BS just told me I should have second biopsy??

Kitchenwitch

BS just told me I should have second biopsy??

Kitchenwitch

Went to interview 3rd BS today. Kept thinking, Well, I'm sure she's not going to say anything different (lumpectomy + radiation), since that's what the radiologist, a pathologist and two other BS's have said.

Well, I guess I'm going to have to stop making idiotic predictions. She said the radiologist (they're at the same hospital and they talked on the phone) said that I should have another biopsy to check out a SECOND area of calc in the same breast. It's much fainter and smaller than the area I'm going to have a lumpectomy for (that's less than 1cm) but he still thinks it should be checked out.

Rage. Tears. Amazement. Shock.

Two other BS's didn't mention this?? The ^%$##R%(@ radiologist couldn't have biopsied both areas at the same time, or at least have TOLD me?? Cannot express how furious I am with him. The doc was really sorry, kept saying she hated to be the bearer of bad news and she was only the messenger (which is true, and I wasn't a bit mad at her).

I'll cut to the chase and say that I'm likely going to go with this BS (I really do think she's very good). We decided I'd do a lumpectomy and biopsy that other area (it's about 5 cm away from the DCIS spot) at the same time. I'll have two wires in my breast to prepare for it.

I know it's a gamble - because 5 days or so after, I'll get the &%^$#@ biopsy result and maybe I'll have to have a 2nd lumpectomy. She doesn't think I'll need a mastectomy (my breasts are very large). What can I say? I know it's a gamble, but she thinks (and he does) that it's an area of less concern, but still needs to be examined. 

What's your opinion of this? Including docs who saw this on the path report but didn't do anything about it? And the rad. who did'nt tell me to my face (or by phone) that I should have it? Couldn't he have just done both biopsies at the same time?? Is that ever done?  

SO FURIOUS AND DEPRESSED i can barely think. 

sejnboys

I have had a similar experience.  My 2nd opinion BS suggested a biopsy of a 2nd area, and my first BS never mentioned it.  I ended up staying with my original BS and did not pursue the 2nd biopsy because I was planning to have a mastectomy either way and figured it did not matter. That was my inexperience at play, as now, 6 weeks later, I am regretting that decision and wishing I'd followed through with that 2nd biopsy.  Now I am going into this mastectomy and immediate DIEP a bit blind since we really don't know what that 2nd area is.  I did not know better then, but now I do and wish I'd gone with what 2nd surgeon said.  I am upset that they did not biopsy both areas, and that it was dismissed when I brought it up.  Live and learn, I guess.  I am impressed that your new surgeon was willing to do the lumpectomy and biopsy the 2nd area at the same time...I was trying to get that done, but was told they would not do it.  I am already 2 months out from diagnosis and have BMX surgery scheduled, otherwise, I'd have it done now.  How fortunate you are to have found this new BS!  Good luck to you.    

dlb823

Kitchenwitch, I'm so sorry this has happened to you, but I think it's often the nature of bc -- that we get these nasty surprises when another doc or pathologist or expert weighs in.  As upsetting as it is to you at the moment, I can't help but think, thank God it hasn't been overlooked.  And the gameplan this newest BS has laid out sounds entirely sensible, rather than putting you through another biopsy.  In fact, since that "new" area is smaller, it sounds like she may be able to get it all while she's in there.

Unfortunately, as you're learning, not all doctors (including radiologists) are equally as good or thorough.  Thank goodness it sounds like you're finally in excellent hands.    Deanna

dlb823

sejnboys ~  We were posting at the same time, but I wanted to comment on your situation.  If you were planning on having a mast anyway, I'm not sure what difference a second biopsy would make in your case.  They will send all of your breast tissue to pathology, so your final path report will tell you if anything else was there.  On the other hand, if you have second thoughts about the choice to go with a mast, it's not too late to postpone your surgery.  Afterall, this is your body and a huge decision, and if your bc is purely DCIS, a slight delay isn't as concerning as it would be if your bc was known to be invasive.  Just some thoughts....   Deanna

Leah_S

After a core biopsy diagnosed IDC the first surgeon I spoke to was very strongly in favor of lumpectomy. I felt it was pointless since I'm very small (size AA) and the lump was not all that far from my nipple so what would be the point? She really didn't want to do a mast, but when I asked about some benign spots on the u/s report (one had a birad of 3/4, the other  two had birad 3) she said "Benign is benign" and didn't suggest biopsy. The second surgeon spoke to me for a LONG time about the reason I was opting for mast - he also thought I could do a lump but respected my choice. I didn't ask about biopsies since it would be academic with a mast. Turns out (in post-op path report) the "benign" spot birad 3/4 was an 8mm dcis. One of the other benign spots was adh. I don't know if radiation would have taken care of the adh but it's highly unlikely it would completely take care of the dcis.

