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Suspicious for focal lymphovascular invasion

everythingwillbefine
everythingwillbefine Member Posts: 35
edited October 2023 in Just Diagnosed

I am so sad that I returned to this board reporting after 3 years of left mastectomy, I just found from MRI that I have developed DCIS in my right breast and "suspicious for focal lymphovascular invasion".

I did not have MRI in the past 3 years. All I had was diagnostic mamo and ultrasound which is all clear. I wonder what if I had MRI last year….

How bad is it? Does it mean metastasis?

I was driving when I got the call. I did not get too much time to think of questions. I will see surgeon on Tuesday. I know I am going to have another Mastectomy. It's Okay. I wish I did BMX 3 years ago!!! But time cannot go back… I will sentinal node biopsy I know. Should I ask for PET scan regardless the result? I am with Univeristy of Chicago. Should I get a second opinion at Cleveland or Anderson? I am going to have chemo and radiation due to the invasion? Why they cannot say for sure. Why they say it's suspicious? Will the answer is confirmed after the mastcetomy?

I have been on Tomaxifen for the past 5 years and still developed DCIS on my right breast. And Lymphovascular invasion!

My kids are still young 11 and 9. I want to live till at least they graduate from college.

Final Diagnosis

A. Right breast 7:00; core needle biopsy: - Ductal carcinoma in situ, intermediate nuclear grade, solid pattern. - Suspicious for focal lymphovascular invasion; see comment.

Comment

While there is no evidence of invasive carcinoma seen in this sample, there is a focus of tumor separate from the area of DCIS that is concerning for lymphovascular invasion. By immunohistochemistry, the periphery of this tumor nest is negative for p63 and positive for CD34. Together, the histological and immunohistochemical findings are suggestive of possible lymphovascular involvement. Immunohistochemistry for ER and PR is pending.

Comments

  • needs.a.nap
    needs.a.nap Member Posts: 162

    Hello @everythingwillbefine. I’m very sorry you received such upsetting news! I wish I knew how to answer all your questions. Your situation is very different than mine since you already had breast cancer before.

    I have researched a lot about LVI (lymphovascular invasion) since I also had it. Mine was found after my mastectomy. It does not always mean metastasis.

    With my sentinel node biopsy, all 6 nodes removed were clear. My breast surgeon did not say much about the LVI and my oncologist also didn’t say much about it, except that she felt confident in my sentinel node biopsy being 6 nodes - “a good sampling” she thought - and that they were all clear. It did not appear as if my cancer had spread outside the breast tissue. My tumor was Stage 1 and my Oncotype score was 16. So for me, having LVI didn’t change my treatment plan. I’m on Tamoxifen to be followed by an aromatase inhibitor after I go through menopause. I did not receive radiation or chemotherapy.

    Did they already tell you that you would definitely need radiation and chemotherapy? Since you had breast cancer before, I’m sure that adds to the concern about what may be happening.

    I know you have so many questions tonight that you will not get answers to until your appointment on Tuesday. I’ll be thinking of you and hoping for the best!

  • everythingwillbefine
    everythingwillbefine Member Posts: 35
    edited October 2023

    Thank you @needs.a.nap

    I picked up the kids from school this afternoon after I got the news from the surgeon.

    On the way home I was weeping silently. I am just so upset and scared.

  • everythingwillbefine
    everythingwillbefine Member Posts: 35
    edited October 2023

    @needs.a.nap, did you do the sentinal node biopsy before the surgery? or it's done during the mastectomy please?

    With my left breast DCIS, my surgeon removed one node during the surgery and it was clear. I did not do a separate sentinal node biopsy before the surgery.

  • maggie15
    maggie15 Member Posts: 848
    edited October 2023

    Hi @everythingwillbefine , LVI means that cells have separated from the tumor and entered the lymphatic channel or vascular (blood) channel nearby. My surgeon explained it as evidence that cells have learned how to spread but, as far as can be seen, they haven't gone far. My oncotype was 24 so chemo was not recommended since I am older than 50; LVI didn't enter into that decision. In addition to LVI I had one positive sentinel node. The only change to my treatment was nodal radiation being added to the planned whole breast radiation.

