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NEED YOUR KIND HELP WITH PATHOLOGY REPORT >> SUSPICIOUS FOR MARGIN INVOLVEMENT ??

Hello Everyone,

I was reading my pathology report (after lumpectomy) once again, and I am starting to wonder if I should ask my BS to perform a re-excision.

The margins from the IDC component look pretty good. However, a suspicious margin involvement from the DCIS part of it is having me worried. My BS kind of dismissed my questions about it before and told me radiotherapy would deal with this anyway…

Details below:

Pathology Diagnosis

Breast mass, right wide excision:

- Invasive ductal carcinoma, Moderately differentiated, Histologic grade 2
Histologic grading (total score = 6)
Tubule and gland formation 3, Nuclear pleomorphism 2 Mitotic count I

Tumor size: 2.3 cm in greatest diameter
Margin: Abuts anterior resection margin (#A9)

0.5 cm from posterior resection margin

0.6 cm from superior resection margin

0.8 from lateral and inferior resection margin

> 1 cm from medial resection margin

Presence of lymphovascular invasion

Ductal carcinoma in situ, intermediate nuclear grade, solid and cribriform patterns
Associated with comedonecrosis and microcalcifications
Present within and away from invasive carcinoma
Spanning in 19 of 20 slides (My understanding is that a good chunk of the 2.3 cm tumor is DCIS)
Margin: Suspicious for medial margin involvement* (#A2)
< 0.1 cm from posterior and inferior resection margin
0.1 cm from anterior resection margin
0.1 cm from superior resection margin
0.3 cm from lateral resection margin

*Distorted proliferative epithelial nest present on medial resection margin

Presence of previous biopsy site
The remaining parenchyma contains lobular carcinoma in situ (LCIS), atypical lobular hyperplasia

Any ideas ? :)

MANY THANKS !!!

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Comments

  • maggie15
    maggie15 Member Posts: 769

    Hi @jlgif94 , I also had questions about my lumpectomy margins. All were very close (<1 mm) and I had numerous radial scars, a type of proliferative epithelial lesion, in the margins. My breast surgeon told me that proliferative epithelial lesions are benign or pre-cancerous so their presence in the margins didn't warrant a resection. Also, she thought that further surgery would undo a good cosmetic result. The word "suspicious for" means the pathologist is not sure whether your lesions extend past the margins so it isn't a definite breach.

    The lymphovascular invasion mentioned in the path report is also relevant to this question. I had LVI which, according to my surgeon, is evidence that the cancer has learned how to spread. Also the first of 3 sentinel nodes was positive. She thought that any spread was probably regional and would be taken care of by radiation but there was no guarantee that this was the case. Further surgery wouldn't change the circumstances.

    If you are uncomfortable with what you have been told you could get a second opinion. I went with my surgeon's recommendation and have learned to live with the uncertainty. Good luck with your decision.

  • jlgif94
    jlgif94 Member Posts: 9

    Hi @maggie15

    Thank you so much for your answer. It makes sense! As this is the only suspicious margin, then yes, I should probably just stick with his recommendation… Seems like your surgeon gave you way more information about this than mine lol, which is good !

    I was initially quite scared about the LVI thingy, but then kind of decided not to focus on it that much anymore… As there's a lot of diverging information about this. Both my surgeon and my MO don't seem to pay much attention to it as they haven't really discussed this further. But the feedback from your surgeon does make it sound quite worrisome.. I hope the chemo will do its job !

    Thanks again for sharing your own experience, take care :)

  • oldladyblue
    oldladyblue Member Posts: 302

    My surgeon told me the same thing: the one margin I had from the IDC less than .1 cm could be resectioned as the VA recommendation is for .2 cm, however, he didn't strongly recommend it as the radiation should handle. Plus I was to be on hormone suppression for 5 years, but I couldn't take the effects of the hormone suppression pills. So sometimes I wonder if I should have done the resection, but so far so good with no evidence of disease (NED) in my check ups. It's a personal decision to do a resection or not.

  • jlgif94
    jlgif94 Member Posts: 9
    edited January 5

    Thank you for your answer @oldladyblue

    Glad to read you have no evidence of disease since then :)

  • oldladyblue
    oldladyblue Member Posts: 302

    It's so hard with this disease to make decisions when given a choice by the doctors, as with all of their years of training, they are often not totally sure what should be done. I was given a choice of doing chemo or not, then when I decided to do chemo I was told to choose what chemo drug I wanted (TC or AC). After surgery I , was given the choice about a resection or not. Any choices upset me to make, as I wanted to just do "what the doctor said". So I had to get used to making choices and living with my decisions. It's hard not to second guess our own decisions. Like @maggie15 said, I have learned to live with the uncertainty. Be kind to yourself and don't second guess yourself after you make a decision.

  • jlgif94
    jlgif94 Member Posts: 9

    @oldladyblue So true ! It is hard. To be honest I don't feel like I'm given an option to make a decision for myself though. The BS decided I don't a re-excision, it feels like I have no say in this. He decided I don't need a full ALND, I have no say in this.. etc. I am upset because I don't want to just do what the doctor said, and you were upset because you just wanted to do what the doctor said… Seems like both ways come with their own mental challenges eh? 😂

    I will keep reading and educating myself on the few pending points, and I'll do my best to not second guess myself afterwards. THANK YOU !

  • oldladyblue
    oldladyblue Member Posts: 302

    Yesterday I had a LEEP procedure to remove and cauterize part of my cervix. I found out I had HPV and high grade dysplasia on my cervix, that showed up LAST year on my PAP, but was not told to me by the doctor or nurse till my PAP this year due to personnel changes at the large women's clinic I go to. Gosh. This year, I did do what the doctor suggested without hesitation, but fault myself for not asking more in detail last year about my PAP. It's a crap-shoot in my opinion, like playing poker and hoping you make the right bets…. I am glad you are willing to educate yourself! Not second-guessing is hard, but constant worry is worse in my opinion.