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Category:

Breast Biopsy

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Question:  #61 2/8/2009		Q:	first of all thank you so much for this site. anyways i had a mammogram that showed calcifications. had a sterotactic biospy. pathologists report came back high grade dcis.but after a partial mastectmy and removal of one node. my surgical report came back as biospy site with focal fat necrosis and early reparative alternation. negative for residual neoplastic disease.my dr is telling me that maybe when i had 1st biospy. they could of gotten all the calcifications. but i know that isnt so. because the dr that done biospy said that he got 8 out of aprox.30 calcifications. he even done a mammogram after biospy. and showed me that i had more calcifications.he said that it was a very focal area.could you please tell me what your thought on this is. as i dont want to have rads. if i never had dcis. sincerely rasquel
		A:	sounds like re-imaging is needed and probably repeat biopsy done as an open excisional biopsy perhaps. if you can come our way, do. 443-287-2778. tell Sheila you have been in touch with Lillie and she requested you be scheduled with one of our breast surgical oncologists.
Question:  #62 2/8/2009		Q:	I had a mammotome in September 2005 and the lab report came back saying dilated ducts with focal apocrine metaplasia. Mild ductal hyperplasia without atypia is identified. Microcalification are identified with the benign ducts. No malignancy is identified. I had to go back in for another mammogram in 6 months. When I came back in 6 months more calification was noted by they would see me in 6 months. This went on for 2 years. I was released December 2007. When I went back for my yearly mammogram in December of 2008, I was called back for more films and then they decided I need to have a core biospy. This was scheduled and I went to the appointment. The biospy was not performed due to blood veins surrounding the microcalification, so they now decided I needed an excisional biospy which is scheduled for February 13th. My question to you is my husband thinks that it is the same problem that I have been having. He isn''t real happy that they need to cut. My sister had breast cancer last year. So for my peace of mind I am going to have the procedure done, but if it comes out benign do you think I could wait longer with more follow ups of mamograms. I am not looking forward to beinging cut myself. The core biospies was bad enough. Thank you for your input.
		A:	With suspicious findings and a family history, it is in your best interest to follow your doctors' advice. I know this is painful both emotionally and maybe physically, but you must follow through as the best chance to cure breast cancer is to catch it early. You may have nothing, but the consequences of not being vigilant are significant. Warm regards.
Question:  #63 2/1/2009		Q:	what are the physical differences between paget''s disease of the nipple and nipple adenoma and melanoma of the nipple. Can there be any other treatment apart from surgery for the above named disease specially if it is a stage 0 paget''s disease. Does nipple adenoma require surgeyb for treatment.
		A:	surgery is the treatment for all three. pathology differentiates them. appearance differentiates melanoma which looks blackish-blue in color and has irregular edge. pagets looks scaley, reddish.
Question:  #64 1/25/2009		Q:	Microcalcifications seen in post breat-cancer mammogram. The doctors decided to biopsy it but said they could not get enough tissue so to follow up again in another six months. Did they likely mean they could not get enough breast tissue or that the calcifications were so small that they could not be biopsied, and is this something to worry about? There were high quality doctors.
