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 -
My biopsy looked very similar. Like the other ladies have said, every case is different though. Once you have surgery, those results may also look a little different. Surgery pathology can show different things than the biopsy. In my case, my biopsy and surgical pathology stayed pretty much the same. I had a lumpectomy with sentinel node removal. They removed 9 lymph nodes, and all were negative. They achieved clean margins with the lumpectomy. So I was staged 1A, Grade 2. I had the oncotype test, which indicated that chemo was not needed. So I went for radiation and qualified for Accelerated Partial Breast Radiation. Which is 5 treatments over the course of two weeks. Higher dose of radiation per treatment, but shorter time Frame. I did not have any issues really. Even though every person is different and might need different things, I just wanted to give you an idea of what my plan looked like. It is very scary, mine was found on a routine mammogram. Could not feel the lump, even after I knew exactly where it was at. I have larger breast, so a lumpectomy was the choice I made. I promise, once you get a treatment plan in place, it does get easier somewhat.
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Thanks ars31178 for the information and comfort. Your operation and treatment seemed to move pretty fast. Can I ask where you are located? I am in SF Bay Area and currently seen at Stanford Health Care system. I feel the doctors here are booked and their availability is quite limited.
Also can I ask why they remove 9 lymph nodes? That seem to be a lot? Were you required to do MRI prior operation?
My breast is quite small. So I think mastectomy might not be much difference? If that is simpler and reduces the recurrence risk? I also had a 1.7cm fibroadenoma in the same breast (right) so this breast seems to have quite some problems.
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And a question about
Glandular (Acinar) / Tubular Differentiation: Score 3
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When I searched, it seemed for Glandular (Acinar) / Tubular Differentiation, high score is good for differentiation? but then it contributed to high Nottingham Histologic Score, that seems bad?
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@september18 My treatment plan did move pretty fast. I am located in Arkansas and was seen at CARTI. Before surgery I was told that they would only remove 2 or 3 lymph nodes. But, I had a bundle of lymph nodes all together, so she removed all of them. She said they were kinda fatty and lumped together. Which of course made me very nervous, but they all came back negative. I would just wait and see what your breast surgeon recommends on the surgery. My Nottingham score was exactly the same as yours, the tubular was 3. My Dr. really did not explain that to me, she just said it was Grade 2. So I really wouldn't stress to much about that. My Dr. focused more on the Oncotype test, than anything else.
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@september18 I did not do a MRI before surgery. I do not have dense breast and my surgeon felt like it was not needed. You will see a lot of early stage breast cancer on here, that did not have a lot of extra testing. I am not sure why some do and some don't. Maybe someone else will chime in on the MRI before surgery.
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thanks @ars31178 . You have a low oncotype score that is great. My biopsy report does not have such a score. Do you get oncotype from biopsy or after operation? Do you have a ki-67 score? Just want to know whether there is any correlation between them…
My HR and HR are both 91-100%, will those play a role in oncotype?
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@september18 You will not get the oncotype test done until after surgery. Mine took about 2 weeks to come back, it was sent off the same time as my genetic testing. My ki-67 was 3%. I am not sure the correlation between a low ki'67 and low oncotype. Yes, from what I understand your HR and PR status will play a role in the oncotype score. I am not sure how old you are. I see you have younger kids, so I am assuming you are fairly young, I was 45 when diagnosed and premenopausal. So I also take tamoxifen.
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@ars31178, ki-67 3% is really low and mine is 20%. I am 47.
Life is really turned upside down with this diagnose. Everything is so difficult. Sad and scared.
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Everything is really hard at the beginning. It is very scary, but I promise, once there is a game plan, it will get better. See if you can get a nurse navigator, they are really helpful in scheduling all the appointments. Also, there is nothing wrong with setting up appointments at a different place for a second opinion.
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All well stated! It's overwhelming but once there is a plan in place, as the others have said, it will feel more manageable. And agree, a second opinion can really be helpful, so you feel more confident in your decisions.
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I want to chime in on the Ki-67 issue. Let me start by saying that not every finding is of equal importance. Ki-67 is one of those as there are many, many oncologists who do not even look at that and lots of questions about its significance.
September 18,
Please, please don’t worry about time frames as you are not in an emergency situation and most breast cancers are relatively slow growing. The Bay Area has a huge population and all of our medical facilities are very busy but it is extremely unlikely that the wait will have a negative impact on your situation. Waiting is stressful but it won’t negatively impact you.
I am not a medical professional, but it appears that you are in a good position and it’s very likely that you will be treated and then go on to enjoy life. Your current situation is very, very far from being terminal so don’t even let your mind go there.BTW, I went to Stanford twice for second opinions (they completely agreed with my Kaiser mo). So fancy and they were great.
Take care0 -
Thanks @exbrnxgrl. It is unfortunate we end up meeting here, but you gals really provided me warmth and comfort. Since we are both in bay area, I do want to meet someday and say "thank you" in person. Thanks for the accompany and encouragement you gave me at this different time.
During an ER visit last year, my dad was diagnosed prostate cancer that met to his spine. So the past year I have been very stressful accompanying him for his surgery, recovery. He recovered well and I am hopeful. But then he had very bad hemorrhage stroke, the day before I got my 4c US diagnose. He passed away several days later. So the past days I've been in hell with double traumas. I never imaged I would win such bad lottery in my life…
It's difficult but I will try to stay positive for my two young kids.
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I have found this website to be helpful:
You can cut and paste your information in and it will produce a clear report that is easier to read. I've used it a few times when I was confused.
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You are more than welcome! I’m sure all of us can recall looking into the great unknown when we were first diagnosed. For me, a lifelong academic and a teacher, I was overwhelmed by how complicated bc can be and by the many possible types and variations. I have no medical expertise whatsoever and it was like having to quickly learn a different language and culture. It took a while for me to feel like I had an understanding of my situation and again, surprised by how varied and complex bc can be.
I would be happy to meet or chat when you feel ready. Just drop me a pm!
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