Understanding Pathology Reports

Question: Please check my pathology results and
advise me how I should proceed. Hope to hear from you at your earliest convenience. Thanks

Answer: Thank you for contacting us. I read through your reports including the clinical notes. The reports were a little too large to post on this site so let me just comment on the pathology diagnosis. It seems you were initially diagnosed with DCIS (cannot rule out invasion) on a core biopsy. The DCIS was estrogen and progesterone negative. At time of surgery, it appears there was at least a 2.2 cm area of invasion in part B, but it is confusing as to the comment of 2.9 cm of invasion in part C. Without seeing the actual slides or speaking with the pathologist, it is difficult to determine if the pathologist felt this was an additional, yet separate, focus in part C. The final pathologic size is listed as pT2, so based on the report it seems they were separate foci, but I cannot confirm that. If these two areas are contiguous that could mean the tumor could be over 5 cm which is a pT3. That could change your overall stage. While some of the margins on the initial resection (parts B and C) were apparently positive, the results of specimens D-I were negative so it appears your final surgical margins are negative. However, given these small “satellite” foci of cancer that were mentioned in parts B and C, when I see this in a report it always concerns me if all of the foci of cancer have been removed. So what is next? I think asking the pathologist if he/she thinks these two areas in parts B and C are contiguous and the tumor is larger than mentioned. Since you have an invasive cancer and you have had a lumpectomy, given the tumor size you would need radiation therapy regardless. The focus in one of the sentinel nodes seems likely at worst it would be an isolated tumor cell (ITC) and, as the pathologist reported, those are staged as N0 and not as a micrometastasis. I read that the breast prognostic marker panel was going to be reported in an addendum but I didn’t see that report. Even if your DCIS was ER/PR negative, if the invasive cancer has at least 1% ER positive cells you could receive anti-estrogen therapy. I suspect given the size of the cancer, chemotherapy will be a recommendation. I would also want to know the Her2/neu status of the cancer. That can determine if you qualify for trastuzumab (Herceptin). I know this is all very difficult to deal with, but you are doing the right thing by asking questions before you begin any therapy. If you find out the results of the breast prognostic marker panel (ER/PR/Her2) let us know and we will be happy to offer advice. Best wishes to you.

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