		A:	i'm not sure what he meant since i didn't hear him personally explaining this to you. so time to call him and ask for clarification rather than worry and wonder about it. new calcs post treatment are worrisome if clustered together and on magnification look irregular around their edging. ask about this too. LS
Question:  #65 1/25/2009		Q:	Was diagnosed with dcis pathology report after partial mast. stated low grade solid and cribiform separate 1 to 2 mm foci, in-situ is present to within 2mm of the deep margin all other margins are widely neg., calcifications present within areas of dcis and seen in association with benign breast tissue,non neoplastic breast largely unremarkable with focal fibrocystic change including extensive dense stomal fibrosis. Under comment its says rare foci of in-situ are identified. Inflammation and scarring and hemosiderin deposition is noted in the area of prior biopsy site + they found a 4 mm fibroadenemo. Under macroscopic exam: predominantly rubbery pink-white fibrous tissue w/scattered yellow adipose tissue. In some areas the fibous tissue has an ill defined gritty and nodular consistency no discrete masses identified. I wanted to know what rare foci of insitu and extensive dense stomal fibrosis is and if the ill defined grittyness means anything. I did not have radiation I declined tamaxifin dt side affects.(I''m 35 and have a mom who was diagnosed too at 47 yrs premenopasal)
		A:	hhhmmm. the bottom line is that there was DCIS that apparently skipped along the inside of a duct rather than all being neat and tidy together. refusing 2 important ways to prevent recurrence doesn't seem like you wanted to take all the steps needed to not revisit this disease again. radiation goes with lumpectomy. they cannot be separated. when you agree to lumpectomy (instead of mastectomy) then you are also agreeing to radiation. tamoxifen for those whose DCIS is hormone receptor positive can further reduce risk by 50%. without taking these steps your risk of recurrence based on previous studies may be around 40% within 2 years. that's a pretty high number. that said, the path report doesn't sounds alarming. it does imply that one margin was close however and that dcis was seen in several different stops within the tissue removed. this is a classic reason why radiation and tamoxifen are important though. Add to that a risk of a hereditary cause of the breast cancer and that makes the 40% number potentially higher. revisit your decisions about this.
Question:  #66 1/25/2009		Q:	My mother is having a core needle biopsy done because of an asymmetric mass on her left breast. We would like to know if it is best to have this procedure done by a surgeon? She is scheduled to have it done at our local hospital''s breast center by a radiologist. Thank you
		A:	radiologist doing it as a core biopsy is the right way to go.
Question:  #67 1/24/2009		Q:	Thanks for the quick answer. Can you tell me if a lactating adenoma can return after a lumpectomy? I know you said the lump could be old milk but was curious if it could also be the same as what was taken out. Also, if it is dried up milk will this be visible on ultrasound?
		A:	it may not be visible always on ultrasound. yes, this can happen post lumpectomy.
Question:  #68 1/24/2009		Q:	I am 43 yrs old and just had a digital mammogram, us and biopsy. The report showed a 2.32x2.83x1.2 lesion. Pathology report= in situ and infiltrating mixed carcinoma having ductal and lobular differentiation. The invasive component shows nuclear grade II/III with a moderate mitotic index. Ca in situ of the mixed pleomorphic lobular and ductal types nuclear grade II/II with moderate mitotic index. Has occassional areas of intraluminal necrosis comprising 60% of tumor. What does this mean? what is nuclear grade? what is moderate mitotic index? I am scheduled to see a surgeon in a few days who I was assigned and no nothing about. How important is the surgeon at this point?
		A:	it is time for a breast surgical oncologist. if you want you are welcome to come to us. 443-287-2778. you'be been diagnosed with mammary invasive carcinoma. a mixture of ductal and lobular cancer of the breast. average growing. also has some noninvasive breast cancer along with it. possibly stage 2 based on diameter measures on imaging. if you want to come our way feel free to do so. we can get you in within a couple of days. LS
Question:  #69 1/24/2009		Q:	I am Question no 5 as of this moment (51 year old, etc ) Got biopsy results today: invasive ductal carcinoma, grade 1, size is .4 cm. Surgeon''s nurse, radiologist, my PA all tell me that this is very early and small. I am scheduled for consult with surgeon next week and surgery on Friday. After biopsy also had digital mammo to make sure radiologist had hit the spot because he said it was so tiny. In fact, the tech couldn''t find it at first but he did find it. He felt confident he had the spot by the marker. I have read just a little about cancer spreading not through lymph nodes but through blood. How common is this? and would this be something that would be seen early on in the process? or any things I need to make sure I ask or take care of. I also did some checking and the only breast cancer in my family is my 85 year old aunt who had a small nodule about 20 years ago. Decided on masectomy although she could have had lumpectomy and took taximofon (sp) for 5 years. Any thing would be helpful here.
