Anyone have an excisional biopsy without a needle biopsy?​

carmstr835

What type of Biopsy did you have? Did cancer reoccur at the biopsy or needle site after your lumpectomy. Anyone have an excisional biopsy without a needle biopsy?

I have had a mammogram on February 17th. On February 28th, they called me to do an ultrasound immediately, 7:00 AM the next morning. I had the ultrasound and physical exam done and was told by the radiologist and nurse, I have cancer. I needed a needle core biopsy immediately. I was to pick a surgeon. They called to make the appointment and the surgeon would schedule the biopsy, I am freaking out I don't know anything about breast surgeons so I asked the nurse to pick me a good one. My appointment was scheduled for March 14th. I got in March 7. The BiRad score I was given by the radiologist was BiRad 5. If they are so sure this is cancer, why not an excisional biopsy and take it all and then test it for type and treatment course? I am getting nowhere. Everyone I call or speak to wants a needle core biopsy. I read the research, any manipulation of a cancer tumor is a possible spread of the disease. Even the needle pokes for lidocaine-freezing your breast for the biopsy can result in needle tracks. That is the reason they remove the needle track for the biopsy.

After the biopsy, how soon is the surgery to remove the cancer for most people, is 3-6 weeks the norm ? I was told 3-6 weeks. Right now it is very small. 1.1 x 1.2 x 1.2 palpable and unmovable solid mass. I just want it out, before it gets a chance to enter my lymphatic system and my blood system and spread this cancer. I am thinking an excisional biopsy with general anesthetic would be the least disturbance, and hopefully they take a very wide margin. I have DD cup size breast, it sure seems possible to me, What does anyone else think? I have an appointment Monday morning with another surgeon at another hospital for an evaluation, however, I am scheduled for the biopsy with Cancer Treatment Centers of America in Chicago on Wednesday. They told me there is not a surgeon anywhere that would do an excisional biopsy without a needle core biopsy. They claim to have the fastest treatment time of any hospital. I can handle things right now, but as soon as that biopsy is done I know I will freak out thinking it is spreading, and they say it will be 3+ weeks to get ready for the surgery. I will be a basket case. I really want an excisional biopsy, but cant find a surgeon that will do it. Anyone have any suggestions? I will travel wherever, even outside the US if need be.

Icietla

Welcome to BCO. We are so sorry about your condition and concerns. You have come to a great place for information, understanding, and support. This is truly a Community of Brothers and Sisters, all personally affected with breast cancer concerns.

I had an excisional biopsy instead of needle biopsy. I first met with the Surgeon on a Wednesday, and I had the surgery two Fridays later -- nine days later. Of course I had all the same concerns, and of course I wished for wide clean margins. One margin was found to be diseased. I had mastectomy surgery two weeks after the excisional biopsy surgery.

A few months later, excess skin was removed in tidying-up surgery. No residual cancer was found.

You must realize that even with an excellent Surgeon's best efforts, there may be diseased tissue left behind in these surgeries. Some lumpectomy surgeries have to be repeated, sometimes done more than once more.

carmstr835

Thank you for your reply. It is good to know they still do excisional biopsies. The ultrasound guided needle core biopsy is all they do where I am. The excisional is used if the core biopsy was inconclusive. I sent you a private message.

doxie

I had an excisional biopsy because the tumor was immediately under the areola, next to the nipple, The radiologist had the needle biopsy equipment in his hand, then refused to do it and called the surgeon. Said it would be too painful as the areola is very sensitive. It took 2 - 3 weeks for surgery. After it was determined to be BC, there was a 2nd surgery for margins, removal of nipple and did the sentinal node dissection.

Icietla

You are very welcome. We hope you will get to have the biopsy type you want and that everything will go smoothly for you.

We all understand that this is a very anxious time for you. There will be what will seem very long times waiting for any procedures, Lab results, any medical appointments.

We are here for you.

(((Hugs)))

Italychick

I went straight to an excisional biopsy too. A birads 5 rating has a pretty high cancer rate, like 95% or something. My mammogram and ultrasound report said even if a needle biopsy was done it was still recommended to excise the entire area because a biopsy could miss the cancerous area.

