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Topic: MRI results received, some questions

Forum: Diagnosed and Waiting for Test Results —

Share with and support others all waiting for test results from CAT scan, PET scan, Oncotype tests, Mammaprint, FISH, IHC, and other diagnostic tests.

Posted on: Nov 2, 2020 11:58AM - edited Nov 2, 2020 02:01PM by Taralynn

Taralynn wrote:

*edited once I spoke to my surgeon*

Hi all, for my MRI results back and have a few questions. I spoke to my surgeon about the results but would like to pick your brains :)

1. The MRI showed a prominent Lobulated lymph node measuring 10mm x 7 mm. When I saw my surgeon 2 weeks ago she did feel one but said it was movable and squishy and she wasn't super concerned about it, it could have just been from my biopsy since it was close by the site. Has anyone had this happen and it was benign?? The surgeon says it could still be from the biopsy and it's not very large at all but she wants to Get an US biopsy because it may change my plans regarding surgery in a few weeks. Pre biopsy, no lymph nodes were abnormal based on the diagnostic mammogram and 2 ultrasounds. If anyone had a similar experience I'd love to hear it.

2. Has anyone done chemo before surgery based on one positive lymph node discovered beforehand? Is this standard?

Good news is the left breast looks fine and it didn't pick up any other masses we didn't know about. No chest wall or Nipple involvement.

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 2, 2020 12:53PM Beesie wrote:

Lymph nodes can inflame/enlarge quickly but then take up to a month to return to normal size. So the node noted on the MRI could still be enflamed from the biopsy.

I don't know how well the MRI sees all the lymph nodes, since there are so many in so many different locations of the breast, chest and underarm. Regardless, there is no screening modality, even an MRI, that consistently see masses or areas of suspicion that are smaller than 5mm. So small tumors and small amounts of nodal involvement often don't show up on any screening. Not to suggest that you have nodal involvement, but just so that you understand that having nothing show up on imaging is a good sign but is far from definitive.

The area of enhancement might reflect the complete area with the 3 masses or it might reflect a wider area that includes some DCIS or perhaps some non-cancerous conditions mixed in with the masses. It's impossible to say. Many of us have lots of benign conditions along with our cancer and those may impact the size of the area seen on an MRI.


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Nov 2, 2020 01:03PM Taralynn wrote:

thank you Beesie! I updated my post based on my discussion with the surgeon, we must have been typing at the same time. Your info is very helpful.

So non cancerous things can enhance on an MRI? Like fibrocystic conditions? I do believe I have DCIS between the masses, that’s just based on my mammogram though, no one has actually said this to me

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 2, 2020 01:06PM Taralynn wrote:

Also I asked if the MRI would pick up the nodes in the chest and all axillary and she said yes and they all looked fine. Of course I know that doesn’t mean they are fine but I’m holding onto some positivity.

The fact that the lymph node is lobular gives me hope also, I know that can be a benign sign

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 2, 2020 01:48PM kathabus wrote:

I was told I had no nodal involvement based on imaging, but wound up with nodal involvement. That's not to say AT ALL that will happen in your case. Sounds like you have many positive signs. But my point is that you really don't have that "whole complete picture" until the pathology comes back after surgery.

In my situation, the nodal involvement meant possible chemo after surgery. Oncotype came back with a low score, so we decided no chemo, but oopherectomy with aromatase inhibitor. If I had no nodal involvement, I would have just done tamoxifen. No oopherectomy. So that is just one example of how a treatment plan would change after nodal involvement. Good luck to you!

43 Years Old, Oncotype DX 10 Dx 2/17/2020, IDC, Right, 2cm, Stage IB, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 3/23/2020 Lumpectomy; Lymph node removal Radiation Therapy 5/14/2020 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 7/20/2020 Prophylactic ovary removal Hormonal Therapy 8/20/2020 Femara (letrozole)
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Nov 2, 2020 01:59PM Taralynn wrote:

thank you Kath! I definitely am keeping myself prepared that imaging is not 100% accurate by any means.

I guess I’m just confused as to why, if she finds this node does contain cancer, she would not want to just remove it during surgery instead of doing chemo to “switch it from positive to negative” as she said. I’m also thinking of the Oncotype which of course won’t be done until surgery! I should have asked more questions but now she’s in surgery all day. I have a meeting with the medical oncologist Friday so this may be a good question for him also.

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 2, 2020 02:05PM Beesie wrote:

Taralynn, I'm glad I didn't lead you astray about the lymph node and the doctor said the same thing, that it could still be swollen from the biopsy. Hopefully that's the case.

When I had my pre-surgery MRI, it showed my breast to be full of "stuff". That was the word my surgeon used because he said that he couldn't know if it was more DCIS (I had mostly high grade DCIS with a tiny microinvasion of IDC) or something benign. To my (quite limited) understanding, some malignant lesions quite clearly show as malignant in MRIs but MRIs are notorious for false positives, so I think there is a large gray area where something shows as enhancement but it could be benign or malignant.

If you have a positive node, see an MO before you decide on next steps. It is not the surgeon's decision as to whether to give chemo prior to surgery or not - that's up to the MO. Normally with ER+ HER2- cancers, a single positive node would not mean chemo first. Chemo first is more common with triple negative and HER2+ cancers, or when the cancer is very large and/or there appear to be many involved nodes. In any case, it's the MO's recommendation that is important here.