		A:	this is a VERY early diagnosis. that's good news. vascular invasion would be mentioned in the report if that was a concern the doctor had. it doesn't happen very often and usually is of concern with larger tumors. much larger. have confidence you will do well. LS
Question:  #70 1/24/2009		Q:	I just had a breast reduction about 2 weeks ago. Prior to the surgery I had a mammo done and there was a something in the upper left quadrant of my left breast. I went and had a partial PET and there was no signs of cancer. During my surgery the surgeon removed a mass from my left breast and sent it to pathology. Can you please simplify the meaning of the pathology report. Thank you. This is what it said: Received in formalin fixative and stated to be left breast mass. It consists of an irregular unoriented portion of rubbery yellow/tan fibroadipose breast tissue measuring 7.0 x 5.5 x 3.0 cm. Diagnosis: -Fibrocystic changes including fibrosis, cysts, apocrine metaplasia, sclerosing adenosis and fibroadenomatoid hyperplasia. -Microcalcifications, Focal.
		A:	so believe it or not, all of the words mean it as benign and normal fibrocystic tissue. congrats. LS
Question:  #71 1/23/2009		Q:	My wife just had a Stereotactic Biopsy for microcalcifications. We received the results today... -Atypical Intraductal Lyperplasia with Microcalcifications -background of fibrocystic change with mocrocysts, apocrine metaplasia, sclerosing adenosis, columnar cell change, intraductal hyperplasia and microcalcifications - recommend excisional biopsy That''s a a whole lot of mysterious words there. We were told she doesn''t have Cancer, that''s the good thing. I know the Atypical Hyperplasia puts her in a higher risk category. I''ve read it could turn into invasive cancer in 10-15 years. I don''t see this report as "good news" as my Wife sees it. I''m more worried now then before. At least, if the microcalcifications were found to have cancer, it would be DCIS and not Invasive. Is there anything she can do to prevent this from turning into cancer (diet, excercise, vitamins)or is this just a some get it, some don''t situation. Her Aunt is a Breast Cancer survivor. I''m sorry for the long questions. But, you were very helpful last time I wrote you before my Wife''s biopsy. Any help, clearing up this mess, would be appreciated. Thank You!!
		A:	there isn't data (anymore) to support that ADH turns into cancer if left alone. What we do know however is that 30% of women with ADH on a core biopsy as she has had do in fact have DCIS already present. thus the need for an excisional biopsy (done as a wire localization procedure). so time for a breast surgical oncologist (NOT a general surgeon who does breast surgeries). if you want to bring her our way, do... we have breast surgical oncologist and breast pathologists (and med onc and rad onc, etc). time for specialization now... its in her best interest. if wanting to come our way call 443-287-2778. LS
Question:  #72 1/23/2009		Q:	I am 26 and had a lump appear during breastfeeding almost a year ago. Had a lumpectomy in aug. 07 and called a lactating adenoma. Since I still nursed I had to have it aspirated as it kept filling up with milk. Now I have a lump in the same location except it is now about 3cm (im guessing). Doctor tried aspirating in office as before but nothing came out but a small gel substance. He said this may be dried milk- could this be possible? I have stopped nursing. He said we will watch and see if it returns in 6 weeks. Could this be scar tissue? Also should I be concerned about cancer in the same spot?? It is oval shaped, freely moveable, soft and close to the surface- only seems attached in one small area at the end in the tissue. Im sorry to ask too many questions but im trying to remain calm and not be scared and the fact that it has returned is a bit scary for me. Is it possible for a lactating adenoma to return? Thanks
		A:	based on deion it would be highly unusual to be a cancer. could be old residual milk. glad you are following it by repeat monitoring. how about an ultrasound in the meantime.
Question:  #73 1/18/2009		Q:	Thank you very much for your quick response to my question. I was left with a few points of confusion that I hope you can help clarify for me. What level is early stage breast cancer( Are they rated from 1-4)? Does early stage breast cancer usually require chemotherapy? What stage does? Are you saying that in 20% of cases where only calcium deposits are found that in fact there can be a tumor growing that is not spotted on the mammogram(20% of the time), or were you referring to the calcifications not always being detectable ona mammo. I''m trying to get clarification on wether when calc''s are all that is seen it is likely that a tumor could be there that was not detected that would be sizeable enough to require chemo. When you speak of early stage breast cancer I''m hoping you mean that in most cases it would not require chemo. What would the size of the calc''s be that would likely require chemo? Did what I describe as a size the size of a skittle for each of 5 calc''s sound like something that would require chemo? Would the size of the calc be known at this point by the radiologist? Would someone be able to determine based on the magnification whether it looked like cancer? What is the liklihood based on what I''ve told you that I have a high stage that will rquire chemo and will likely cause my life to be substantially shortened? I am about to turn 47. Thank you for responding so quickly! I really appreciate your input.
