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Topic: Diagnosed 10/16/19 Errors in report

Forum: Just Diagnosed — Discuss next steps, options, and resources.

Posted on: Nov 13, 2019 03:21AM

444ItsHandled wrote:

I am confused with my report, obviously some errors so not confident with my doctors at this point. The doctor's follow up notes say DCIS right breast, which is wrong it is the left and that's the side they did the biopsy so obviously I am very nervous!

I am scheduled for a MRI Friday and a Lumpectomy on the 26th now I see the end of my report says negative for malignancy and now I don't know if that was the first diagnosis that was revised or if DCIS is negative for malignancy?


My report: "Awesome news" email was changed in 2 days....

10/16 E-Mail "Awesome news! Your biopsy is normal, nothing to worry about, we'll go back to once a year screening :)"


10/18/2019 1:56 PM

Component

ADDENDUM

The case was inadvertently signed out prior to additional studies performed. The diagnosis is changed to reflect results of additional testing:

Left breast, lateral, 5.3 cm from the nipple, stereotactic core biopsy:

Ductal carcinoma in situ, low nuclear grade, cribriform and solid type with associated calcifications

Carcinoma in situ measures 4 mm in largest contiguous focus

See comment

Comment: Immunostains CK5/6 and p63 were performed. CK 5/6 demonstrated absence of staining in the ductal cells, while p63 showed positive staining and retention of myoepithelial cells surrounding the ducts, thereby supporting the above diagnosis. A breast profile will be performed with results provided in a separate report.

The stains performed on this case contribute to the final diagnosis and are medically necessary. The appropriate positive and negative controls were reviewed and are adequate.

Clinical History

Grouped calcifications lateral left breast - FCC vs DCIS

Final Diagnosis

Left breast, lateral, 5.3 cm from the nipple, stereotactic core biopsy:

Usual ductal hyperplasia and adenosis with dystrophic calcifications

Negative for malignancy

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Nov 13, 2019 05:46AM - edited Nov 13, 2019 05:46AM by gb2115

This Post was deleted by gb2115.
Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen. Age 38 at diagnosis.
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Nov 13, 2019 08:38AM Beesie wrote:

Well that's confusing.

You need to talk to somebody who can provide clarification.

The issue, I think, is that there can be a fine line between a low grade DCIS diagnosis vs. a diagnosis of a benign but high risk condition.

My interpretation is that perhaps your biopsy sample was at one point thought to be one, and then revised to be the other. What's unclear is which is the final diagnosis. Did the 'Addendum' come after the previous 'Final Diagnosis' or is the 'Final Diagnosis' a conclusion at the end of the 'Addendum'?

Also confusing is that normally when there is this uncertainty, it is between DCIS and ADH, whereas in your case it states "usual ductal hyperplasia and adenosis with dystrophic calcifications", which is a further one step removed (towards the benign side) from DCIS. Confusing low grade DCIS with ADH is common (well maybe not common but it certainly can happen) but confusing DCIS with usual ductal hyperplasia seems odd.

In any case, it's likely that either a lumpectomy or excisional biopsy (basically the same surgery but done before a final diagnosis is made) would be recommended. In the case of a DCIS diagnosis, a lumpectomy would be done to ensure that all the DCIS is removed. In the case of ADH or a similar high risk condition, an excisional biopsy would be recommended to ensure that there isn't any DCIS hiding in the mix, which does something happen. In both cases, a sentinel node biopsy would not be required. So the surgery is the same either way.

Some website info that might explain why there is confusion:

Ductal Carcinoma in Situ of the Breast Differential Diagnosis

Low Grade DCIS vs. Atypical Ductal Hyperplasia (ADH)

  • Low grade DCIS requires all of the following
    • Complete filling of ducts by cells with uniform round nuclei without substantial overlap
    • No streaming of cells
    • No columnar cell population
    • Sharply punched out cribriform spaces, microacini or bulbous papillae
      • Solid low grade DCIS is rare but must be excluded before using this feature to diagnose ADH
    • Size over 2-3 mm and involvement of at least two ducts
.

And from the BCO site; here you can see what usual ductal hyperplasia, ADH and DCIS would look like under a microscope (the 3 images that I've circled in blue):

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Nov 13, 2019 01:42PM 444ItsHandled wrote:

Beesie: Thank you so much for your detailed response. Yes, confusing! I will make a call to clarify if the 'Addendum' came after the previous 'Final Diagnosis' or is the 'Final Diagnosis' a conclusion at the end of the 'Addendum' as it came as a 1 page document. They did the biopsy and scheduled an MRI as I have implants and they "want to make sure nothing is hiding behind it". Lumpectomy is scheduled for the 26th so I need clarification of the report which I will be sure to get.

Thank you again!

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Nov 13, 2019 02:59PM - edited Nov 13, 2019 02:59PM by 444ItsHandled

This Post was deleted by 444ItsHandled.

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