Excisional biopsy

Fortysomething

So, I've been lurking this website since my first mammogram, thought I could get some input. I'm 41, fought my first mammo because theres no history and I have implants and didn't feel like having my small circle of people who know to widen. Did it anyways, first mammo on 5/9, called back 5/11 and also had an ultrasound done by tech and radiologist. Recommended wire localization with excisional, he's on vacation this week, so I go Monday, June 5. My oldest graduates the day before. I've talked my husband to death, he's always on the "it's nothing", and it very well might be, but when it's you, every thought imaginable comes in. (Like I'm telling anyone something new!) I'm a Birads 4 this is my description

Focal asymmetry containing several fine pleomorphic calcifications in the outer left breast at mid depth. Questionable but not definitive distortion associated with this abnormality.

pupmom

Why would anybody know about your mammogram or implants unless you told them? Medical information is secure and confidential, so why risk your life to keep something hidden that will never be revealed??

That said, your husband is correct. It is, in all probability, nothing. But if it is "something" you will have found out early, a good thing.

Best wishes!

Fortysomething

Thanks! We have a lot of friends at the facility I am going to, that's was the dreaded part. Some people think implants are for attention, mine was to feel normal 😀

runor

I am struggling with whether or not to reply (gee, can you guess which way that struggle ended?)

I was also a 'most likely nothing' that turned out to be something, and here I am, still reeling from it all and it's been months already.

Statistically speaking though, the odds are in your favour. The vast majority of suspicious mammograms that are followed by biopsy turn out to be nothing, or at least not cancer. Breasts do have other issues (I have several cysts, they are many years old and never change) so not everything that they might find will be bad news.

In my case even though a core needle biopsy was suggested, it is known that needle biopsies (again, in the case of radial scars) give sketchy results. I chose to skip the needle biopsy and went straight to surgical biopsy. Yes, I had the whole wire guide thing. (ewww!) In my case I had the wire in my boob done in one hospital at 8 in the morning, walked out with an antennae of wire sticking out under my armpit (asked Hub if he could get wifi on his cell by using my boob to pick up signals) climbed in the truck and Hub drove me to another hospital, an hour away, where I sat in the waiting room for 5 more hours waiting for the surgical biopsy. I was NOT a happy camper!

However, I survived and I am the worlds biggest wuss ! Going into it I was worried sick. Frantic! Freaking right out! I am needle phobic and it's probably good that my boob was trapped in the mamm machine or I would have run out of the hospital, screaming and topless! I was also mortified to realize that under compression my boob is the size of a manhole cover! I just closed my eyes and thought, I've had a baby and my wisdom teeth pulled, it can't be worse than that. And it wasn't. The wisdom teeth were WAY worse! By far.

I hope that you can make one more post saying it was nothing at all and then get on with life and put this behind you. You have more strength in you than you realize. We all do. Many women have walked the same path. I hope it's nothing, as your Hub says. Let us know how it goes.

Fortysomething

I literally lol'ed after reading this! Thanks for the encouragement, time has drug on and I find myself going from it's nothing to making out a will in the same hour. I will post again, hopefully with a spectacular b9. 😊

mustlovepoodles

Well, Forty, if you don't have a will already there's no time like the present, LOL. We all need one. Thankfully, BIRADs4 is still 80% benign, so I think there is great hope that this is not cancer.

While you're waiting try to keep your hands busy. I find that when my hands are busy, my mind is quiet. If I sit too long in one place I tend to preserverate on my worries which makes me more and more anxious.

MelissaDallas

Rarely do core biopsies give "sketchy" results. It is preferable to do the least invasive biopsy possible to accomplish the purpose. There are risks to any invasive surgery, plus it creates scarring in your breast that can obscure masses on future imaging. Very few doctors will agree to just do a surgical biopsy without doing a less invasive one first. If the needle biopsy is negative there is no reason to do surgery unless the results are discordant, which is a small percentage of them.

Fortysomething

Well, I survived the biopsy! I am feeling super bruised at my rib cage, probably normal?? Now the waiting part.... How long until your results come in? I keep thinking no news is good news. I had this done Monday afternoon.

MTwoman

Fortysomething, try ice (if they didn't give you cute little round ice packs at the hospital). Every pathology department is different in how long it takes, depending on work load, vacation schedules etc. One of mine had results in only a couple of days, one was a week+. Waiting is awful! Good luck for B9 results.

Fortysomething

Still no news.... I hate that I've been in a funk since May 9th. I called the doctor's office today and the surgeon (I went to a general surgeon for excisional) is gone until next week, but the nurse told me she would call me as soon as the results were in. I really thought I would know something by now. Is no news good news? I'm starting to wonder. Thanks for letting me vent, it does help😘

MTwoman

No news means they're not finished with your sample. It has only been 3 business days, so that is actually not very long. Try to hang in there a bit longer, glad the nurse will pass on the info without waiting for the doc. Good luck for b9 results!

Fortysomething

DCIS high grade with apocrine features.. So now what? Doctor is gone until next week, is this cancer or not?

MTwoman

Fortysomething, So very sorry you've joined our club.