		A:	early stage is stage 0 and 1, and tumors that are smaller and sneak into a stage 2. calcs usually present as 0 or 1. The need for chemo is based on many factors and not just stage. tumors that have an invasive measurement of 2cms or larger (stage 2) may require chemo but some don't. stage 0 never requires chemo. stage 1-- half do and half don't. again, the prognostic factors of hormone receptors and her2neu and your age weigh in here as well.usually when things are found as being calcifications and not a definitive solid tumor yet the stage is stage 0 or 1. low probability you are dealing with advanced or higher stage breast cancer.
Question:  #74 1/18/2009		Q:	I am having a breast biopsy on Tuesday. I had a mammogram that show new calcifications on my right breast. Which was then followed by a magnification showing not two but four each the size of skittle according to the radiologist. I had previously had calcification on the same breast and was followed because of these calcifications as I understood it at the time with sonograms in addition to the mammograms I was receiving each year. After a few years of stable mammograms and sonograms my doctor indicated I no longer needed to have the sonograms and now I have new ones in the same area as the other ones were, and am in need of a surgical biopsy. Was this an appropriate course of action? I have a typical interductal hyperplasia. What is the percentage of people who have this that get a diagnosis of cancer whena recurrence of calcifications are present? How often do calcifications develop into invasive breast cancer? How often are tumors present that are not seen on the mammogram? How often is it the case that what is seen at the time of surgery is quite diffferent then what was seen on the mammogram? How often do calcifications lead to cancer at a level that reuires chemptherapy?
		A:	30% of women with what you are describing will have early stage breast cancer found at time of open excisional biopsy so smart to follow through with tuesday's procedure. The size of the area that is involved with calcs can influence whether there is a probability that invasive cells may be present along with noninvasive dcis. 20% of the time cancer can be present that neither mammo now ultrasound was able to see. it isn't that calcs require chemo. calcs that are irregular in shape and clustered together can be a marker for detecting cancer early. tumors that have some size to them and have poor prognostic factors are the ones that receive a ticket for chemo. LS
Question:  #75 1/18/2009		Q:	I am a 51 year old who went in for annual mammogram, ended up going back for diagnostic and then ultra sound and am working with Dr. to get a biopsy scheduled. After the diagnostic the radiologist''s note says 5 mm nodule. The "the magnified CC view suggest poorly defined margins along the posterior and medial aspect." After the ultrasound: this is the report: persistent nodular density upper slightly medial aspect of the right breast. At the nine o''clock position, there is a irregular area of architectural change fairly close to the nipple axis. (a note about which images show this). There is irregular posterior acoustic attenuation. This area of vague architectural change has poor margination. Its size is slighty larger than the nodule on mammography. Summary: What is probably concordant with the nodular density on the right mammogram is an area of architectural change and lobulation at the 9 o''clock position. The last lime says both tests are suspicious and biopsy is recommended. BI-Rads 4 I am just looking for any insights or what to expect. I especially don''t understand the part about lobulation or ifnthe close to the nipple axis means anything. We were shown the tests and it was clear there was a nodule that was defined mostly except for the posterior section. Both the radiologist and physician said this could be things other than cancer but I know that poor margination part is not good. Thank you for any insigt.
		A:	take a look to see if it has a letter after the bi-rad 4 number. if aa 4a then 20% risk of it being cancer. if a 4b then as high as an 80% risk. irregular edging is worrisome. the parts that you were focusing on merely define its location and aren't significant as far as determining what it is. it is very tiny. that's the good news. so if it ends up being cancer i would anticipate it being a stage 1.