I would try different surgeons and get the procedure you want done. I don't understand the doctors saying nobody will do an excisional biopsy since my surgeon didn't bat an eye when I said I wanted to do it and not a needle biopsy, and my insurance approved and paid.

candles1

I have had both situations: straight to excisional biopsy and docs insisting on core biopsy first. The two excisional biopsies I had were: (1) the calcs were in an area deemed difficult to access and (2) calcs reappeared in the exact same spot as a prior biopsy from the year before. Both ended up being benign by the way. I have had many core biopsies as well.

I have read about the tumor-seeding possibilities of core biopsies too. It's not very reassuring that the ultimate lumpectomy or mastectomy removes the cancerous "seeds" because that doesn't eradicate the possibility that a cell or two jumps into the bloodstream during the disruptive and inflammatory process of the biopsy. But, I imagine this is very rare and I don't think there's any literature on it.

On the flip side, consider what happens after multiple excisional biopsies for what are ultimately benign lesions. A lot of tissue gets removed and this can be disfiguring after enough of them. Unlike the mere possibility of tumor seeding from core biopsies, this is the certain result of too many excisional biopsies. I should know because this happened to me. When DCIS finally hit, I had very little choice but to go to mastectomy; a lot of breast tissue had been lost over the years and another lumpectomy would have left me basically flat anyway.

carmstr835

Thanks everyone for your replies!

Well, I went to the surgeon for a consult today and got talked into 2 needle core biopsies one for each breast. I scares the heck out of me because I believe they spread the cancer. I was there to have my radiology reports read and to try to talk the surgeon into an excisional biopsy. He refused to even discuss it. I am so scared. I believe the cancer is spreading every minute that it is there. They punched it 6 times for 1 lesion and 5 times for the other as well as several needle pokes with the lidocain in both breasts. I am in no pain now, just very very concerned that I made the wrong decision. It was growing fast and 2 radioloists now have identified the 1st tumor as cancerous. I think that is credible. Anyone else experience that growth speed? I am imagining what was 1.13 x 1.23 x 1.18 lesion is now a 1.4 they didn't give the rest of the dimensions. I am thinking the largest dimension is 1.23 and 1.4 is almost .2 x10 = 2.0 at this rate the tumor will be 2.4 cm by the time is gets removed....I had a mammogram last year, nothing there at all...

In the other breast, they found something they called a focal asymmetry. I was given an ultra sound of both breasts, the original (1st) lesion has grown .2 cm in 12 days. No idea about the other one, they didn't know it was there until this surgeon's radiology department found it. The radiologist was very worried and told me I need to do something right now, no waiting. I told her I would sleep on it, but then decided to just go thru with it. That is the quickest way to surgery. Surgery is scheduled for March 24th. 2 excisional biopsies and 2 sentinal node dissections one for each breast.

I hope I can stay sane until the 24th. I asked for a bilateral mastectomy, but he refuses. I am not looking forward to a liftime of sureries, I want it out all of it.

ElaineTherese

carmstr,

I understand your eagerness to have your lump removed ASAP. I think that's everyone's first reaction to hearing the word "cancer." But, the size of the lump and its growth are not necessarily signs that it is spreading.

No one has ever died from having a lump of cancer in the breast. The problem with BC is that if it is invasive, cancer cells may enter the bloodstream and/or lymph system. Those cancer cells can circulate and find a new home -- in the bones, in the liver, in the lungs, and even in the brain. So, even if you have your lump removed tomorrow, there's no guarantee that you will be "cured." I'm not writing this to scare you; I just want to point out that surgery is often only one part of a BC patient's treatment plan.

Do you know whether estrogen fed the growth of your cancer (is it ER+)? Do you know whether your cancer tested positive for the overexpression of the HER2+ protein (is it HER2+)? Or, is it triple negative (ER-/PR-/HER2-)? With both HER2+ cancer and triple negative cancer, chemo is often recommended before surgery. As a triple positive patient, I had five months of chemo before I had my surgery, and was consequently able to get Pejreta, the newest targeted therapy for HER2+ cancer. So, in some cases, surgery first isn't necessarily the best treatment plan.

