Odd comment on biopsy report

jomako

I had a biopsy done on April 20th at Moffitt Cancer Center. I was informed that the results were benign, but originally asked to return in 3 months for another mammogram. That has been changed to a 6 month follow-up with a diagnostic mammogram.

There is an addendum to the biopsy report and I was wondering if anyone else had ever had any comment like this on a report. I am not quite sure what to make of it.

"Please note, despite the core tissue specimen radiograph showing complete removal of the small group of numerous calcifications, only rare microcalcifications were seen on histology."

During the procedure, I heard the doctor mention that the calcifications moved when he injected the second round of Lidocaine to numb the area and that he would adjust his approach in order to get to the correct area. I don't know if that could be related to the comment on the report - I was facing away from the doctors and there was quite a bit of background noise, so I couldn't hear everything being said.

My final diagnosis is columnar cell changes, stromal fibrosis, and cysts with rare microcalcifications. I am left to wonder what happened to the microcalcifications that showed up on the imaging, and whether this biopsy might have just been a humongous waste of time. It seems like either there never were numerous microcalcifications to begin with, or the samples they took weren't from quite the right area. Can there be numerous microcalcifications in a sample that are missed by histology? It seems unlikely as the report notes that:

"Multiple additional deeper sections were performed on all tissue blocks and only rare additional microcalcifications were identified."

But this is Moffitt - if they had any concerns about the accuracy of this biopsy, surely they would have expressed them, right? So maybe I am just overanalyzing.

Has anyone ever had or heard of a similar situation?

BarredOwl

Hi jomako:

I'm not sure I get it, but it does seem to suggest some sort of unexpected or potentially discrepant finding. You are naturally wondering how often does this occur, and is it likely to represent a sampling artifact with no implications for the accuracy of the pathology findings, and why is that likely.

Perhaps you can request additional explanation of the process, observations, and potential implications of same via a discussion with the radiologist, pathologist, and/or breast surgeon.

By the way, I am wondering if the "core tissue specimen radiograph" is actually a radiograph taken during the biopsy procedure of some or all of the core sample removed by the needle during the biopsy (done to confirm the presence of micro-calcifications in the tissue removed, and indicative of sampling of the correct area of concern)? Then, the pathologist evaluated sections from the tissue blocks, and seemingly did not find the amount of microcalcifications he would have expected based on the radiograph? Does all the tissue in the core specimen radiograph go into the tissue blocks or are they separate samples? I have no idea.

BarredOwl

jomako

Thank you for your response. The only other mention of the specimen radiograph is in the description of the procedure:

"Six 9-gauge specimens were excised using vacuum assistance, and sent to pathology for histologic analysis. A specimen radiograph demonstrated the targeted calcifications. A top hat shaped tissue marker was then deployed into the region to mark the site of the biopsy for future reference."

I sent a message using Moffitt's patient portal and hope to get some clarification about exactly what all of this means.

jomako

Moffitt Cancer Center is just amazing. A nurse left a voicemail for me yesterday, then called at 7:30 a.m. today because she wanted to be sure I had an opportunity to ask any questions.

She was very thorough - she spoke to the radiologist who supervised the biopsy and they looked at all of the imaging and reports, then consulted with the pathologist as well. They don't know why there is a discrepancy between the removal of the microcalcifications shown on the imaging during the biopsy and the lack of numerous microcalcifications in the samples.

So the reason why they want another diagnostic mammogram in 6 months is to see what is going on. Originally, they had discussed having me back in 3 months, but the radiologist felt like waiting a little longer to give the breast more healing time would be best. Since we're dealing with microcalcifications that are challenging to get a clear view of with imaging, it makes sense to make sure there isn't any inflammation making obtaining the images any more difficult.

While I wish they had just given me the detailed information at the start, I can appreciate the fact that they probably just wanted me to focus on the fact that no malignancy was found. Their responsiveness to my questions and willingness to investigate and admit when they don't know or can't explain something reassures me that I am going to the right place. So I'll just have to let this little mystery go until November, when hopefully we are able to figure out what happened to these missing microcalcifications!

BarredOwl

Hi jomako:

Thanks for the update

You can try and forget about it for six months, or you may want to meet others on a six-month watch here:

https://community.breastcancer.org/forum/47/topics...

BarredOwl