Question:  #76 1/17/2009		Q:	I recently had a stereotactic biopsy of my left breast. The 2cc biopsy from my breast tissue diagnosis reported fibrocystic changes, including epithelia hyperplasia, apocrine metaplasia, and tall columnar cell metaplasia with atypia, not otherwise specified, with clacifications. Please explain to me the metaplasia with atypia. I have seen 2 breast experts and one feels I should be concerned with this and the other feels that as long as I do follow ups and keep track of this that it should not be a problem. Are these the beginning cells for Cancer or are the Cancerous cells or not? Please help I am a bit confused.
		A:	this deion signifies increased risk of breast cancer. the next step should be doing an open excisonal biopsy and sampling more tissue. 20-30% of the time DCIS, noninvasive breast cancer, will be already present. you want a breast surgical oncologist doing this procedure. if you want to come to us call 443-287-2778.
Question:  #77 1/11/2009		Q:	Hello. My Wife recently was diagnosed with microcalcifications in the upper outer quadrant of the left breast. She is scheduled for a sterotactic biopsy this Friday. Ive read all the statistics and I''m hoping she is in the 80% benign category. I was curious if she fell into the 20%, what are the chances of it being invasive? I''ve read it is usually DCIS and it is at the earliest stage of breast cancer. She gets her yearly mammograms and has always had calcifications. Is there a high chance microcalcifications are a sign of invasive breast cancer and does that chance increase because it is in the outer quadrant of the left breast? Any help would be appreciated.
		A:	The most common site of breast cancer is upper outer quadrant. That does not mean there is higher risk for invasive cancer. As you know, calcifications that change require biopsy to rule out any cancer cells. The mammogram is not showing a tumor, it is showing changes in the calcifications that indicates a possible problem. Changes in calcifications are not high indicator of invasive cancer. If dcis, ductal carcinoma in situ, the non invasive cancer, is found, surgical removal of the dcis will be recommended. There is always a possibility of invasive component found in tissue removed at surgery that is not seen on biopsy. Most often it is just dcis. ds
Question:  #78 1/11/2009		Q:	I am 47 years old with no history of family breast cancer. I recently had a stereotactic core biopsy done on my left breast. I had this procedure done 5 days prior to me getting my period. The biopsy was done because my annual mammogram showed a small cluster of about 5 microcalcifications. All of my previous mammograms have always showed ''normal''. The pathological diagnosis was the following: "Radial scar with foci of florid intraductal hyperplasia and papillomatosis. Multiple foci of intraductal papillomatosis and hyperplasia." Their comments were: "Suggest excisional biopsy in view of the presence of radial scar and florid proliferative fibrocystic disease. Specimen x-ray was reviewed." Please help me to understand what the diagnosis is and if it is absolutely necessary for me to get the excisional biopsy performed. Also, what is the benefit to having the procedure performed? Thank you.
		A:	The excisional biopsy will give a definitive diagnosis from obtaining more tissue than that of stereocore biopsy. Removal of the tissue with the hyperplasia and papillomatosis is done to rule out any chance of malignant cells in area of these findings. It is a very low chance but needs to be ruled out. ds
Question:  #79 1/12/2009		Q:	Dear Sir, Madam In April 2007, I woke-up one day with a sore reddish nipple in the right breast. I saw my doctor, and was refered to a surgeon and was told it was a normal fibroadenoma, and was discharged. I saw another doctor, and did a mamo, and ultra sound which came normal (although no cyst was seen during that time, despite the fact that there was a palpable lump in my right breast). I saw another doctor who ordered a FNAB and the 1st said: mildly atypical cells, however the chromatine pattern does not look malignant) and another biopsy was advised. the 2nd ruled out fibroadenomas and no signes of mailgnancy. The doctor advised that we remove the lump and do another biopsy but I refused and decided to travel abroad. I saw a breast specialist who after looking at all the exams I did and a breast examination told me this is fibroadenoma and I have them in both breasts. It is worth mentioning that I had one in the left breast 5 years ago, and was fibroadenoma. I was told this is a nipple infection. I came back but the infection still exist although I was given local treatment for it. I saw another doctor and was told it could be duct estacia. I was afraid of paget''s disease but 3 doctors had assured me it is not paget. My nipple symptoms are still the same, I saw a dermatologist and was told this is a derma disease but did not take treatment for it. It is almost 2 years till now the nipple is a bit pinkish (light pink or red) only on the tip of the head. The area around the nipple is normal looking with o damage, the nipple is not damaged, but sometimes it builds up like plaque or wart and it falls buy itself or when I do some oil treatment for it or I tear it off. then it goes back to normal and after a while it build up again. It does not bleed and no discharge from it. It is not inverted and does not have any changes apart from the redness on it. I am not sure, but when I did the 1st FNAB the doctor inserted the nipple inside the centre of the nipple with the needle it was very hard and tough, not sure if this had damaged the nipple. No other changes in my breast or lymph nodes. Can you advise what this could be, I thought of attaching pictures but did not find a place to. Awaiting to hear from you soon
