No clue what I'm doing

Snatches

Good evening. I'm 38, female. I had my yearly OBGYN appointment last month and my Dr felt a lump in my left breast.

Because of my family history, he sent me for a mammogram. Right after the mammogram, they told me I had to go to ultrasound. I didn't ask why. The tech ultrasounds me and then brings in a Dr, she ultrasounds my breast as-well.

I am given a paper and script for a biopsy. The repot says Bi raids 4C. Pleomorphic microcalcifications,dense breast tissue and other things.

So I went and had to biopsy. The Dr that performed the core biopsy couldn't find the lesion so she just took some tissue samples near where she could see it in the previous ultrasound.

I got a call back from my dr stating that the lesion wasn't biopsies and that pathology of what was was good, the only thing they see us chronic inflammation.

My Dr wasn't satisfied so she sent me for an MRI and today she took the lesion out and the surrounding dense tissue.

I honestly don't know what's going on. I haven't googled because my Dr said not to, but curiosity got the best of me tonight.

I don't think I ask enough questions because I don't know what to say or ask.

Any input or questions I should ask?

Thank you

Jaime

I

ChiSandy

Yes, Jaime. First, I have a few of my own. Where did the biopsy attempt take place--a small community hospital or a university medical center? If at the latter, was it at a specific breast health center within the facility? Second, who unsuccessfully tried to biopsy your lesion--a general surgeon, general radiologist, breast surgeon, breast cancer surgeon or breast radiologist? Obviously, the first is worst and the last is best, simply by virtue of volume of specific experience. Next, was the possibility of an MRI even discussed? “Dense breast tissue” makes mammographic and ultrasound imaging less reliable than MRI--and at a breast health center at a university hospital, MRI-guided core biopsies are readily available whereas that technology does not exist at many small-town (or even urban secular or faith-based “community” hospitals). I say this as the wife of a cardiologist (and primary-care gerontologist) who practices at a small urban independent faith-based community hospital, slightly larger suburban one, and a major university-affiliated multidisciplinary medical center (part of a top-notch multi-hospital system that happens to be faith-based itself). Guess where he sends most of his patients who need anything beyond primary care?

Did the same radiologist who did the diagnostic ultrasound do the core biopsy? I ask because my first radiologist was “non-invasive” and the second specialized in invasive breast radiological procedures: image-guided (stereotactic, ultrasound and MRI) core-needle biopsies, pre-op wire localizations and radioactive seed placements, etc. The difference between the types of experience between the two was considerable. A surgeon--maybe even a general surgeon--would do a good job at incisional and excisional biopsies but may not be as skilled at being able to follow an ultrasound image to the “target” of a lesion to be core-needle-biopsied as would an invasive breast radiologist.

Who finally excised the lesion--your OBGyn, the radiologist who performed the ultrasound, or (assuming it was yet another doc) the doctor who attempted the core biopsy? Considering the original ultrasound led to a BIRADS 4c classification (e.g., "highly suspicious" for malignancy--4a is "slightly suspicious,” 4b is “moderately suspicious,” 5 is “high likelihood of malignancy” and 6 is an already-confirmed malignancy), it’s a darn good thing it’s out--but depending on the path report, you should strongly consider a second opinion from a breast surgeon at a major university medical center (preferably one with a breast health center)--if malignant, you will need an actual lumpectomy and sentinel-node biopsy to accurately “stage" your tumor to determine your treatment plan. And in the USA, there are programs to help transport you to such a facility for your surgical treatment and even defray the costs should you otherwise be unable to afford it. (Can’t speak to the UK, Aus, or Canada--maybe one of our members living there can weigh in)