IDC grade 2 with dcis with cribriform and micropapillary pattern

My wife aged 36years. She had a painful lump in right breast which was removed and tested.Results were Grade 2,Score6. After consulting oncolorgist she had Wide Local Excision(Lumpectomy) last week. Specimen size 8x6.5x0.4,margins 0.6cm from tumor. Tumor description:on serial sectioning a large 4cm cystic cavity filled with blood is identified.A 1.5x1.5x1 irregular hard grey white nodule is seen adjacent to cystic cavity and protuding into it. Skin is free of tumor.Histological diagnosis:Infiltrating duct carcinoma,grade 2. Histological rade: Tubule formation :10-75% Nuclear Grade:Moderate pleomorphism Mitotic count:10/hpf Perivascular or perineural invasion absent Intraductal component:Extensive dcis with cibriform and micropapillary pattern Classification in tumor:Occassional foci of microcalcification present Regional lymph nodes are free of tumor(0/32) Pls. explain the results and how I should proceed,like does she needs medicine/ radiotherapy or she needs chemo.Chances of reoccurence. thanks for your help... Thanks

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Answers (3)

Thursday, May 22, 2008

PJ Hamel

Sanjay, you absolutely need to talk to your wife's oncologist about all this. (S)he will explain it, and determine whether or not your wife needs chemo and/or radiation. Just looking at these results, I'd guess radiation for sure, plus perhaps chemo—although the fact that her lymph nodes aren't involved is VERY good news, and may preclude the chemo.

The following is a short explanation of some of what you were trying to understand. Best of luck to you both - PJH

Tumor grade includes tumor size, plus the following three factors. Each is assigned a score from 1-3; your “final grade” will be between 3-9. The higher the score, the more advanced/dangerous your cancer.
•Tubular (or cellular) differentiation: This is based on how closely the tumor resembles normal breast tissue. A score of 1 means it resembles normal breast tissue closely, which is good. A score of 3 means it differs a lot from normal breast tissue, which isn’t good.
•Mitotic rate: This measures the number of malignant cells that are actively dividing. The higher the score, the more aggressive the cancer; a score of 3 indicates the fastest-growing cancer.
•Nuclear grade: This measures the size and shape of the cancer cells’ nuclei. A low score (1) means nuclei are small and regularly shaped; a high score (3) means they’re larger and irregularly shaped. A score of 2 means they’re somewhere in between “close to normal” and “out of control.”
Adding up your three scores gives you your Scarff-Bloom-Richardson (or just Bloom-Richardson) score. Tumor grade ranges from low (1-3) to intermediate (4-6) to high (7-9). Like golf, a low score is better than a high score.

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