Biopsy vs MRI

KeepCalm64

Hi I'm new here and thank you all!

I had a suspicious finding on mammogram and repeat mammogram both with 3D imaging. Follow up ultrasound showed nothing. Breast surgeon says that a biopsy would be very difficult because area is only visible on one angle of the mammogram; I would need a surgical biopsy. He's only mildly concerned because of the way it looks. He offered an MRI but said (I think I understood) that it will probably show up on MRI but that doesn't change the difficulty in doing the biopsy right now. He suggested waiting 6 mos and repeating the mammogram. I'm ok with that approach but a little nervous about waiting. I don't want an aggressive approach to a mildly suspicious lesion....should I opt for the MRI? I can call the office and ask for one and my insurance will pay.

MelissaDallas

MRIs are even more nonspecific than mammograms. Everything lights up so there are more false positives. If you are really concerned I guess they could maybe do an MRI guided biopsy-that would require an MRI and then an MRI guided biopsy later. It sounds like they are giving it a Birads 3, which is a less than 3% chance of being cancer. You might clarify that. I personally would probably do the follow up. Rarely would six months make much difference one way or another. Most cancers have been growing for years before they even show up on imaging.

KeepCalm64

Melissa you sound exactly like my MD. Thank you. I'm honestly not too worried just wanted to hear from others. He essentially said if it's cancer it won't go from curable to incurable in 6 mos. I think that was supposed to be reassuring. Waiting for copy of report. I thought birad 4 but not positive.

MelissaDallas

When you ask lots of questions you usually can get a more nuanced view of the situation from the doc. My last biopsy was for a "complex cyst vs inframammary lymph node."It had show up a couple of times before. I was frustrated with multiple procedures over a couple of years. I told her I would have been perfectly fine with just watching it for stability. She said she would have been too! I was already there so we went ahead and did it and of course it was just a cyst that collapsed when she stuck it.

BarredOwl

I don't understand why if the area of suspicion could be visualized by MRI (currently unknown), that wouldn't "change the difficulty in doing the biopsy." Is the area of suspicion located in an area that could not be accessed by MRI-guided biopsy, such that a surgical biopsy would still be your only option after an MRI? MRI-guided biopsy is a minimally-invasive procedure, and they should be able to correlate an area of suspicion detected on MRI to the current site of suspicion by mammogram.

BarredOwl

Anonymous

Hi KeepCalm. Sorry to cyber-meet you under these circumstances. I'm now 11 years cancer-free, which means that the options available to me were not the same as you have (I didn't have 3D imaging, BIRADS, BRCA testing, Her2 testing, etc.). What I did have was an ultrasound tech who stuck to her guns. My doc/radiologist used a portable ultrasound after the tech discovered a "finding." They didn't really tell me anything about what they were seeing, I gleaned all my information from listening to them talk back and forth. Doc said "But, see...it disappears when you move the ultrasound wand like this." Tech said "I'm not arguing that; I'm just saying there is something there on certain images." So, doc asked me to wait 2 months. I had NO problem waiting (I'm FAR from an alarmist) and practically ran from the office. I went back in two months, at which point I could feel a "thickening" of that area. Of course it did end up being a cancer.

I'm noting this experience because 6 months sounds like a long time for BIRADS 4. I don't know how your insurance works, but I wonder if they might split the difference and go 2 months. My doc thought I might have "something" because of where I was in my menstrual cycle (which is why she made me wait). I did have a core needle biopsy, done by this same team of 2 people (u/s tech and radiologist). Mine was also hard to find because I got a hematoma when they gave me the numbing shot, so "it" was hidden, and close to the chest wall.

One more item to mention. When I got an MRI--after confirming the biopsy but before surgery--they discovered a 2nd tumor behind the first. If I had opted for a lumpectomy, and if I hadn't had an MRI, that second tumor might not have been found. So MRI does help with imaging. I just wonder what they think the wait will do? Make it grow so they can see it better? Hmmm...I don't know. I feel like a 2nd opinion is in order. I hate to rush into over-diagnosing, but it just seems like a long time. I mean, I had 6 month visits for a long time even after a mastectomy. If BIRADS was lower I would definitely wait.

No matter what--best to you.

Capermom

I would get an Mri...they didn't see my lump on mamagram or ultrasound then we did mri and found it and also were able to get a Seco d look ultrasound correlate with it...still waiting for my dr apt on the 14th. I would not be comfortable waiting 6 months. Good luck