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Lumpectomy with Sentinel Node Biopsy
Questions about Lumpectomy with Sentinel Node Biopsy.
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AskedPublicly Submitted Question
7/22/2017I had biopsy of left breast on 03/29/17 in which 4mm IDC and micropapillary DCIS was removed. Grade 2, Ki67 20%. ER/PR +90%. HER2-insufficient sample. Breast MRI 04/14/17--Unifocal 6mm carcinoma of left breast Lumpectomy & SNB on 05/08/17 removed 2mm low grade cribriform DCIS. No invasive found. Clean margins--closest margin was posterior at 3 mm. pT1aNO(I-). Decided no rads given age 69. Started Anastrazole on 06/22. Tumor Board recommended follow up mammo 6 wks post surgery as they felt number of calcs removed with bioposy and surgery did not equal calcs in original mammo. Follow up Mammo on 06/16/17 revealed surgery removed all original calcs and biopsy clip, but a new cluster was found which were very indistinct on pre-surgery mammo. These were 3 cm posterior to original cluster before surgery and 1.5 cm after oncoplastic surgery (moved forward). Biopsy on 07/12/17 found 4mm of cribriform and comedo DCIS. ER 97% and PR 37%. Radiologist got needle hung on surgery marking clip, removed it and wasn't able to place biopsy marking clip. All calcs removed. Surgeon is concerned she now will be unable to reliably find area to excise in new lumpectomy. Do you know of a way this area can be located without clip or microcalcs. Radiation Oncologist says if I do not have surgery to this new area, I should have radiation. What is your advice on what I should do now? I live in Arizona.
RepliedJHU's Breast Center Reply
7/22/2017Likely there are a few calcs remaining that would be seen on imaging done with tomosynthesis (3D mammography). If unsuccessful, at a minimum request that your case be presented to their weekly breast cancer tumor board for a larger group of breast specialists-- breast surgical oncology, medical oncology, radiation oncology, breast imaging radiology, and breast pathology- to render their opinions. Without or with re-excision, radiation will likely be recommended.

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