Best wishes!

carmstr835

I completely understand the fact it may be already spreading through my lymphatic system and my blood. I was hoping to have this removed through an excisional biopsy without disturbing the tumor but not possible. At least not now. I had the core needle biopsies done Monday. I won't have the results from the biopsies until Thursday or Friday. All I know is they have no doubt it is cancer, and it is growing fast. They will do an excisional biopsy on Friday March 24th.

ElaineTherese

Hoping the best for you! Hoping you don't need chemo and all. But don't forget that chemo and hormonal therapy are systemic treatment and that surgery and radiation are localized treatment. If your cancer is invasive, it needs a blood supply to grow and thrive. Chemo and hormonal therapy can thwart the spread of cancer through the bloodstream. You may discover that the risks of chemo outweigh the benefits, but many times, that assumes that you're willing to do hormonal therapy. Best wishes!

carmstr835

Thanks Elaine.

carmstr835

Updates, I had the biopsies both breasts. Not real impressed with the surgeon not giving me options. Surgery scheduled for Friday. Bilateral radical mastectomy, no reconstruction at this time. I am concerned a bit about the reconstruction 12 months later, If I go through with this surgery on Friday, I doubt I will ever do the reconstruction. I can't put my family out for elective surgery and that is what it would be.

Thanks for all our replies, I wanted to go to a surgeon that could do it myway, but I have since been diagnosed , with cancer in both breasts now, as well as the tumor in my right breast is growing fast, I cant wait for 4-6 weeks to start it all over again.

MTwoman

carmstr835, I am so sorry you didn't get the options you wanted and don't feel a good connection with your surgeon. How can we help?

Sending you healing light and ((hugs))

Icietla

carmstr835, I am so sorry about your diagnosis and that you are not able to get reconstruction coincident with your next surgery. Your mastectomy surgery will probably be the modified radical type, not as extensive as the old-fashioned radical type, which is done only rarely these days.

We have a great support group of "flat" (without reconstruction) members right here on BCO. Some participants are flat by choice; some are flat because of health conditions not permitting reconstruction; and some are temporarily flat while they wait to have reconstruction arranged.

https://community.breastcancer.org/forum/82

You can use this form linked here to request free lymphedema alert bands.

http://lymphedema.com/alertform.htm

carmstr835

You were right Icietla,

It was simple mastectomies, one was modified radical. I did not go through with this surgeon. I canceled and had it the next week at a different institution I needed to trust my surgeon, and my new one I do. He is wonderful, I still didn't get reconstruction immediately and I am OK with that for now. I cant seem to find the right place to go for prosthetic breasts however, so I am just flat now and my clothes don't fit at all. I was DD. That is a small price to pay to keep my life. I can deal with it for now.

Icietla

Hi carmstr835. I am glad you got through it all okay and found a Surgeon with whom you are comfortable.

While you are waiting for Reconstruction you can do a lot of reading in our Reconstruction section to learn about the Reconstruction types available.

In the Living Without Reconstruction After Mastectomy section you can find lots of good leads on prostheses, including free ones from the Knitted Knockers organization.

Please also look around in the Lymphedema section. This is not to scare you! -- only to inform you! You are at life-long risk for lymphedema in either or both of your arms, but your arm at the side having had all those axillary lymph nodes removed is at especial risk for lymphedema. Please learn about precautions you can take to minimize the chance of its development, learn what the possible warning signs are for the start of lymphedema, etc.

The clothes -- I think it depends on the clothes. Speaking generally, each person's style, likes, and dislikes are their own. Will you start a new discussion thread in the Living Without Reconstruction section, and tell us (or show and tell us) generally about your usual style/s of dress? We will try to help.

carmstr835

Thanks Icietla for the suggestions on lymphodema. I will get back to the prosthetic stuff eventually, Maybe Tuesday, if I feel up to keeping that appointment. I started my chemo Wednesday and that will be the 7th day. I might not be feeling well, But I will try. I am so thankful for this forum and all the help from everyone that really understands us.