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Nov 2, 2020 02:37PM Taralynn wrote:

thanks Beesie! I will ask the MO when I see him Friday!

I’m going to make the biopsy appt today but last time I had to pay $1400 for it so if the result wouldn’t even warrant a change in treatment plans anyway, I’m curious if the MO would say to forego it and see what the surgical pathology says.

When you say neoadjuvant chemo is Sometimes used with larger tumors, is that generally to shrink it in hopes of getting a lumpectomy? Or is it standard even if getting a maatwctomy

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 2, 2020 02:43PM Taralynn wrote:

Mymain concern is the fact that last time I had to wait 10 days for a biopsy appt then another week for results. So this will really push back my surgery.

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 2, 2020 03:12PM Beesie wrote:

Here are the NCCN Guidelines for pre-operative systemic therapy (i.e. chemo):


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Nov 2, 2020 03:26PM Taralynn wrote:

ah ok! The surgeon pretty much referenced bullet point 3 under “in patients with operable breast cancer” section. Thanks again!

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 3, 2020 09:59PM hnsquared wrote:

Taralynn....During my first appointment with my breast surgeon she felt a lymph node that felt unusual. She did an ultrasound and biopsy right then and it had cancer cells. That changed the plan for me. My surgeon ordered some blood work, genetic testing, mri and my case went to the tumor board. My mri did not show the cancer in the lymph node. The tumor board recommended neoadjunct chemo AC-T prior to surgery. I also found out I have the PALB2 genetic mutation which raises my risk for breast cancer. Chemo first allows them to see how the tumor responds....I had an excellence response and just a few mm of cancer cells in the tumor and lymph node after the surgery pathology.

I hope that you don’t have lymph node involvement and that your surgery goes smoothly. I will say I was scared of chemo and it was much more manageable than I expected. Sending you positive vibes

Dx 2/20/2020, IDC, Left, Stage IB, Grade 2, ER+/PR+, HER2- Chemotherapy 4/1/2020 AC + T (Taxol) Surgery 9/21/2020 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 11/11/2020 Whole-breast: Breast, Lymph nodes, Chest wall Targeted Therapy Herceptin (trastuzumab)
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Nov 4, 2020 01:11PM - edited Nov 4, 2020 01:16PM by Taralynn

thank you hn! I had a consultation with a RO this morning and she didn't feel the lymph node my surgeon did. Who the heck knows what's going on! Unfortunately couldn't get a biopsy appt until 11/16 but gonna check daily for cancellations.

I got my genetic testing back and it just says negative. Doesn't specifically list what is negative. Is the PALB2 automatically included in the genetics test?

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 4, 2020 01:16PM Taralynn wrote:

hn, with having the chemo shrink your tumor so much and then surgery, did you or will you need radiation alwo

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 4, 2020 09:46PM hnsquared wrote:

Hey Taralynn.... so my genetics testing was done through myriad and it tested for brca and listed like 20 something other genes it tested for. Unfortunately it found a mutation for me in the PALB2 gene. For awhile after biopsy I felt like the bad news kept coming😂. Does your genetic test list what it looked for?

So yes I will start radiation soon... I did simulation yesterday. I know with some cells as small as mine was snd only 1 node there are studies being done to see if radiation is necessary or over treatment. I don’t want to do radiation but when all this started I said I wanted to be aggressive and hope to not do this again. My team recommends radiation to be aggressive. I was 49 at diagnosis and I’m premenopausal. After radiation I’ll also start tamoxifen. All the fun 😃.

Trust me... the beginning when you know you have cancer and everything else is unknown is the hardest. Once you have a plan believe it or not you will feel better.

Sending you all positive vibes

Heather

Dx 2/20/2020, IDC, Left, Stage IB, Grade 2, ER+/PR+, HER2- Chemotherapy 4/1/2020 AC + T (Taxol) Surgery 9/21/2020 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 11/11/2020 Whole-breast: Breast, Lymph nodes, Chest wall Targeted Therapy Herceptin (trastuzumab)
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Nov 16, 2020 10:10AM Taralynn wrote:

update on the lymph node - I went this morning for the US guided biopsy. The radiologist didn’t see any lymph nodes that were abnormal. She said what the MRI showed could have been reactive from my previous biopsy and she didn’t see any that she felt required a biopsy today. So we move right onto surgery! I’ll take any little bit of good news I can get right now.

Mom of 3, Diagnosed at 39. Dx 10/15/2020, DCIS/IDC, Right, Stage IIA, Grade 2, ER+/PR+, HER2-
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Nov 16, 2020 09:33PM hnsquared wrote:

Taralynn.....that is awesome news!!! I’m so happy for you. The waiting and testing is so hard. Now you can get surgery scheduled and feel like you are moving forward.

Hesther

Dx 2/20/2020, IDC, Left, Stage IB, Grade 2, ER+/PR+, HER2- Chemotherapy 4/1/2020 AC + T (Taxol) Surgery 9/21/2020 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 11/11/2020 Whole-breast: Breast, Lymph nodes, Chest wall Targeted Therapy Herceptin (trastuzumab)

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