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Topic: Re-excision post lumpectomy for LCIS

Forum: LCIS (Lobular Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for LCIS.

Posted on: Jun 22, 2017 02:33PM - edited Jul 28, 2017 10:16PM by LoveT

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Jun 22, 2017 03:21PM YazMar74 wrote:

Hi LoveT, I was in the same predicament, just had my second surgery last Thursday - because margins were not clear the first round - and because they found microinvasion they checked my sentinel lymph node - I am now awaitng those results. So depends on what they find - I started at simple DCIS stage 0 - now up to Stage 1. I found the second surgery was very easy - on me. Makes me wonder if they even did anything. I will take it as a good sign - they knew where to go and did what they had to do. In and Out.

Good luck with it.

Dx 5/2/2017, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+
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Jun 22, 2017 03:41PM leaf wrote:

I have not, but if the pathologist found ONLY spots of CLASSIC LCIS and/or ALH in your lumpectomy specimens, AND there are no other 'suspicious' spots on your mammogram/MRI/ultrasound, then I don't understand why (s)he wants to re-excise. Why? Because most classic LCIS is multifocal (meaning it occurs in more than 1 spot in a breast) and much is bilateral (meaning it occurs in both breasts). They know this because prior to about 1990, they routinely did bilateral mastectomies on LCIS women, and they could look at the mastectomy specimens. (They didn't discover pleomorphic LCIS until roughly the late 1990s.) Most lumpectomies remove enough tissue to make a good specimen that the pathologist can read more easily.

So, most classic LCIS (and nothing worse - in other words no pleomorphic LCIS, no DCIS and no invasive breast cancer) women have multiple spots of LCIS. The only way you can RELIABLY diagnose LCIS is by looking at a tissue specimen under the microscope. Much/most LCIS is diagnosed as an incidental finding when they find some suspicious finding on mammograms/ultrasound/MRI. Some/most LCIS is found not AT the suspicious spot, but adjacent to it. So you cannot reliably remove 'all the LCIS' in a woman, because you can't tell where the LCIS is without removing the tissue and looking at it under the microscope. Even if you have bilateral mastectomies, there is still some breast tissue left behind.

If an LCIS woman later gets invasive breast cancer, this invasive breast cancer often is found in a place in the breast that looked totally normal under imaging (mammogram/ultrasound/MRI). So you can't reliably tell what tissue is LCIS without removing it.

If you ONLY had a core biopsy, then they often do re-excise the area to be more sure that there is nothing worse than LCIS in the area. Because the sample is much smaller, the friction of the core biopsy needle can distort the tissue, making it more difficult to accurately diagnose the tissue.

When a core biopsy shows classic LCIS (and nothing worse such as pleomorphic LCIS, DCIS or invasive breast cancer), then they often excise the area. They do that because they want to be more sure there is nothing worse going on in the area. Its not to remove the classic LCIS, but to make sure there isn't pleomorphic LCIS, DCIS, or invasive breast cancer in the area nearby. Roughly 20% of the LCIS core biopsies are upgraded to something else such as DCIS or invasive breast cancer.

Best wishes that you have 'nothing worse' than classic LCIS.

Classic LCIS.If knowledge can create problems, it is not through ignorance that we can solve them- Isaac Asimov Dx 12/8/2005, LCIS, ER+/PR- Surgery 1/24/2006 Lumpectomy: Left Hormonal Therapy 7/15/2006 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 22, 2017 04:06PM MelissaDallas wrote:

I agree with Leaf - I figure they could stick a needle randomly in either of my breasts and have a good chance of coming back with a piece of LCIS.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.
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Jun 22, 2017 08:04PM - edited Jul 28, 2017 10:15PM by LoveT

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Jul 31, 2017 06:09AM NicolaSue wrote:

I am puzzled - my LCIS DID show up on mammo. How can this be? Everything I've read says it's an incidental finding only picked up when something else is being investigated. But in my case I had a cyst show up on one breast on a mammo and then what the radiologist described as a 'flicker' on the other breast and ultrasound, biopsy and removal confirmed that it was LCIS (and nothing else). It was 9mm. Perhaps LCIS shows up if it's a particular size, or in a particular part of the beast. Anyone know?

LCIS diagnosed Spring 2017. Vacuum excision biopsy. First follow up mammo 2018 - clear
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Jul 31, 2017 06:10AM NicolaSue wrote:

I am puzzled - my LCIS DID show up on mammo. How can this be? Everything I've read says it's an incidental finding only picked up when something else is being investigated. But in my case I had a cyst show up on one breast on a mammo and then what the radiologist described as a 'flicker' on the other breast and ultrasound, biopsy and removal confirmed that it was LCIS (and nothing else). It was 9mm. Perhaps LCIS shows up if it's a particular size, or in a particular part of the beast. Anyone know?

LCIS diagnosed Spring 2017. Vacuum excision biopsy. First follow up mammo 2018 - clear
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Jul 31, 2017 08:23AM MelissaDallas wrote:

Were there other findings on your pathology report? Mine was found because sclerosing adenosis showed on my mammogram.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.
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Jul 31, 2017 11:20AM NicolaSue wrote:

No nothing showed, only LCIS. I had two pathologists in different centres look at the tissue and both said the same.

LCIS diagnosed Spring 2017. Vacuum excision biopsy. First follow up mammo 2018 - clear
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Aug 13, 2017 10:55AM leaf wrote:

Classic LCIS *usually* is an incidental finding. *Something* has to trigger a breast biopsy: some palpable lesion or feature on mammogram, ultrasound or MRI, or whatever. They aren't going to biopsy women's breasts with no reason; they wouldn't know what to biopsy.

Some LCIS women here have had things on their mammogram, or palpable masses. The thing is that those features are NOT a reliable feature of LCIS. In other words, if you take all the people with palpable masses, or microcalcifications, or whatever feature on their mammograms, MRI or ultrasounds, only a tiny fraction of those people will have classic LCIS (and nothing worse), and even fewer have pleomorphic LCIS. They often do breast excision after a core biopsy shows classic LCIS to make sure there isn't something worse (such as PLCIS or DCIS or invasive breast cancer) in the area.

Classic LCIS.If knowledge can create problems, it is not through ignorance that we can solve them- Isaac Asimov Dx 12/8/2005, LCIS, ER+/PR- Surgery 1/24/2006 Lumpectomy: Left Hormonal Therapy 7/15/2006 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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