It is stage 0 bc. I don't have specifics on apocrine, but per Stanford's website " No known significance for apocrine DCIS beyond that for usual DCIS" read further here.

http://surgpathcriteria.stanford.edu/breast/dcis/apocrinedcis.html

DCIS is catching bc as early as possible. The treatments are typically based on personal risk profile (your age, family history and potential genetic risk) coupled with your DCIS characteristics (hormone receptor status) and size of tumor (increased genetic risk, large tumor and small breast size or multi-focal dcis may increase likelihood of mx recommendation vs lx). Chemo is not a NCCN recommended intervention for pure DCIS, as the side effects far outweigh the risk, nor is targeted therapy (like Herceptin, that is used for HER2+ bc). Typically, surgery is performed to remove the dcis cells (either lx or mx). If lx is chosen, radiation is typically performed, although there is a test that can be done on your specific cells to see if the risks of rads outweigh the risk of recurrence (which can be used to support a decision of no rads, if that is your preference). Then, if your dcis is ER+/PR+, an MO (medical oncologist) will discuss the option of Tamoxifen or an AI (aromatase inhibitor - if you're post-menopausal). There is a forum for DCIS here: https://community.breastcancer.org/forum/68

One of the women on these boards, Beesie, has a pretty extensive thread called "A Layperson's guide to DCIS" that can be very helpful in understanding what's going on.

((hugs))

Fortysomething

one more question. I don't see my surgeon until next Thursday (a week) and I am trying to figure out this terminology. It states the DCIS abuts surgical inked margins. Does this mean I don't have clean margins?

MinusTwo

Forty - I don't know for sure, but all you've had so far is a biopsy so 'clean margins' are probably not up for discussion yet. Don't try to borrow trouble. And stay off google. Just list all your questions for the doc & then put it away for a week. Binge watch TV, read a good book, take a walk, whatever you can to do keep your mind busy.

MTwoman

I agree with MinusTwo, margins are not really important unless you've had an excisional biopsy, lx or mx (procedures meant to remove the entire mass/lump, NOT biopsies intended to sample masses/lumps)

Jima_

Hi,

I also had the surgeon dr recommending the excisional biopsy.
The mammogram identified a cluster of microcalcifications with pleomorphic appearance, underlying malignancy (ACR BI-RADS category 4/ suspicious abnormality).

The dr surgeon, recommends an excisional biopsy - wire-localization of the microcalcifications cluster under mamogram, followed by excision surgery, removal of complete cluster, check on radiography that all has been removed, and then close.

What is usual procedure for the biopsy in case of clustered pleomorphic microcalcifications? is a full removal biopsy? or are there some who recommend a needle biopsy first?

I am not sure remember all the dr said, why she recommends the excision/full removal of cluster. I guess we get a little touched by the news

thank you in advance,

MTwoman

jima, I'm a little confused by your statement "underlying malignancy" but you haven't had a biopsy yet? And with a BIRADS 4 (with no qualifying letter like a, b, c) there is a 66-77% chance that it isn't a malignancy. If they were more certain, you'd have been a BIRADS 5. Someone else may be able to give you more details about why your doc is recommending excisional vs core biopsy, but I believe that when there isn't a lump or mass, that the area of concern can better be marked by the wires and then removed. Otherwise, the core needle could miss the cells they want to sample while they are sampling. So this seems like a reasonable approach. But I would confirm this with your surgeon and make sure you understand your choices. Good luck!

Jima_

Dear MTwoman,

thank you so much for your fast reply
I checked the report: "A cluster of microcalcifications in the right upper outer quadrant shows pleomorphic appearance, an underlying malignancy has to be considered."
I have to schedule the surgery, so I will confirm with the dr her recommendation.Thank you.
And the very best to you as well.

MTwoman

ah, okay, "has to be considered" makes sense. thanks and good luck!

Jima_

Hi,

anyone else with experience on usual biopsy for clustered pleomorphic microcalcifications?
Is an excisional biopsy directly recommended?

I would highly appreciate. New in the country where I am now living. And not sure, what drives this recommendation received from the dr.

Thank you, Jima

MTwoman

Jima, here is a link to information from the Mayo Clinic about pleomorphic microcalcs.

http://www.mayoclinic.org/symptoms/breast-calcifications/basics/definition/SYM-20050834

They are not always a sign of malignancy, but they can be. That is why you are being recommended to have the area biopsied.

Jima_

Thank you MTwoman. for the link.

I had the second, zoom in/ close up mamo, based on which have been referred to the breast surgeon (bs), with clustered pleomorphic micro-califications. The bs advised for excision biopsy (full removal of the clustered pleomorphic microcalcifications). What I am trying to understand if is normal to have excision biopsy (full removal at biopsy), so was looking for others with experience in this

thank you so much, highly appreciate your kindness & support,
JIma

MTwoman

Hopefully, they'll chime in. From what I understand, it's hard to biopsy a lump if there isn't a lump. If you sample the area (with needle or core biopsy), you could miss malignant cells (if they are present) and then give a false negative report. So the area comes out and is then sent to pathology where they can be certain not identify whatever types of cells they find. Good luck!

Jima_

Thank you m dear MTwoman!