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Tumour size on ultrasound vs actual pathology?

1982m Member Posts: 224
edited September 2021 in IDC (Invasive Ductal Carcinoma)

Good morning,

I had surgery 2 weeks ago and am awaiting final pathology. It will prob be another week or two until I find out. My tumour was estimated at 1.5cm via ultrasound. It couldn't be seen on mammogram and was poorly visualized on MRI.

I was wondering how close your tumour was to the pre-surgical estimate?

Edit to add:

I'm also curious if your grade changed too from biopsy to pathology. My Nottingham score was 5/9 so grade 1. I'm curious if most people's grade stayed the same as biopsy of if it changed.

Thanks in advance for sharing :)

Edit: my pathology came back- IDC a measured 8mm. However, there’s multifocal DCIS on the inferior aspect of the sample. It was also upgraded from grade 1, to grade 2.


  • leesad
    leesad Member Posts: 100
    I was told my tumor was tiny 6-8 mm based on ultrasound, biopsy and MRI. It was actually 3 cm’s after my BMX. Was the first of many surprises. I wish all the doctors had never estimated prior. My grade remained the same.
  • 1982m
    1982m Member Posts: 224

    I’m sorry LeesaD. That’s a sh$tty surprise for sure. Thank you for sharing.

  • elainetherese
    elainetherese Member Posts: 1,625

    Different imaging systems can show different sizes. The ultrasound had my tumor at 3.9 cm; the MRI had it at 5 cm, plus a lovely satellite tumor. I will never know its true size because I did chemo before surgery and it was all gone after chemo. My tumor was Grade 3. Because tumors are heterogenous (not always the same grade through and through), I might have also had some parts of the tumor that were Grade 2. Who knows? Frankly, the most important thing to know about my tumor was that it was HER2+ and bigger than 2 cm. That drove my treatment plan, not the precise size or grade.

  • 1982m
    1982m Member Posts: 224

    Thanks for sharing ElaineT.

    I’m hopeful I do stay under 2cm and grade 1. That makes me lower risk vs higher risk,

    I know I'm triple positive but I think if I remain under 2cm and grade 1 I'm more likely to receive weekly taxol and herceptin (which I'm hoping for) then longer chemotherapy. I'll know for sure in a few weeks. I am overall just a curious person so hearing others experiences is helpful :)

    Thanks for sharing

  • salamandra
    salamandra Member Posts: 736

    My ultrasound and mammogram estimates were a bit under (1.3cm) and my MRI was way over (5cm). I came out to 1.8cm. I believe my grade stayed the same (2).

    You really really really can't know until surgery.

    I think of the risk on a spectrum though. At 1.8cm, I'm technically under the 2cm for staging/treatment/etc, but I'm cognizant that I'm way closer to being above 2 than I am to being under 1. There is no magic at 2cm, except for the magic of statistical data aggregation/manipulation/calculation. I'll either recur or not, and only time will tell.

  • everything about my tumor remained the same from biopsy to surgery and I waited almost 2 months for my surgery. I was definitely stressed out at the time thinking it was growing and spreading. But there was no evidence of that. The lymph nodes that they biopsied were clear too.

  • specialk
    specialk Member Posts: 9,221

    1982M - why is your surgical pathology so delayed? My tumor size and grade remained consistent with imaging, although even though it was very palpable it was missed completely on mammography at 2.6cm. It was clearly visualized on both ultrasound and MRI, but the MRI missed positive nodes that met the visible size threshold. I don't image well, a 3cm pre-malignant ovarian mass was also missed 10 years earlier. I had the US done on 9/9, but did not have surgery until almost two months later due to a wait for genetic testing and schedule alignment between the BS and PS for the type of surgery I wanted, but my triple positive, and grade 3, tumor stayed relatively stable size-wise. Wishing you the best and hoping that things your path report has zero surprises!

  • 1982m
    1982m Member Posts: 224

    Thanks everyone for sharing!

    Special K- I live in a Canadian province that tends to have longer wait times. I was told pathology would take about a month. I tried to get the surgeon to order me a port while I wait, but she wouldn’t.

