Expert: Claes-Gustaf Nordquist, M.D. - 2/13/2008

Question
I have just been diagnosed (by needle biopsy)with IDC and would like to know what the following mean from the pathologist's report:

Total Nottingham Grade/Score: Grade 3 (of 3)/8 points (of 9)
Tuble formation: 3/3 points; Nuclear Pleomorphism: 3/3 points; Mitotic Count - 2/3 points

Black's Nuclear Grade:  Grade 3 (of 3)

Carcinoma In Situ: No Significant Amount

Tumor Size: Longest continguous length 0.8 cm

This was the preliminary report and we're awaiting the final breast profile studies and addendum report.  

The surgeon said the likely options (subject to final report) would be 1) modified radical mastectomy (aggressive tx); or 2) lumpectomy and sentinal node biopsy plus radiation therapy.

Can you please explain what the stuff from the pathologist's report means and what the prognosis might be?

Thanks so much!  

Answer
Well the bottom line of these findings is that this is a rather aggressive cancer that grows quickly and is invading its surroundings. Its cells shows themselves to be rather immature which fits with the overall picture. On the other hand the tumor seems to be small (not bigger than 8 mm - around 1/3 of an inch). My conclusions from this are: Yes if you do not care much about the surgery and the ONLY important thing for you is to get rid of this cancer. Then alternative 1. (modified radical mastectomy) is for you. On the other hand if you want good treatment BUT ALSO want to keep your breast, then alternative 2. (lumpectomy with sentinel node biopsy and postsurgical radiation therapy) probably is your choice. The result is about the same with regards to the possibility of a cure. And your prognosis should in spite of the pathology of this lesion be good. However you must also understand that more pathology studies after surgery may give new different results that may change your situation and further therapy may be necessary, even though the risk for this is not big it does exist. The choice is yours!
Good luck!