Birad 4 & wait-and-see

KS1

A routine followup ultrasound revealed a 6 mm mass in my axilla (where my original BC was) that the radiologist called "highly suspicious" (Bi-rad 4).  The radiologist is emphatic that it should be biopsied, but my surgeon thinks it is a false positive, and says it can't be biopsied non-surgically.  My axilla's been through a lot (2 ca-removing surgeries, complete LN dissection, 4 or 5 incision and debridements, high dose radiation)  and there have been complications (lymphedema, brachial plexus neuropathy, cording, non-healing wound, infection) so doing a surgical biopsy wouldn't be fun.   My surgeon can't feel anything and he says I am extremely easy to examine (I am very thin) and he strongly recommends watchful waiting with a repeat U/S in 6 months.  My medical oncologist is deferring to him as to treatment. So, I'm taking my surgeon's advice -- he's been right every time and my feeling is that if a surgeon doesn't want to do surgery that says something.  But I have to admit to being pretty nervous.  Most of the time I am able to suppress thinking about it, but when it comes back, I am filled with that all-too-familiar sensation of nausea/panic/numbness/dread/foreboding.  Has anyone else been in a similar situation?  Did everything turn out "ok"? Any suggestions on how to get through the next few months without driving myself crazy?  

PiscesMoon

hi KS1

i've not had your experience but i'm sure someone else on these boards has - there are so many of us!

i've thought long and hard what i would do if i was ever in your situation.  with birads4 80 percent of these pups are benign.  it sounds like you trust your team pretty well.  i more than likely would also listen to my team - but still go insane from worrying about it.  your poor body has been through so much it would be scarey to put the area through yet another surgery.

{{{ hugz }}}

~M

Beesie

With BIRADs4, wait and see is not usually the recommendation.  The definition of BIRADs 4 is that the area does not have the appearance of malignancy but that cancer cannot be ruled out. That's why a biopsy is pretty much always recommended when a film is rated as being BIRADs4.

It seems though that your surgeon doesn't agree with the BIRADs 4 classification.  BIRADs3 is the "wait and see" rating and your surgeon appears to be leaning that way.  Since this is the rating based on your ultrasound, what about your mammo and/or MRI?  And if you have not had these done, can you have them done?  If they show the same concern, that would mean that a biopsy really is necessary.  But if they are clear, then it might be a bit safer to go with the "wait and see" approach.  Another option (or an additional option - I think having the mammo and MRI is important) would be to have a third party - another radiologist - review your ultrasound film to see what he/she says. If you get agreement on the BIRADs4, then a biopsy probably is in order; if the radiologist agrees with your surgeon, then maybe you can wait.

KS1

Hi Beesie & Piscesmoon -- I had a mammogram done at the same time, and the birad 4 was for the combination.  I don't know if there was anything in the mammo (given the high axilla location, I doubt the region was even in the mammo field). The first radiologist said she had a second radiologist (at the same hospital) look at it and that one concurred that it should be biopsied.  I asked the radiologist if there was anything else that could be done -- MRI, PET scan, anything --- and was told that they wouldn't add anything. My surgeon seemed so confident -- and I was so happy to get the "get out of jail free card" -- that I didn't question him. The 3 times I've had to wait a week for path results, I could barely eat or sleep.  I am not sure how I will endure 6 months. Maybe I could getdo a clinical breast exam in 3 months, and then have the U/S in 6 months.  Does this forum have a hand-holding thread?  Or maybe a buddy system for people who are in similar situations of waiting?  

KS1

An update - I saw my radiation oncologist (routine post-rad follow up).  She says my clinical situation is very unusual (location of tumor, treatment, complications etc) and that the radiology report was odd, especially given my clinical situation.  (For example, it says that palpable mass looks like a very suspicious lymph nodes, but my 4 BC docs can't palpate anything,  I had a complete axillary node dissection, and even if it is a LN, it doesn't meet size criteria for further investigation.)  So, she agrees with my BC surgeon that a "wait-and-see" approach is best. Twenty-two more weeks of waiting until the repeat U/S.  Guess  I should find a comfy chair in the "waiting room" thread of this forum ... 

beckward

KS1,  I had a similar situation just a few weeks ago, without all of your complications.  I was told to "wait and watch" by first bs.  Like you, I was not a good waiter.  My onc. and  gyn. finally agreed with me that we needed to find out what it (palpable lump, bi-rad4).   Radiologist did an US guided needle biopsy and it was fine...granular tissue and blood.  There are SO many things that can show up as abnormal after a surgery.  All of the funky things like fat necrosis, encapsulation, enlarged lymph nodes, cysts, can be palpable lumps. You are prob. OK, but I would pursue a biopsy so you can have some peace.    Let us know what happens... Beth 

KS1

 I've waited 6 months and in a couple of days I'll see whether the lump has grown or not.  I've tried to make the time count -- spending more times with my kids and going on a fantastic "real" vacation.  But, being in limbo for so long has been difficult.   At  times I have felt stuck - unable to think or plan beyond March.  I dread what I might learn with the burning fury of 1000 stars (or the fury of the cursing mommy doing taxes), but part of me is glad the wait is almost over.  I pray my 6 month "stay of execution" becomes a full pardon. BC sucks.  A lot.  KS

chele

I hope it turns out to be nothing.  I'll get results in a couple of days too.  I hate all the waiting!  I don't know how you managed waiting 6 monts!  I'd have lost my mind. 

KS1

Chele, I do hope your news is like mine. My US revealed that the mass in my axilla has not grown in the past 6 months. Indeed it is slightly smaller. The mass was 10 mm x 10 mm x 6 mm, but now is < 10 mm in the largest dimension which is too small to trigger further investigation. The radiologist (who was insisting I have a bipsy 6 months ago) is just recommending a repeat u/s in 6 mo. Life resumes - KS1

lago

My Birads 4 ended up being 5.5cm IDC (with some additional >20% DCIS)  very fast growing grade 3 HER2+.

I'm not trying to scare you but why wait?

AlaskaAngel

Hi KSI

I have always wondered why on earth, when imaging results are difficult, the doctors don't ever seem to reach into the bag of tricks and do some of the alternative tests to see if the general picture might help the patient reach a decision. I'm talking about such things as CA 27.29, CA 15-3, liver function testing like ALT and AST, and alk-phos, or maybe even check for mets with a bone scan. Your situation is unusual, but I've wondered about this in terms of the women who have, for example, especially dense breasts. Why don't they just do the additional lab testing routinely for those people, and perhaps in your situation, instead of "wait and see"?

AlaskaAngel

chele

That's great news KS1!