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Dec 27, 2017 01:19PM
Dec 27, 2017 01:36PM
It sounds like they did not make clear to you whether further testing identified any invasion or not, so clarification is needed.
By the assessment of the pathologist, DCIS (Stage 0 disease) is confined to the inside of the ducts, and has not invaded the surrounding breast tissue ("non-invasive").
The pathologist uses special stains to assess the integrity of the myoepithelial cell layer surrounding the ducts. If they can see that cells have broken through this layer into the surrounding breast tissue (an area of "invasion"), then the diagnosis becomes invasive breast cancer (Stage IA or higher). When the size of the invasive tumor is ≤ 1 mm in greatest dimension, it is considered "microinvasive" disease (abbreviated as "T1mi").
If it turns out that an area of invasion was identified (which is not clear at this time), be sure to write down the features of the DCIS and of any invasive disease (if present) separately.
- For the DCIS: What is the estimated size, grade, architecture (e.g., solid, cribiform, papillary); ER and PR status, (and HER2 status if assessed)?
- For the invasive disease: What is the estimated size, grade, histology (e.g, ductal, lobular) ER, PR and HER2 status of the invasive disease?
HER2 status can be determined using different methods:
(a) Immunohistochemical methods ("IHC"), which detect the HER2 protein over-expression); and/or
(b) In Situ Hybridization methods (e.g., "FISH", "CISH"), which assess HER2 gene amplification).
If HER2 status is determined by validated IHC, then under applicable 2013 ASCO/CAP guidelines for HER2 testing, the result is reported as:
0 ("negative") OR
1+ ("negative") OR
2+ ("equivocal") OR
3+ ("positive") <============ "3+" or "+++" indicates HER2-positive status
The waiting and worrying is very hard. I felt much better once I met with the breast surgeon and hope you do as well.
Even if you get a good explanation from the surgeon, as best practice, be sure to obtain the written pathology reports for your review and records and confirm verbal information against your written report.
Stage IA IDC, 9/2013 BMX. Right: IDC (1.5 mm, grade 2) with DCIS (5+ cm), 0/4 nodes, pN0. Left: DCIS (5+ cm), 0/1 node, pN0(i+).