    I had a lumpectomy so there were no surgical implications. In the case of your mastectomy, if radiation is recommended be sure to ask how it will impact reconstruction if you are opting for that.

    I'm sorry that you have had to jump back on the breast cancer roller coaster. LVI is not a positive thing but it certainly is not a death sentence. I hope you can get your questions answered at your upcoming appointment. All the best!

  • everythingwillbefine
    everythingwillbefine Member Posts: 35
    edited October 2023

    Hi @maggie15 Thank you for your reply!

    When I had mastectomy 3 years ago with my left breast, I chose to go flat. So this time I will do the same to the right side. I am guessing that I will have chemo and radiation. I don't know my ER, PR and Her2 status yet and hope to find out on Monday. I sure will also need to find out the oncotype score. And is there anything else I need to find out please?

    Last time I had to use FMLA. after surgery I have been off work for 6 weeks. Did not think that I will have to take FMLA leave again in such a short period!

    I am not sure if I should have any hope that after the mastectomy that the final path report will say no LVI.

  • needs.a.nap
    needs.a.nap Member Posts: 162

    @everythingwillbefine It’s understandable that you are afraid and upset. I’m sure this was not what you were expecting!

    I know it sounds extra scary and if you start Googling “lymphovascular invasion” you’ll find all sorts of negative information. I wouldn’t recommend trying to figure it out. I looked through hundreds of references and realized most of them said the same thing. But it’s not a complete picture.

    Yours is definitely not a complete picture yet! They can only tell so much with the small tissue samples from your biopsy. DCIS on its own cannot spread outside the breast. I don’t know if DCIS can change directly into LVI or if it must change to become invasive cancer first and then that invasive cancer can start spreading into the lymphovascular channels around it. It does not mean it has gone into your lymph nodes yet. Let’s hope it was caught as early as possible on your MRI and it hasn’t started spreading anywhere!!!

  • needs.a.nap
    needs.a.nap Member Posts: 162

    Hi again @everythingwillbefine. My sentinel node biopsy was done at the same time as my mastectomy. They ordered the Oncotype score at that time - they need a tumor tissue sample to send for that test.

  • Today I am still waiting for my ER PR status.

    I have not got call yet from doctor.

    But I was scared of thinking it could be tripple negative as I developed this DCIS while I am on tamoxifen 20mg.

  • needs.a.nap
    needs.a.nap Member Posts: 162

    I’m thinking of you @everythingwillbefine and hope you get answers at your appointment tomorrow

  • needsanap and Maggie,

    I want to give an update.

    i had mastectomy last Monday and today the 2 drains were removed. i healed very well. Final pathology said no DCIS nor IDC is found and lymph nodes are clean. So the biopsy removed all the DCIS! So no lymphovascular invasion!

    I am so relieved! I know I am very lucky! Now I need to call my OB to get D&C. Right after I got this breast cancer diagnosis my OB called saying that my lining was too thick and there is a polyp and she want to do a D&C to get something out for testing! She thinks all related to tomaxifen. Now that I had both breasts removed and I no longer need tonaxifen so hopefully the lining is going to thin out on its own. I also had a period on my surgery day! Crazy! 

    I will update on my lining issue later.

    Thank you!

  • maggie15
    maggie15 Member Posts: 848

    Hi @everythingwillbefine , I’m glad the surgery went well and the pathology was clean. Hopefully your D&C will go well, too. It’s great that you can stop taking tamoxifen. Thanks for the update.

  • needs.a.nap
    needs.a.nap Member Posts: 162

    @everythingwillbefine I’m really happy you received such good news! That’s excellent! I hope you are able to rest and recover quickly … and then focus on everything else. Thank you for letting us know how you are doing!! I’m so happy for you 😊