		A:	Fibroadenoma is a mass that is benign and does not become cancer. You have atypia on biopsy which is not fibroadenoma. We would recommend open excisional biopsy(removing the lump) of atypia as 25 to 30 percent have noninvasive cancer present. The nipple redness is a seperate issue. A piece of tissue looked at under a microscope would provide a definitive diagnosis. Consider a skin punch biopsy of the nipple to get that diagnosis. ds
Question:  #80 1/12/2009		Q:	Hi In may I had excisional biopsy for two areas in left breast- results b9 but with ALH. 6 mos. f/u mammo looked fine but dr. recommended a screening MRI. MRI showed left breast was clear but found a 15mm non-mass linear enhancement on the right side. Scheduled an MRI biopsy for next week. I am beyond anxious. What percentage of MRI biopsies turn out to be benign?
		A:	Don't have exact percentages, but the odds are in your favor as most biopsies in general are benign and even more so for MRI biopsies. MRIs are generally more sensitive for picking up cancers, but they also pick up more false positives (biopsy negative). That said, follow through with this as one can never be sure until the pathology tests come back. GOod LUCK!!
Question:  #81 1/12/2009		Q:	I had a breast surgical/ wire local done yesterday and while in the Radiology room saw the mamogram which showed the entire aerola area as pure white.My aerola is thickening no other symptoms except warm breast. This is the breast I had radiation in 7 months ago -the area radiated was a different one than the aerola area- can scar tissue from radiation end up in another part of the breast and be so specific to the aerola? they did a punch needle biopsy and found nothing there- is there something here to be concerned about if they advanced to a surgical biopsy? could it be IBC with different presenting condition- only thickening of aerola?
		A:	Density of breast tissue is seen as white on a mammogram. For you, the areola is dense as is the area radiated. It does not mean that radiation effected the areola. IBC would not likely present this way. ds
Question:  #82 1/12/2009		Q:	Thank you for your help over the last few weeks. My last message was sent January 2nd, and your reply was: you''ve had surgery today so breast changes, such as dimpling and swelling are to be expected right now. dimpling is a sign of cancer when it is the presenting physical symptom that takes you to the doctor in the first place. deion sounds favorable that you will get good news. we will hope so. LS My doctor told me that I would have the results back in less than a week. Today, I called their office and they told me the report was waiting to be signed by the pathologist and then the doctor could read it. Is it unusual to take over a week for the results? My lump was completely removed one week ago today. Why would the pathologist have finished the report and not signed it? Does the length of time it is taking them have anything to do with what the results say? Someone told me that positive/cancer results come in quicker than benign. Is that true? Thanks
		A:	It usually takes about a week. The length of time is for staining and other preparation and for reading. The signing is for the official results. Perhaps your surgeon could give a call to pathologist to help expedite getting results. ds
Question:  #83 1/3/2009		Q:	I am 43 years old and just diagnosed with Breast cancer. I have had a lumpectomy and axillary node dissection(4 nodes removed,all negative.)My initial Diagnosis was DCIS, comedo type microcalcification..Minute fibroadenoma.Fibrocystic changes.Upon re-excision, the Diagnosis was invasive ductal carcinoma, Nottingham grade 1.Margins are free of tumor.Microscopic examination reveals, minute foci of invasive ductal carcinoma and foci area of ductal carcinoma in situ. Two foci of invasive carcinoma grade 2.These two lesions were 4.5mm and 4.1mm. No vascular invasion identified. Also in the report, it states that, stained sections of block 3 show small nests and clusters of adenocarcinoma which form rounded slightly nodular expansile masses. Excluding the rare,isolated entrapped duct, the nests are devoid of myoepithelial cells. I am not comletely understanding all of this, if you could explain. Also Hormones receptors are negative. I have read a lot about Hormones receptor positive treatments, but not about treatments for Hormone receptor negative. Is this a good or bad thing, and where may I be able to find more info. about the subject ? Any info would be greatly appreciated.
