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Aug 26, 2019 10:16AM
TJF, since your biopsy pathology already includes microinvasions, your diagnosis is already IDC. DCIS-Mi (DCIS with microinvasion) is actually an invasive cancer diagnosis, Stage IA with a T1mi tumor. Breast Cancer: Stages
T1: The tumor in the breast is 20 millimeters (mm) or smaller in size at its widest area. This is a little less than an inch. This stage is then broken into 4 substages depending on the size of the tumor:
- T1mi is a tumor that is 1 mm or smaller
Stage IA: The tumor is small, invasive, and has not spread to the lymph nodes (T1, N0, M0).
To your question: "Does anyone know the percentage of originally diagnosed DCIS cases that change to IDC after surgery? Especially for the ones with a nuclear grade of high?", most studies I've seen over the years put the figure in the range of 20% - 25%, although some studies do reflect a higher percentage.
High grade and a large area of DCIS are two factors that increase the risk that an initial biopsy that found DCIS will turn out to be IDC upon surgical excision. The risk level for high grade DCIS isn't well documented but appears to be in the range of 40%, particularly if the lesion is large. Upstaging to invasive ductal carcinoma after mastectomy for ductal carcinoma in situ
Fifty-one (22.6%) of 226 lesions were upgraded to IDC after mastectomy. Preoperative factors associated with upstaging to IDC included patient-reported signs and symptoms, a clinically palpable mass, ultrasound findings classified as category 4 or 5, the ultrasound appearance of a mass or widely distributed non-mass abnormality (NMA), and a high Ki67 index. Evaluating the frequency of upgrade to malignancy following surgical excision of high‐risk breast lesions and ductal carcinoma in situ identified by core needle biopsy
In our study, 51.1% of CNB samples were diagnosed with DCIS. About 76.1% of samples with a CNB diagnosis of DCIS underwent excisional biopsy. About 80.4% had concordant diagnosis of DCIS, and 19.6% of samples were discordant upon surgical excision. Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision
The overall upstaging rate was 42.7% (216/506). Multivariate analysis found that a palpable lesion, a lesion size >20 mm, a high grade lesion, and use of the 14-gauge needle method were independently associated with upstaging (p < 0.05 for all variables).
Rrobin, I had not seen your last question. I absolutely do not consider myself to be in remission. According the the National Cancer Institute, this is the definition of remission: "A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body."
With a diagnosis of a breast cancer that has a relatively high local or distant recurrence risk, "remission" is reasonable term. For DCIS or DCIS-Mi treated with a MX, I find the term to be completely inappropriate. After my MX for DCIS-Mi, my risk of local recurrence was 1%-2% and my risk of distant recurrence was at most 1%. To me, remission means that I am waiting for a recurrence to happen. To the contrary, based on those extremely low recurrence risk figures, I have always consider myself cured until proven otherwise. I of course recognize the risk and remain vigilant, and I know that I could be that 1%, but I don't live my life expecting a recurrence or thinking that it is likely, which to me is what the word "remission" implies. So to your question, I had successful UMX surgery for DCIS-Mi just under 14 years ago.
“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke