decisions to be made--DCIS suspicious for microinvasion
Hi everyone,
This is my first time posting.
I have a DCIS (grade 3 ER+ PR+) diagnosis and am kind of stuck between having a mastectomy or trying cryoablation first. In order to make that decision, I am trying to figure out how to make sense of my likelihood of being upstaged at surgery.
One sticking point is microinvasion. So I guess I'm wondering if anyone has ever had a biopsy that was "suspicious for microinvasion" turn out to not be microinvasive upon surgery. (Not that anyone's experience can foretell what mine is). If you had microinvasion, were there other signs, like something on your MRI, ultrasound, or mammogram?
I wanted to reach out because I know there are a lot of knowledgeable people out there and I hope you might weigh in a thought.
I appreciate this forum so much and I hope you all are doing well and feeling supported.
Best,
lw
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Hi @lemonwedge,
There was a study done at Memorial Sloan Kettering which found that 28% of biopsies “suspicious for microinvasion” turned out to be microinvasive. It comes with the disclaimer that the study size was limited by consisting of data from a single institution. Another study attempted to look for DCIS characteristics that would predict microinvasion but couldn’t find any.
My biopsy diagnosis was the same as yours but the surgical biopsy turned out to be IDC with a small amount of DCIS in the region. A biopsy is a limited sample of the tumor so this can happen. According to the ultrasound the lesion was 1.6 cm but after excision it turned out to be 3.2 cm. The margins contained multiple radial scars which hid the tumor from imaging. My surgeon had warned me that in her opinion the tumor would be larger than it appeared and probably invasive.
My situation is not the norm but approximately 25% of breast cancer diagnoses are upgraded after surgery, not surprising given the small sample collected by the biopsy needle. It’s hard to predict what might happen in your case. You should ask your surgeon for their opinion.
Good luck with your decision. I hope you have a successful surgery with minimal side effects.
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Lemonwedge: I have been studying everything breast cancer for 11 years since diagnosis. And I have never heard of cryoablation. I looked it up and it is not commonly offered in Canada. So I cannot offer any info. But I did experience a suspicion for invasion that resulted in extensive DCIS without invasion. So it does happen, but you will definitely want to have a surgery that can definitively count out invasion. Missing that micro invasion could be very costly if you are opting out of radiation, hormonal therapy, etc that can deal with little surprises. There is no way of knowing for certain until your tissue is tested through pathology. And only tissue removed can be tested unless I am missing something else. Quite possible. My recommendation is to do your homework by exploring all available information and studies available, speaking with your medical specialists and seeking second opinions. Knowledge is power and it looks like that is exactly where you are going. Wish I could help more and will be seeking more info info about this procedure for breast cancer myself. All the best.
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I am back. I found a study that may address all your questions. I am hopeless with technology so will simply type the heading for you to search on Google. I had to search to address my own curiosity.
It’s HIH. National Library of Medicine
It’s a report entitled “Could ultrasound guided cryoablation be used to manage low risk DCIS?
You were correct to question your suitability for this procedure based upon the possibility of microinvasion.Only a thorough discussion with your medical team can provide you with answers to your questions.
It would be really cool if someone with experience jumps in here.
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@maggie15 Thank you so much for sharing information from the study you mentioned and for the stats, as well as your personal experience. I have been looking and looking for more info on micronivasion. It's so rare. I'm just bracing myself for all the possibilities of what might be found when/if I have surgery. I hope you are doing well!
@tb90 I appreciate your advice about gathering information and getting second opinions and hearing how your situation played out. With cryoablation, the recommendation (at least from the studies I've read) is to follow up with radiation or endocrine therapy, and it is being used to treat Stage 1 breast cancer, but I do worry that there could be some missed information if I don't get all of the tissue checked out. Cryo has been used for benign breast findings for a long time. It's being studied in Israel on Stage IV bc patients, and there have been studies conducted here and in Japan on Stage 1 bc. The focus here has been on using it for women who can't have surgery due to other health issues, but I believe it will eventually become a standard of care. (I declare with my totally unscientific crystal ball.) Treating DCIS with cryo is beginning to happen, too. The main issue seems to be that it (obviously) misses areas of concern outside and in the periphery of the cryo zone, which is why it's being used in conjunction with other therapies, and since DCIS can be so hard to visualize. Apparently cryo supposed to help the immune system recognize the cancer, which seems exciting. Anyway, the FDA just approved a device for cryoablation in bc patients, so I think it will begin to get more visibility soon. I hope that you find the information that will help you as well. I will check out the article you mentioned! Take care!
*Also, I want to thank you both for responding to my post. You are treasures. I was so nervous to post here and I really appreciate your wisdom and support and hope I can return the favor. I am so scared of having surgery and so shocked by all of this, it is really a gift to hear from people who have been where I am. Thank you.
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Hi there! Thank u for this info- interesting! I had BMX done for large area of dcis and final path did pick up 1.3mm invasive focus. None of my prior imaging had detected that invasive focus. So I'm stage 1a. Treatment was only surgery.
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Thanks for the info, snm!
I just got back my pathology after BMX. There is microinvasion after all. Is surgery usually the only treatment? Fingers crossed.
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For my case my team didn't think radiation was needed because invasive tumor was so small. Plus it was found in left breast and I didn't want to risk potential cardiac issues from radiation if not really needed.
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Thanks for sharing your experience @snm! I hope all is going well for you. I would be protective of my left side, too.
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