you please clarify me on this?

Thanks can you please let bluebutterfly know about that.

Jini05

[bluebutterfly2222]

You are most welcome.

We'll be thinking of you!

[Jini05]

Thank you so much and for sure I will keep you informed you guys of the outcome once I meet up with my doctor this coming wednesday.  Thanks to Zouzi for noticing the confusion :-)

Thank you for caring and believe me I really appreciate it.
Jini05

[bluebutterfly2222]

Clarification: I unintentionally made it sound as though DCIS is not breast cancer. It is, but if that's all you are found to have, it is a very early stage (Stage 0), which is highly treatable.

In attempting to simplify the term  "invasive carcinoma,"  I meant to say (invasive breast cancer) rather than (actual breast cancer).

I regret any confusion this created, and give thanks to Zouzi for noticing my error!

bb

[bluebutterfly2222]

Hi,

Your report indicates that you have DCIS (ductal carcinoma in situ) and also had a focus (specific part) of the sample that was SUSPICIOUS for  invasive carcinoma (actual breast cancer), but this could not be definitively determined.

As japdip indicated, you will  need further surgery, probably an excision biopsy or lumpectomy, and some type of follow up treatment.   If the invasive cancer is confirmed, it would most likely be at a very early stage. (This is where the benefit of having regular mammograms comes in!)

However, your doctor is the only one who can give you definite answers about these findings and what the next step should be.

Please update us after you meet with your surgeon--we care!

Best wishes...

[Jini05]

You mean I have breast cancer already?  I thought I only had a cluster of calcifications that could become cancerous but are not yet cancerous.  What kind of treatment would this entail?  I am meeting my surgeon next week actually one week after having the pathological report.  Do you think I will need a lumpectomy or a mastectomy?  Is it an initial stage or it is very bad?  I have been doing my mammogram on a regular basis for 5 years now.  Thank you and Regards

[Jini05]

You mean I have breast cancer already?  I thought I only had a cluster of calcifications that could become cancerous but are not yet cancerous.  What kind of treatment would this entail?  I am meeting my surgeon next week actually one week after having the pathological report.  Do you think I will need a lumpectomy or a mastectomy?  Is it an initial stage or it is very bad?  I have been doing my mammogram on a regular basis for 5 years now.  Thank you and Regards