		A:	so based on this information it is stage 1 breast cancer. originally anticipated to be stage 0 but due to small amounts of invasive cells found that bumps it up to a 1. not bad... inquire if the hormone receptors were done on both the invasive cells and separately on the DCIS. that is important. it is preferred to be positive for hormone receptors but given the small amount of breast cancer that you had i wouldn't sweat over it. it means that hormonal therapy won't be an option. so next step is to see radiation oncologist. this is an early find. good news. anticipate doing well.
Question:  #84 12/28/2008		Q:	I had a mastectomy and the pathology revealed a 6mm well differentiated IDC and a 15mm ILC. Both are grade 1, stage 1, estrogen receptor positive, and her2 negative. Lymph nodes not involved. Only the ILC was sent off for oncotyping. I was told that the IDC was not sent because it was small and well differentiated. I do not see that information on the website. I just see that oncotyping is designed for early invasive breast cancer. So I am wondering if both should have been sent off.
		A:	usually both would be sent.
Question:  #85 12/28/2008		Q:	I am 48 years old, sister deceased from BC, first time in our family. I had a core biopsy for a irregular shaped solid mass in my right breast, the results stated that the microscopic examination shows findings suggestive of a fibroepithelial neoplasm. The histopathologic differential diagnosis includes fibroadenoma and phyllodes tumor. The latter diagnosis is considered because of areas of increased stromal cellularity. and my case is being sent for a second opinion, final diagnosis pending. does this mean that they are not sure which one it is or what? and what are snomed codes? mine says M8000 P1140 T04020 please help and thanks for a wonderful site
		A:	the numbers are the registration code #s for logging in your specimen. sounds like they are unsure what it is. hope you have sent it to a cancer center where there are "breast pathologists"-- pathologists who specialize in analyzing breast cancer. if not, then consider sending it to us. if found to be phyllodes, a very wide margin is needed to ensure it doesn't return.
Question:  #86 12/27/2008		Q:	Hi Lillie, I just had an excisional biopsy after numerous tests and a stereotactic biopsy. I don''t know the results yet but can the doctor tell if it''s cancer just by looking at the mass ? He told my husband it didn''t look like cancer. I am desperate to get results since doctor really thought it was cancer after MRI. Thanks again for your time.
		A:	he can't tell usually by just looking at the raw tissue. we will hope that you get the news soon so you can move forward with a celebration or with treatment. either way, i'm just a click away...LS
Question:  #87 12/27/2008		Q:	cancer diagnosed in 1/08 back for mamo and ultrasound 12/08 and radiologist recommends surgical biopsy for 3 " leison- not palpable and hard to view- not needle as they are having a hard time seeing this thing and MRI is not an option as I had radiation just 6 months ago and it skews the reading..why would the radiologiost refer me for a surgical biopsy? I am assuming it is cancer if this is the case as the surgeon called it a lumpectomy..isn''t a lumpectomy a cancer diagnosis? very confusing...
