Ask an Expert is a free question-and-answer service about breast cancer and breast health that is available on weekends. If you'd like to ask a question or comment, please visit us again on Saturday or Sunday. In the meantime, please search the existing topics using the search tool at the top of the page. It's quite possible that one of our many existing topics already addresses your question.
If you would like a consultation with a breast specialist at the Johns Hopkins Avon Foundation Breast Center, call 443-778-2778. It is possible to get an appointment for a second opinion within a few days of contacting us.
We hope you find the information helpful!
|Forum||Questions||Ask a Question|
|Types and Stages of Breast Cancer
Questions about the different types and stages of breast cancer.
|Asked||Publicly Submitted Question|
|3/20/2011||I had 2 surgery on right breast. The first was surgical biopsy done by a local doctor. The specimen was sent to a bigger city and they had the following result:Ten outside slides (LS11-244), designated as right breast, biopsy with needle localization:DUCTAL CARCINOMA IN SITU (DCIS), MODIFIED BLACK'S NUCLEAR GRADE 2 (INTERMEDIATE GRADE), SOLID AND CRIBRIFORM TYPES , ASSOCIATED WITH COMEDO NECROSIS AND CALCIFICATIONS, DCIS IS NOTED IN TWO OUT OF THE FOUR SUBMITTED TISSUE SECTIONS AND THE MAXIMUM DIMENSION IN A SINGLE SECTION IS 0.7 CM. DCIS IS NOTED WITHIN 1 MM FROM CLOSEST INKED MARGIN. DCIS IS POSITIVE FOR ESTROGEN RECEPTOR (100%) AND PROGESTERONE RECEPTOR (100%). APPROXIMATELY 10% OF THE TUMOR CELLS SHOW LABELING FOR Ki67. The 2nd doctor said 1mm is a too close margin so he did re-excision and the result is:(A) RIGHT BREAST, SEGMENTAL MASTECTOMY:RESIDUAL DUCTAL CARCINOMA IN SITU (DCIS), INTERMEDIATE NUCLEAR GRADE, SOLID AND CRIBRIFORM PATTERNS , WITH CANCERIZATION OF LOBULES, COVERING AN ESTIMATED AREA OF 1.0 CM IN GREATEST DIMENSION, NEAR THE ORGANIZING PREVIOUS BIOPSY CAVITY .DCIS IS FOCALLY PRESENT LESS THAN 0.1MM FROM THE CLOSEST DEEP RESECTION MARGIN. The remaining resection margins are free of DCIS. Fibrocystic changes including adenosis, apocrine metaplasia and stromal fibrosis DCIS IS FOCALLY PRESENT LESS THAN 0.1MM FROM THE CLOSEST DEEP RESECTION MARGIN.My question is: 1) Why did the 2nd doctor find a even bigger DCIS in 2nd surgery (the 2nd was 1 CM and first one 0.7 cm) and the mamo did not find it? I had 2 mamo's before the 1st surgery and 1 mamo before the 2nd surgery.It would be more understadable if a much smaller DCIS was found in 2nd surgery. Should I doubt there are more DCIS that are not digged out? 2) Is that 0.1MM margin to close? The PA said the doctor already scapled the fascia. What can we do with this deep DCIS? Will it go into the chest? Should I do MRI or consider mastectomy?|
|Replied||JHU's Breast Center Reply|
|3/20/2011||Re-excision was indicated after first surgery; DCIS, while not invasive, can be diffuse throughout the breast-"like a puff of smoke in the air", so even though the close margin was excised, the DCIS is more involved in the breast. Depending on density of breast, DCIS may not be entired visable on mammogram; MRI's can help with DCIS in dense breasts, however with several excisions at that site, reactive surgical changes likely to reflect on scan. Ask to have your case presented at the Multidisciplinary Tumor Board at your hospital, for recommendations to be made by medical oncologistss, radiation oncologist and other breast surgical oncologists. Yes, sometimes a mastectomy is necessary with DCIS. We would be happy to see you here at JHH Breast Center as well. Best wishes.,|
Please note: This service is not intended to provide primary medical advice concerning specific medical care or treatment. Ask an Expert is a free service operated by health care professionals at the Johns Hopkins Avon Foundation Breast Center. Due to the volume of questions and their complexity, there are times when medical oncologists, surgeons, radiation oncologists or oncology nurses are consulted for their input. These individuals volunteer their time for this service and will respond as soon as they are able. Please do not post or send the same question to us in multiple locations or categories.