    Covid has compounded wait times. A internal inquiry a few years ago said our province was waiting excessive times and they have tired to implement a better systems. Pathology and surgical wait times can be a lot. I waited 3 years to get a breast reduction consult and was supposed to get the surgery Feb 2022 (a year from the consult).

    Sometimes I’m angry bc if I had just pay out of pocket for it 3 years ago. Now I’ll miss my breast reduction surgery and get radiation instead (they also lack co-ordination. It wasn’t my turn for BR yet so they couldn’t do it with lumpectomy with the surgeon who approved it). My breast surgeon said I couldn’t do it before radiation now…. its stressful.

    Not all provinces are like the one I live in. Not even all cities. But I can’t get medical care in other provinces if it’s offered in my home province unless it’s a clinical trail. So I wait.

    In my honest opinion they prob started catching many of 2020’s breast cancer patients when we took a dip in Covid cases. We’re full swing with cases where I am now too.

  • specialk
    specialk Member Posts: 9,221

    1982M - Oh that is frustrating, sorry you are having to deal with a wait on your pathology, and now not getting the surgery you had originally wanted combined with this one, that is a bummer. Has your surgeon or RO commented at all on whether radiation may affect your reduction possibilities? I know it can have an impact on different types of reconstruction because radiated skin can become compromised and doesn't stretch as well, but I don't know whether it can impact healing for a reduction. Might be worth asking if you are still planning the reduction in 2022, in an effort to be fully informed. Hang in there!

  • bcincolorado
    bcincolorado Member Posts: 4,696

    I had dense tissues and they first thought mine was small and it was large when it was all over with. Mine did change but I had very dense tissues and did not have 3D mamo to start with at the beginning when diagnosed. I think imaging has improved a lot over the years even for people like me.

  • nancy2581
    nancy2581 Member Posts: 407

    I was told my tumor was 1.5cm. Um no it was 2.8cm almost twice as big. Oh well


  • 1greekmomma
    1greekmomma Member Posts: 6

    My tumor did not appear on mammo or ultrasound. 26mm by 16mm on MRI. Completely disappeared after NAC, which meant mastectomy because initially they could not mark it with a clip (too close to chest wall). Worked out in the end because post-surgery pathology showed residual DCIS (grade 2) in the breast tissue anyway.

  • 1982m
    1982m Member Posts: 224

    Special K- I don't find my care overly co-ordinated. It’s very step wise. I don’t have connections with one doctor until I’m done with the first. I haven't been able to talk to a radiation oncologist about the possibilities of breast reduction after radiation- I've heard a few times it's not the best idea. I was thinking once I move onto the medical oncologist trying to co-ordinate with the radiation oncologist to do the reduction before radiation- but I think it would be out of pocket and cost around $10'000- but I still plan on trying. I'm super grateful that most of what I have to have is covered but also feeling a little un grateful since I know it's better else where in other provinces. But I chose to live and work here- so my I guess I get what I get. If I had a crystal ball and foreseen this I prob would have moved to Ontario or BC. Haha.

    bcincolorado- that's a big discrepancy! Im glad you seem to be well. I also have dense breast. I'm also pretty sure I didn't have a 3D mammogram either.

    Nancy- I'm also surprised how off they can be! That must have been a big shock.

    1GreekMomma- glad you had such a good response to chemo! At times I wish I had done chemo before surgery so I could see how the tumour responded. I'll never know now really.

  • margueritekv
    margueritekv Member Posts: 3

    My biopsy estimated that the tumor was "at least 7 mm." Of course, I ignored the "at least..." part in the hope that my tumor was only 7mm. But on final pathology report, the tumor was 12 mm, almost double.

    On the biopsy, my Nottingham Grade was same as yours, 5/9 for Grade 1. On the final report, neither the individual scores nor the total changed. I hope this gives you a little peace of mind while you're waiting for your data.

    This seems awful that you're still waiting for data. My surgery was last Wednesday morning, and the peri-op staff asked whether I wanted my final report from the surgeon or posted directly to the patient portal. I opted for patient portal and received it the next afternoon. I wish everyone could get results this quickly!