		A:	something that is 3 inches in size should be able to easily be core biopsied first before removing it. it is always wise to know what something is before surgically excising it. the surgical technique is different. ask the doctor if he used the term lumpectomy loosely or if he believes this is cancer. frankly, if you've had radiation already and now he thinks this is cancer then a mastectomy with reconstruction would be the treatment, but only after it is confirmed with a core biopsy that this is cancer. if you want to come our way call 443-287-2778. LS
Question:  #88 12/27/2008		Q:	I have recently been diagnosed with Paget''s disease of nipple. This is a recurring cancer since I had lumpectomy and radiation 3 years ago to same breast for DCIS only. My pathology report says very little. Cytokeratin 7 and polycional CEA positive Mucicarmine and PAS/diastase focally positive. I have no palpable mass. What are the chances that this is in the nipple only, DCIS only, or God forbid, invasive?
		A:	the odds are in your favor that it is DCIS, and though it may be limited to the nipple/areola complex the treatment would still be mastectomy with reconstruction since the breast cancer be re-radiated. so consider diep flap reconstruction since implants and previous radiation don't go well together. if you can come to us, do. 443-287-2778. LS
Question:  #89 12/21/2008		Q:	Sorry if this question came through twice, or in the wrong forum..... I just had a right mastectomy because of biopsy that identified a 6mm IDC. Pathology report indicates that the original tumor that I discovered was actually excised at the same time as the biopsy, and was not there for the final pathology. However, there was present evidence of LIC and LCIS, and within the mastectomy specimen a second primary infiltrating lobular carcinoma was identified. The ILC was estimated to be approximately 15mm. Additionally lymph nodes were negative (4 sentinel nodes) and no lymphovascular invasion identified. Initial biopsy report indicates the IDC was estrogen positive (90%) and HER 2 negative (10% 1+). Path report indicates the ILC was estogen positive (95%) and HER 2 moderate (50% 2+). My surgeon then sent the ILC specimen for FISH testing and it came back HER 2 negative. The ILC specimen was sent off for OncotypeDX testing. I was told that the IDC could not be sent because it was not there in the breast when it was removed. My surgeon says I am still stage 1, grade 1. I see an oncologist next week. My questions are: 1) Am I worse off in any way because it was found that I have more than one type of cancer in the same breast at the same time? How common is that? 2) Was a unilateral mastectomy a good enough choice? (MRI showed no evidence of carcinoma in left breast). Should I be concerned about my left breast? What kind of surveillance should be done on my left breast from now on? 3) Since I had 2 types of cancer, if my oncotype score is in the intermediate range, should I have chemotherapy? 4) Is it possible that if it had been, I might have received different scores for the IDC and the ILC? If so, then should I be concerned that the IDC was not able to be sent off for oncotyping?
		A:	1. no, not worse off. and we don't add all the tumor measurements together either. each is independent, thus he told you stage 1 which is correct. not that unusual either. 2.yes, unless you carry a breast cancer gene raising your risk of getting it bilaterally. annual mammography still is fine for the remaining breast. 3. wait to see results first. grade 1 commonly comes back as a low score by the way. we'll see what yours is... 4. i think oncotypeDX was developed originally for IDC. don't know how well it works for ILC. ask the oncologist what data he has regarding that. you can also yourself visit www.genomichealth.com to read more about that test. LS
Question:  #90 12/20/2008		Q:	hello Lillie.Thank you for my many questions answered. After one US, 2mammos, one MRI and a stereotactic biopsy, the breast specialist that I see is going to do an exsicional biopsy. He says that the MRI, which he thinks is highlhy susp because there is a 2.5 cm mass with irregular borders that showed enhancment and the biopsy results dont match up.path results as follows:lt breast biopsy:non proliferative fibrocystic changes and proliferative changes (moderate epithelial hyperplasia)w/o atypia.no malignancy. My doctor does not believe these results, he thinks they missed the mass during biopsy. What are your thoughts? MRI birad 4
		A:	can't guess on this-- need to see the imaging studies. if you want a second opinoin with us about this contact sharon bean at 410-955-7288. it is unusual to recommend excision without validating what it is before it is removed. so correlation of the images with the biopsy results is supposed to be done by pathology and radiology regularly. usually a weekly meeting is held to review all these cases. if they feel the wrong area was biopsied then another biopsy should be done-- core or stereo.you might want to consider traveling to us for that purpose. if it was known to be cancer, the surgical procedure would be slightly different. wider margins needed, sentinel node biopsy done, and other measures taken. LS