I sometimes wonder if the higher recurrence rate after lump (I think local recurrence is abut 4% after mast, 7% after lump but not sure of numbers) is actually "benign" spots that are ignored. It's upsetting to find this out now, but it would be even more upsetting if nothing were done.

Best of luck.

Leah

sweatyspice

Kitch -

Was this second area mentioned in your radiology report?  Did you ask about it?  Do you have your radiology report? 

As you're learning, a lot more of this than you'd like is your own responsibility.

Of course, even assuming you'd asked about it, surgeons 1 & 2 probably felt it could safely be ignored.....and the radiologist?....dunno.

There's a lot of disagreement among MDs when it comes to treating DCIS.  Bottom line seems to be they really don't know all that much about what they're doing, they're just making educated guesses.  

Kitchenwitch

Sejnboys: I hope you feel OK about your decision. As DLB says, if you're having a mastectomy anyway... And are you sure they don't biopsy it afterwards so you know what you're dealing with?

DLB: Good point. I'm going to go with "better to get that biopsy over with during the lumpectomy so nothing crucial was missed" as an attitude. I was just upset at the idea of having a second core biopsy. No fun at all. It's funny how I hear over and over how the lumpectomy isn't as painful or traumatic as that biopsy! (Tho I'm dreading it anyway...) 

Leah: I find your mention of "recurrence" & previous spots very interesting, especially in light of your findings. That must have been a relief. The BS I talked to yesterday was very unhappy at the idea of a second spot of DCIS being exposed to radiation while the breast was being radiated the first time. It can't be re-radiated, she said.

Sweatyspice: From the beginning of this, I (moronically) trusted docs to do their best work. I've had lots of experience in knowing what an idiotic idea that is, but I just didn't feel like reading the depressing words. I know, I'm a jerk. Yes, it's in the report - with the radiologist's recommendation. The BS I saw yesterday is the only one who TALKED to the rad (they're at the same hosp) so I suspect he added a stronger suggestion in his talk. But his report DOES say he thinks it should be biopsied. Now I'm thinking the other two docs saw that, think it WAS biopsied and there's nothing there. But who the hell knows? I'm going to call both of them today. 

sejnboys

This BC stuff is so complicated.  I'd originally made the decision to go with mx as I was waiting for my BRCA results, knowing if it was positive I'd do the bmx without question.  My results were negative (thank goodness!)  but I still felt that I would do the bmx, and I knew I wanted to do immediate reconstruction.  I've met with three BS and all were a bit perplexed about this second area, not even able to say they thought it was cancer, but were concerned.  This second area is a good bit larger than the biopsied DCIS area, and is the reason they recommended the mx in the first place.  So my concerns about knowing what this second area is, are 1) if it turns out to be something that I will need rads/chemo for, that is not good for the reconstructed breast, and 2) if that area is not even cancer and the actual DCIS is very small, then maybe I'd make a different decision knowing as much as I do now.  I think I feel strongly enough about my reasons for doing the bmx, that the results would not change that.  But I would still like to know what that area is before going into the DIEP, as I will decide to wait on that if it is something more invasive.  I was feeling as though my hands were tied because I was already scheduled for bmx on 1/12 and I had all my family care plans coordinated and such.  But the Universe seemed to have stepped in today, as my PS called this am to postpone my surgery.  While I've been so very frustrated today trying to make this 1/12 date work, I am now thinking maybe this is an opening I should use.  So I am going to find out tomorrow morning if I can go ahead and have the biopsy now before my rescheduled bmx w/ DIEP date (whenever that may be...I don't know yet).  I don't know....maybe I am way over-thinking all of this, but it just feels better to me if I knew ahead of time, even if it means another biopsy.