Just diagnosed. Please help with biopsy report
overwhelmed and scared.
====A. Right breast, R1 at 10:00, 3 cm from nipple, core biopsy
- Invasive ductal carcinoma (see comments)
- Focal ductal carcinoma in situ
B. Right axilla, rax at 10:00, 10-11 cm from nipple, core biopsy
- One lymph node, negative for carcinoma (0/1)
Value
INVASIVE CARCINOMA OF THE BREAST: BIOPSY - All Specimens
Procedure: Needle biopsy
Specimen Laterality: Right
INVASIVE CARCINOMA OF THE BREAST: Biopsy
INVASIVE CARCINOMA OF THE BREAST: BIOPSY - All Specimens
Protocol posted: 3/22/2023
SPECIMEN
Procedure: Needle biopsy
Specimen Laterality: Right
TUMOR
Histologic Type: Invasive carcinoma of no special type (ductal)
Histologic Grade (Nottingham Histologic Score):
Glandular (Acinar) / Tubular Differentiation: Score 3
Nuclear Pleomorphism: Score 2
Mitotic Rate: Score 1
Overall Grade: Grade 2 (scores of 6 or 7)
Largest Invasive Focus in this Limited Biopsy Sample: 9.9 mm
Ductal Carcinoma In Situ (DCIS): Not identified
Lymphatic and / or Vascular Invasion: Not identified
Microcalcifications: Not identified
Breast Biomarker Reporting Template
BREAST BIOMARKER REPORTING TEMPLATE - All Specimens
Test(s) Performed:
Estrogen Receptor (ER) Status: Positive (greater than 10% of cells demonstrate nuclear positivity)
Percentage of Cells with Nuclear Positivity: 91-100%
Average Intensity of Staining: Strong
Test Type: Food and Drug Administration (FDA) cleared (test / vendor): Ventana Roche
Primary Antibody: SP1
Test(s) Performed:
Progesterone Receptor (PgR) Status: Positive
Percentage of Cells with Nuclear Positivity: 91-100%
Average Intensity of Staining: Strong
Test Type: Laboratory-developed test
Primary Antibody: 1E2
Test(s) Performed:
HER2 by Immunohistochemistry: Negative (Score 1+)
Test Type: Food and Drug Administration (FDA) cleared (test / vendor): Ventana Roche
Primary Antibody: 4B5
Test(s) Performed:
HER2 by in situ Hybridization: Negative (not amplified)
Method: Dual probe assay
Average Number of HER2 Signals per Cell: 1.9
Average Number of CEP17 Signals per Cell: 1.55
HER2 / CEP17 Ratio: 1.23
Test Type: Food and Drug Administration (FDA) cleared (test / vendor): Ventana HER2 Dual ISH DNA Probe Cocktail
Test(s) Performed: Ki-67
Ki-67 Percentage of Positive Nuclei: 20 %
Primary Antibody: MIB1
Cold Ischemia and Fixation Times: Meet requirements specified in latest version of the ASCO / CAP Guidelines
Testing Performed on Block Number(s): A1
METHODS
Fixative: Formalin
Image Analysis: Not performed
Comment(s): HER2 IHC was scored and reported according to ASCO/CAP Guidelines as negative, equivocal or positive for protein overexpression. As of 6/2024, in order to identify all cancers that may be eligible for evolving treatments targeting minimal levels of HER2 expression, samples reported as IHC 0 here exclude cases with any membranous staining (even if <10% of the sample). Samples with a reported score of IHC 1+ include all cases that have any incomplete membranous staining (both >10% and <10% of the sample).
Comments
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First of all, I am sorry that you have joined the club, and I remember how terrifying those first few weeks are. Second, I am not a doctor, so I can't speak to what kind of treatment you will need or anything like that. Having said that, it looks like, from your biopsy report, that you have a small ER+, PR+, Her2- breast cancer, which is the most common kind. The one lymph node they biopsied was negative, which is good. There are three grades of cancer, with 1 being the least aggressive and 3 being the most aggressive. Yours is grade 2, which is in the middle.
This is very treatable. The next few weeks will be filled with appointments and possibly additional testing, like an MRI. Additional tests are so your surgeon can get as complete a picture as possible in order to plan your treatment; it's standard and not a cause for alarm. Don't be worried if things move slowly, this is also normal.
Once you get your plan you will feel a lot better!
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Thanks maggiehopley for the comfort.
Lost and very sad. Was told "one step at a time", but each step is so difficult every day. feeling I've forever lost the happiness I once had.
And any surgery advice for small breast women? I am 34A/B. my main goal is to live longer seeing my young kids (11 and 9) growing up. Would nipple preserving mastectomy be a good option? Probably not much difference from Lumpectomy for small breast person? Don't want to do immediate reconstruction (is that needed for small breast) because don't want to make treatment/recovery complicated. I don't mind to be flat as health is the most important factor for me now. Please share your thoughts, experience, and advice. Thanks.
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Sending hugs, @september18. We're so sorry to hear of your diagnosis, but as you can already see, we're all here to support you as you navigate your diagnosis and treatment.
You might find this section from our site helpful to understand the pieces of your path report.
As maggie says, you'll feel better once you get a treatment plan in place. Hang in there — you've got this!
—The Mods
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Hi @september18, I'm sorry that your diagnosis brought you here. As far as your surgical options and their potential results go it would be best to ask your breast surgeon. Things depend on tumor size, location and body type which is so individualized that the advice would apply only to you. Sometimes a surgeon will offer multiple options (e.g. lumpectomy, aesthetic flat closure) so that would be the time to investigate what each surgery entails. When I was first diagnosed I had no idea that there are so many types of breast cancer and treatment variations. While there are groups of people who undergo similar regemins your treatment will be customized to you. All the best!
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September18,
Surgery and your surgical options are highly individualized. As Maggie notes, there are several factors that will determine what your best options are but only your doctor can help you with that. Things like nipple and skin sparing surgeries are dependent on your breast cancer and may not be a choice depending on factors relevant to your bc. Reconstruction is a broad term for quite a few different procedures and all options may not be open to you. It’s a bit mind boggling and I too had no idea about the different possibilities as well as the fact that your cancer itself factors into the recon choices. Heck, I didn’t even know that bc had so many different types and variations. I thought there was simply… breast cancer.
I know you want things to move quickly (pretty sure we can all relate to this) but know that this is not an emergency and don’t try to get too ahead of yourself. Take care0
