Pathology after surgery versus biopsy pathology
I am just curious. Has anyone on here had a different result from what the biopsy results were to when surgery was done and the pathology from it?
In other words was there anything less or more than what the original biopsy said when they did surgery and the results from it?
Just wondering should I prepare for any surprises?
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Oh, yeah. My pathology went from three tumors to seven and from two kinds of cancer to five. And they found micrometastis in one lymph node.
A bit of a shock, to say the least. My breast surgeon, who I adore, told me it was because I'm special. Riiiight. I don't think special is the word I would have picked. Cursed, maybe.
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My experience - needle core biopsy showed Stage 2, grade 2 and CT scan looked normal for lymph nodes and tumor about 3 cm. 5 weeks later I had my lumpectomy and pathology changed to Stage 3A, Grade 3, 2 + nodes, and surgeon removed 6 cm of tumor and tendrils. But I am here, one year out from diagnosis. I did chemo over 20 weeks, right side mastectomy (no reconstruction) and 6 weeks of radiation. Just had an abbreviated MRI yesterday for the other breast and it's all clear. My oncotype was 20. I'm taking anastrazole for 5 yrs and possibly for 10. Also approved for Verzenio to start in November. Good luck to you
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LOJ,
It can happen but then again it might not! I think the guesstimate on size was fairly accurate for me and though no nodes appeared to be involved on imaging, one sn was positive for cancer. I think that as long as you recognize that this is a possibility, you are prepared. What you should not do is try to predict if this will happen to you based on what others report here! So do keep the possibility in mind but don’t spend too much time dwelling on it. This is currently an unknown for you so don’t give it too much importance until you have the facts. Take care.0 -
My biopsy said my cancer was grade 1, my pathology said grade 2. My biopsy did not pick up on any DCIS. My pathology found grade 2 multifocal DCIS. My biopsy measured the largest part of my tumour as 8.5mm but was found to be 8mm on pathology (which is better and very close to what the biopsy said). My ultrasound said the tumour was bigger at 1.5cm. My nodes looked negative on MRI and were negative on sentile node biopsy.
They didn't retest Her2 or ER/PR test.
Really no huge surprises for me but there defiantly can be differences.
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Mine turned out to be larger and with a micromet in the sentinel node. And although the biopsy showed a mix, the post-surgery pathology said lobular.
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I think exbrxngrl says it best, recognize the possibility that you might get revised information, but don't worry too much about what others here have experienced. Its such a head game as it is. I did find the "after surgery surprise" to be a little more difficult to handle so kudos to you for mentally preparing your self. Sometimes I think that conversation gets missed, the fact that your initial biopsy is just one piece of your information and that nothing is definitive until your final surgical pathology.
My biopsy was DCIS, I was "upgraded" to IDC post surgery.
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My pathology remained the same but the lesion was slightly larger than imaging suggested (6mm on imaging; 8mm on excision).
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I was told based on biopsy and imaging including MRI and ultrasound, small tumor 6-8 mm and no lymph node involvement. Post mastectomy, tumor was 3 cm's with two nodes showing micromets. Made surgeon go back in for ALND and found two more fully positive axillary nodes. Surprise after surprise. My thoughts are doctors should not give any estimated info to patients and don't say anything except 'we
don't know' until after surgery. I still have PTSD from the surprises. I had all my doctors saying small, tiny and even my breast surgeon saying to me in our consult 'wow this is a great catch by your radiologist (who was a breast specialist) as it's so small and could easily have been missed' 🙄. Bottom line you don't know anything definite until after surgery. My receptors and grade remained the same as what biopsy showed.
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LoverofJesu, my theory for cancer diagnoses is to prepare for the worst and wish for the best. I was diagnosed with ILC as well and this is a type of BC that most likely comes with many surprises. I wish you happy surprises, just a small tumor, and no lymph node involvement.
LeesaD, if you don't mind me asking, what hospital did you get your treatments from? I can see you had it all, BMX, radiation, chemo, AI and Zoladex. All for Oncotype 3.
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Mine biopsy was grade 1, single 8.5mm tumour but the measured 1.5cm on ultrasound.
My pathology was 8mm tumour, grade 2, and surprise multifocal DCIS in the margins. I don’t feel like it was much worse then what the predicted. My grade 1 was already close to grade 2- it was boarder line on biopsy. No lymphovascular invasion on either biopsy or path. Sentile nodes looked clear on MRI and 4 nodes taken and were negative.
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Had to delete my post bc apparently I already answered! Haha. Oops. Chemo brain!
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Lillyishere- I was treated at Monter Cancer Center on Long Island. It's Northwell network.
Yes, I had it all. With the tumor being three times the size of what was estimated and then the micromets in the sentinel nodes, I really pushed for ALND even though oncologist and surgeon thought it was not necessary. In the few weeks between BMX and ALND, my oncologist sent out for Oncotype. I then had the ALND and both my surgeon and oncologist called me with the results within five mins of each other saying 2 of 14 axillary nodes were and I quote 'full of cancer' and fully positive even though sentinel nodes just showed micromets. MO set me up asap for port placement and for AC+T chemo. While preparing for all of that, we get the results of the Oncotype and it was a 3 which was I guess good news but my cancer seemed to be on the move and the Oncotype good for up to just three positive nodes. I had 2 with micromets and 2 positive so sort of grey area. My oncologist was encouraged by the 3 score and pivoted and said let's change the chemo regime and take away the Adriamyacin as now he felt the heart risk was not worth any benefit.So I had TC four rounds. Then had radiation and wanted to go right to AI's even though I wasn't in menopause. Did the Zoladex for ovary suppression just for a few months so I could begin AI's until my oophorectomy.
I was ok with being aggressive with treatments and took every percentage point I could. My oncologist, who I loved by the way (he's since retired), did say once that he felt he could be over treating me with the chemo and the 3. We knew AI's were most what my cancer would respond to due to the low Oncotype but with 4 involved nodes he felt he had to give me chemo. I never wanted to regret later on not doing all I could. For me I needed the full picture hence why I pushed hard for the ALND. I knew I could not live not knowing if there were further nodes with cancer and my doctors couldn't guarantee me there wasn't. It was the best decision I ever made and it changed my entire treatment plan. If I didn't have the ALND, we just would've waited for the Oncotype to come back and it would've been the 3 and I would've skipped chemo as no one would've given me chemo with just two nodes with micromets and a 3. Would've skipped radiation as not recommended with BMX and two nodes with micromets and I would've been sent on my merry way with AI's and two fully positive nodes still there.
So lots of surprises initially and I did end up liking my team a lot. I'd go in for an appt and my oncologist would say oh he just got a text from breast surgeon about me regarding something and then my first meeting with the radiation oncologist, she said she was familiar with my case already from the tumor board meetings they'd had. Very happy with Northwell and keeping all doctors and treatments in one network. They all communicated very well once we knew what we were dealing with.
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I had a little bit of a surprise. I was ER/PR+ and Her2- at biopsy, proceeded with neoadjuvant chemo and then, at surgery, my residual tumor was Her2+. This is really unusual. So you should be prepared that some things can change-size, nodal involvement and pathology, but you usually have good direction going in.
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