Jan 14, 2022 09:42AM beesie.is.out-of-office wrote:

emstein, sorry you've had surprises from the pathology. That is, unfortunately, pretty common.

First off, don't worry about the DCIS. Most IDC, about 85%, has some associated DCIS. That the DCIS wasn't found in the biopsy and was found in the surgical pathology doesn't matter. DCIS is the less serious condition, so other than removal (which has already happened), it can be ignored. Anything done to treat the IDC will be more than adequate to treat the DCIS.

Now, to your questions:

Does grade 3 automatically mean chemo will be recommended? Absolutely not. With your pathology, I expect that your Oncotype test will be the most important deciding factor. It's impossible to know what your Oncotype score will be, but with an ER+,PR+,HER2- node negative cancer, more often than not chemo is not required.

Does grade 3 typically effect oncotype scores? Not directly. Grade is not a factor in the Oncotype calculation, which includes an assessment of 21 genetic components. But grade might affect some of those other components, so it could indirectly affect the score. ER and PR are big factors as well so being ER+ and PR+ will be helpful.

Since I'm er pr+ her2-, does that mean I'm luminal type a? I believe so.

How did you find out your Ki-67? I don't see it on either the biopsy pathology report or the surgical pathology report. Many facilities don't use/report Ki-67. Mine doesn't. If it's not in your report, it probably means that your facility doesn't use it. On it's own, Ki-67 typically does not factor into treatment decisions, however it is one of the 21 genetic components evaluated by Genomic Health when determining your Oncotype score. So your Ki-67 will indirectly be factored into your treatment decisions, through your Oncotype score.

Only one lymph node was taken...should they have taken more with the grade 3 change and lymphovascular invasion? No. First off, there was no way for the surgeon to know during surgery that your tumor was grade 3 or that there was lymphovascular invasion. But more importantly, the process of a sentinel biopsy is what dictates how many nodes are taken. Isotopes and/or blue dye are injected into the breast. Only those nodes that 'light up' with the isotopes and/or dye are removed - those are the sentinel nodes, the first nodes that anything from the breast flow into. Because of how nodes are grouped together, there is no way for the surgeon to know which nodes are sentinel nodes without benefit of the isotopes/dye. Therefore during an SNB, a surgeon will only remove those nodes that have 'lit up' from the isotopes/dye. For some people, that's just one node. For others, it could be as many as 5 or 6 nodes. In your case, it appears that you have just one sentinel node.

Hope that helps!

Feb 2, 2022 12:45PM odyssey305 wrote:

emstein, thank you for posting about your experience! I feel a little less alone now with my own surgical pathology surprises. I just received my report (I had a lumpectomy and sentinel node dissection two days ago) and I'm in shock after learning that I had micromets in 1/5 nodes. I'm now considered stage 1B and at the higher end of grade 1. While I understood that the big picture can, and often does, change after surgery, I wasn't mentally prepared for this news. Throughout this whole ordeal of scans/diagnosis/treatment planning, etc. I've been mostly calm, but seeing micromets on my report has unleashed a flood of worry. I've been trying to stay positive and focus on the fact that this was discovered early. But this feels a lot like pandora's box - who know what other surprises are in store for me. This also may throw my surgery + rads plan out the window, but honestly I'm ok with whatever my onc recommends. So many people have gone through this and I know I will get through this too, it just sucks to feel like the ground beneath my feet keeps shifting. All this to say, I understand what you're going through!

Bessie, thank you so much for the information! I've been lurking on this forum for awhile now, and I've been so grateful for the knowledge and insights you share!

Best wishes and healing vibes to you both!

Feb 2, 2022 02:28PM odyssey305 wrote:

Hi AliceBastable. That's a great question. Initially, before discovering the micromet, I thought lumpectomy and sentinel node biopsy was all that was needed surgery-wise, then at some point rads and endocrine therapy. Once I got my final report I worried that the micromet may indicate an auxiliary node dissection (I got that from the NCCN guidelines, but I think I misinterpreted that). But as I was typing this my surgeon called to let me know that additional surgery is not necessary, given that it's only in one node and so small (1mm). She also mentioned that chemo may be in my future, but that will be based on my Oncotype and MO recommendations. Fingers-crossed for no chemo, but then again, maybe throwing the kitchen sink at this thing is the way to go. BTW, I love your signature line about life being boring! That's my goal too and I promise to never take boring for granted again!!

Mar 4, 2022 09:34PM - edited Mar 5, 2022 12:31AM by odyssey305

Hi Emstein, it's good that you met with your MO, at least to get an idea of what she's thinking. It sounds like your Oncotype will be a big factor in treatment, which makes the wait SO much harder. I'm really sorry it's taking so long to get your report, one month does seem like a long time! I've read posts from other women who have contacted Genomic directly, so this may be an option for you too.

You asked about my oopherectomy. I actually haven't had this surgery yet, but it's planned for after rads, so sometime at the end of April. But yes, it is a part of my BC treatment. My Oncotype score came back with an intermediate score of 17, but showed no benefit of chemo. MO felt like the best way to go is ovarian suppression + AI, but she also strongly recommended that I have my ovaries removed sooner rather than later. I think this was partly based on my estrogen level, which is/was pretty high. So for now I'm on ovarian suppression while I wait for surgery, which has been like menopause lite. I was really dreading another surgery, but I've read that it's a fairly straightforward outpatient procedure, and it will save me potentially years of ovarian suppression meds with better results. I think speaking with your gyno is a great idea, especially since cysts are a potential side effect of hormone therapy.

Take care and keep us posted on your next steps!

Mar 11, 2022 03:15PM emstein wrote:

Hi Pattik and Odyssey,

Thanks for the advice! I was just about to call the Oncotype folks when my oncologist called with my results. My score is 18, so less than 1% benefit of chemo. Woohoo! I'm so relieved.