I’m anxious to hear what John Hopkins will say
Also another opinion at GBMC
When you go in for your second opinions, I think it might be helpful if you could review the meaning of the coding pN0(i+). In this expression, the lower-case "ï
" has a special meaning. The "ï
" is an abbreviation for immunohistochemistry
, otherwise known as IHC.
You can further appreciate the context when you understand that IHC is not the default method for analyzing lymph nodes. The default staining method for pathology is called the H&E method (hematoxin and eosin) and is what is used routinely for preparing and processing specimen slides for review under the microscope. I think the IHC method is used for lymph nodes only in special cases or when a doctor requests it.
In your pathology report, you were told that they found Isolated Tumor Cells and that the coding was pN0(i+). The lower-case ï"in this coding is meant to say that they had to use the special IHC method in order to find any Isolated Tumor Cells; these cells weren't visible otherwise.
The following quote may explain the situation a little:
...To avoid confusion, patients identified with occult disease should now be classified as pN0(i+) if detection is
negative by hematoxylin and eosin (H&E) staining but positive by IHC ...
What this means is that when your pathology analysis was done with the standard, default H&E staining method, they couldn't detect any ITCs at all. In order to detect any ITCs they had to do a second analysis on different slices from the same lymph nodes. If they hadn't done this second analysis, you would have been staged as pT2N0M0 straightaway and told simply that you were Stage I -- and for Stage I the standard-of-care is "No further treatment".
You may want to ask why they decided to do the extra IHC analysis on the lymph nodes. Is it standard procedure in this hospital? Is it because the doctor requested it? I think normally they wouldn't do the extra IHC analysis, unless they had a reason. (That's just my personal opinion)