    (My final pathology report did not include Oncotype test which won't even be ordered until I meet the oncologist next week.)

  • murfy
    murfy Member Posts: 254

    My mammogram showed tumor bigger than the MRI, which was bigger than the US. Pathology revealed that my 2.6 cm tumor was mostly benign papilloma containing an IDC of only 1cm.

  • 1982m
    1982m Member Posts: 224

    Wow!!! Pathology the next day!!! I am still waiting. It’s been exactly 3 weeks. I know the surgeon doesn’t even have it bc it is posted for us 3 days after the surgeon receives it.

    My biopsy was very quick but this pathology is driving me crazy.

  • AMG2
    AMG2 Member Posts: 90

    Mine was 1.2 cm on both mammogram and US, but estimated to be 1.4 cm on MRI. Surgery showed it as 1.2 cm.

  • margueritekv
    margueritekv Member Posts: 3

    Gosh, 1982M,

    That's a horribly long wait. It it's any consolation, my wait BEFORE the surgery was horrible because all our local hospitals have been cancelling many surgeries, including cancer procedures, because our hospital resources are in crisis due to surge in covid-19 cases. We were on pins and needles for about three weeks, while the cancer continued its assault. I'm still amazed that my surgery was not cancelled, perhaps because I was not expected to need an overnight stay.

    By the way, we were diagnosed on same day.

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,742


    Yes, waiting is hard especially when you were unsure of when the wait would be over.

    For those waiting after initial dx, whether for surgery or tx, please remember that a few weeks is unlikely to make a difference in any outcome. You, for instance, have a stage 1grade 1 tumor so although it was hard to wait mentally and emotionally, it would be highly unusual for your cancer to have progressed or done any damage. Grade 1 is indolent and your cancer has probably been growing for years before it was detectable. So no worries on that end though the emotional part is tough . Take care.

  • wondering44
    wondering44 Member Posts: 252

    Hi 1982M - I had a different result with each test.

    annual mammogram - 2018, 2019, 2020 all good

    saline breast implants 11/2020 all good

    diagnostic breast ultrasound and diagnostic breast mammogram 06/2021 2.2 cm mass and suspected DCIS (biopsy confirmed dx 07/2021)

    pathology from needle core biopsy found 1.3 cm IDC cancer and DCIS

    MRI 07/14/21 - 2.2 cm mass path confirmed cancer mass from biopsy, additional 1.1 cm mass and .5 cm mass found.

    pathology from mastectomy 08/20/21 - 8.5 cm non-invasive ductal carcinoma, 8 cm invasive ductal carcinoma (the 3 masses shown on MRI and the lump confirmed during US & diagnostic mammogram). Grade 3. The non-invasive cancer didn't show on any of the diagnostic tests. The size of the cancer was not accurate on any of the diagnostic tests.

    My MO said even if my pathology had showed something different prior to the mastectomy the cancer more than likely would not have responded to chemo due to my gene typing. Oncontype score 8. The time between the initial diagnosis and pathology was not long enough for the cancer to get significantly larger. I had clear margins and no cancer found in the nodes which is a great result.

    The waiting between tests for results is excruciating. Even though much more than expected, getting the final result was a relief and helped me move on to the next step.

    I picked up my pathology report prior to my surgeon giving me the results. He wanted to do it in person a week after surgery. I called him the same day I picked up the report. It was ready two days after the surgery. He gave me results over the phone and again at my follow-up appointment. Some of the results come in within a couple of days. Some come in much later like the Oncontype.

  • 1982m
    1982m Member Posts: 224

    Thanks everyone! My family doctor printed out my pathology for me. I had some great news.

    Original size estimate: 1.5cm and pathology results have it as 8mm. Original grade was 1 but pathology says 2. There was surprise DCIS that wasn’t seen that was in the margins. No plan yet for that.

  • margueritekv
    margueritekv Member Posts: 3

    exbrnxgrl, you have a good perspective on the situation. I can't imagine how the people who have more serious situations must feel when their medical care is put on hold.