On Thursday I received the first of the surgical pathology reports. I’ll get another at the end of the month after my bilateral mastectomy. This one reported on nine tissue samples that were taken on my November 19th surgery.

First and foremost, my nodes remain “negative for carcinoma”. In addition, the sub-nipple biopsy also indicates negative for carcinoma. That means, that my upcoming surgery on December 17th will be a nipple sparing bilateral mastectomy with immediate flap reconstruction. The surgeons will do what they can to keep my nipples (yay). It may not seem like much to someone who isn’t going through this process, but the whole idea of looking down after surgery and seeing yourself has a huge psychological impact. As much as I may not feel that I ‘care’ about my nipples, I know that if they were gone I would really feel it. Since the technique is rather specialized, I’m also contributing to the education of residents & fellows during the process. For me, that gives some meaning to this horrible experience. It makes it important.

The next part of the pathology talks about the three lumpectomies. I had three known tumors based upon the initial pre-chemo MRI (L1 was the largest mass at 2.4cm x 2.3cm x 3.0cm), L2 was a small mass only found on MRI at 1.0cm x .9cm x .8cm, R1 was a mass 2.7 cm x 2.1 cm x 2.0 cm). The earlier biopsies showed DCIS in the left breast. It is not uncommon to see DCIS (pre-cancerous cells) when there is IDC. In addition, chemotherapies doesn’t target DCIS.

L1 – This was the biggest success. What was left in the area was scar tissue with a single .2cm cancerous mass. In addition, there was DCIS close to the margin (in essence, if I had been only doing a lumpectomy, this would be said as not having clean margins therefore additional surgery is required- it doesn’t matter because they are going to remove all the breast tissue on the next surgery).

L2 – This showed only normal tissue. My guess here is that they go the wrong spot, because the marker was out of place. We will find out more about this in the mastectomy pathology.

R1 – This showed the part that worries me the most. This showed a mass of 2.1 cm x 1.6 cm of IDC and additional DCIS. 10% of the invasive mass was DCIS. Here the margins were not at all clean with additional invasion at the margins. What concerns me most is that the chemo had little effect on this mass. It is a little smaller (so at least it isn’t bigger), but not significantly so.

The pathology included staging for my cancer:
Left: ypT1a ypN0 (post neo-adjuvant chemotherapy, stage 1A no lymph nodes)
Right: ypT2 ypN0  (post neo-adjuvant chemotherapy, stage 2 no lymph nodes)

In summary, the left breast shows definite signs that the chemo worked, where on the right the treatment effect is listed as “indeterminate”.