What Does The MRI Report Indicate?

Posted on Mon, 18 May 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 18 May 2015 Answered on

Mon, 8 Jun 2015 Last reviewed on

Question : I have recently completed 4 rounds of TC chemotherapy for a triple negative breast cancer diagnosis. Stage 1b, tumor was 1.9cm by way of US, 2.3 cm when measured by MRI. Apparently no affected lymph nodes. A swollen node was biopsied prior to treatment and showed to be benign (this node also lit up just slightly on the initial MRI). At the same time, as the initial diagnosis, a mildly complex cyst (I think it had a single septation) was identified in my left breast. It has not been biopsied, but was visualized by way of mammogram and ultrasound. Also, nothing lit up in this breast on my initial MRI. Completed 4 rounds of TC treatment (every 3 weeks) with a good response, but not a complete response (tumor shrank to 0.5 cm). Had lumpectomy 2 weeks ago, clear margins and sentinel node biopsy was also negative, although the biopsy showed the node was fibrotic and had been chronically infected (maybe cancer at one time) but was cancer free. Follow-up MRI still shows no node involvement and nothing on left breast. So my question is what should I do next? My current doc thinks I should just move on to radiation, but I had received a second opinion that thinks I should get an additional 4 rounds of Adriamycin therapy. Is this overkill? Or is it something that should be done for TNBC? I've also within the last several weeks had mild, occasional achiness in my left axillary area, but again nothing showed on MRI taken 2.5 weeks ago? Should I be concerned?

Answered by Dr. Grzegorz Stanko (2 hours later)

Brief Answer:
Radiotherapy is your next step for sure.

Detailed Answer:
Hello!

Thank you for the query.

Stage 1B is an early breast cancer. This simply means that your 5 year survival is almost 100%. However this stays unclear as there are some changes in the sentinel lymph node after the chemotherapy. This can indicate that the biopsy before treatment was false negative and there were some cancer cells in the lymph node. So you could be IIA as well.
But this is not that important right now. Lack of cancer cells after chemotherapy is a good prognostic factor.
Your next step is radiotherapy for sure. No doubt in that.
4 cycles of chemotherapy is enough. Some can say that you should have another 2 cycles of TC chemo, but it is known that the effectiveness of 4 vs 6 cycles is the same.
Next 4 cycles of different chemotherapy is not a standard treatment even in TNBC.

You should also have checked ER receptor in the removed lump (I know it has been done before the surgery, but the ER status can change after chemotherapy).
And for sure, if it has not been done yet, BRCA1 and BRCA2 mutations should be checked.

Hope this will help. Feel free to ask further questions.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar