My radiologist is questioning my pathology report

Lboquist

Hi,

I had a vacuum assisted core biopsy about 3 weeks ago, 10 samples were taken and tested. The pathology was reviewed by two pathologists and came back benign. I was so relieved and haven't thought much about it since I got the good news from my doctor. Today her nurse called and said that the radiologist is questioning the pathology report and thinks I should have an excisional biopsy. She said it is totally up to me if I want to do that and my doctor would give me a referral. What the heck?? I read the pathology report and googled all the terms I didn't understand. There isn't anything in the report that indicates cancer or pre cancer cells - no micro calcification, no atypical hyperplasia, etc. Everything seems normal and benign. The nurse wouldn't elaborate on the radiologists opinion... so I am confused about what to do. Also, it is curious that the nurse called and not my doctor. She called when my mammogram came back as suspicious and with the pathology results, etc. The nurse usually only calls for things that aren't urgent. Any opinions?

Thanks so much!

Lisa

Ingerp

Did a breast surgeon do the biopsy? If you are working with one you trust, I might go back and ask him/her to review the path report. A quick sit-down with a BS might be really beneficial.

MelissaDallas

I think what they are thinking is the benign result is discordant with the imaging. They would be really happy to be proven wrong, but they strongly believed there is more going on than what the biopsy pathology showed. I would be inclined to have the excisional biopsy. If not I would insist on short term follow ups of three months or six months for a while to prove stability.

Recap

They usually do imaging following a core biopsy. Maybe the radiologist is not satisfied with the post-biopsy imaging, even though the samples were benign? Another possibility is that they did further lab tests on your samples. There are a zillion lab tests that can be done, some yield instant results, and some take longer. There are also many different types of lab equipment that not every lab may have, and possibly your samples were routinely sent on to a bigger lab. Excisional biopsy vs wait and worry-I would want the biopsy. Discuss with the surgeon your feelings about wide margins of safety vs cutting it close.

Maybe Dr Mammo can explain something I have wondered about-our masses are not the exact same shape as a pencil, but the core needle is like a hollow inflexible pencil. Does the vacuum/core needle only collect linear samples, or does it suck in tissue from beyond/around the pathway? Is there variable suction strengths based on an individual person's tissue? Is the tissue condensed/compressed as it is vacuumed in and thus is a larger sample than we realize?)

Georgia1

Hi Lisa. That is a little confusing, isn't it? Hard to give advice without seeing your mammography and pathology reports, but I agree with others on getting either a second opinion or, if it is possible given your schedule and finances, an excisional biopsy just for peace of mind. Another way to go would be to schedule a conversation with the radiologist to review the images and understand what his/her concern really is. Maybe there are multiple masses?

Sorry not to be more help.

klvans

When I was called in for my suspicious mammogram the radiologist looked at the sonogram. She told me I would need a biopsy and that it looked like cancer. She didn't mince words. She said that if the biopsy came back benign based on what she saw on the image she wouldn't believe it and would want me to have a more thorough excisional biopsy. I also talked with my ob gyn before the biopsy results came back. She told me that radiologists are so experienced with imaging that they are usually right about what they see. It was hard to have my radiologist be so frank but in the end I was grateful for her candor. I would do as your radiologist suggests and have further testing right away. There is no down side to it. It will rule out cancer or get you on to treatment if that's what's needed. Early treatment makes such a difference. I hope you don't need it but if you do it can give you a much better outcome. Don't let your fear stand in the way of obtaining the knowledge you need to ensure your health.

Egads007

I’m with the crowd here, I’d get it done. I’m so sorry you had your happy first results dashed, it has to be just awful for you! Never lose the hope, this may turn out to be just fine...get that second opinion to err on the side of caution and give you some answers. Keep us posted, we’re here for you!

Rondeezee

Hi Lisa,

So sorry to hear that your wait continues. What a shocker it must have been to hear that the Radiologist did not agree with the benign pathology. In your quest to get the true story of what’s going on with your lump, you may want to consider the excisional biopsy. You’ll know for sure and if it is malignant, you can get it treated in its earliest stages. Hopeful for b9 results and I will keep you in prayer. I go in for my biopsy on Thursday of next werk

Aliceinchains

I am literally going through the same thing. The radiologists and my new breast surgeon all say that images (mammogram and ultrasound) point to cancer yet the biopsies taken (2 in the right breast and 4 in the left) show nothing. Before I can move on to the next step I’ll have an MRI done. I’m anxious to get some answers. It’s not even a disease that mimics cancer or that would’ve been brought up up-front. These doctors are amazing and never give up. Let’s do the same. I’m here for ylu

Georgia1

AliceInChains makes a good point about requesting an MRI.

Lboquist

Thank you everyone. I spoke with my doctor, who is always very cautious and she also was confused by the radiologists recomendation after reviewing all the information . The pathology showed nothing suspicious at all and the tests, which took over 5 days, seemed really thorough and were reviewed by two doctors . We are sending the tests and imaging to a breast cancer center to get a second opinion and will go from there. I have a follow up mammogram at that center scheduled for 6 months. We are in a really rural area so our hospital isn't always the best so we agreed that this was a good decision. We will wait and see what the second opinion is.

chronicpain

It is shameless that they delegated a nurse to bring you the bad news. This is something a doctor should have done herself,, even if later in the evening, if she was too busy with patients in the day,

Georgia1

Lboquist, that sounds like a great plan. Traveling for care is a pain, but an accredited, comprehensive breast cancer center would likely have more experienced radiologists. Hope you are breathing easier.

dtad

Lboquist...So sorry for the confusion but IMO you should get a second opimion at a major university teaching hospital. Also did you see a breast surgeon rather than a general surgeon. Rural areas tend not to have the most state of the art equipment or the best trained docs. When I had my biopsy my radiologist oncologist told me if it came back negative she would send me to a breast surgeon to have it removed. Of course that doesn't mean its malignant. It means it should have an exact diagnosis, not just benign. I also would request a breast MRI before you have any type of treatment or surgery. Good luck. Try to remember most breast lumps are benign. They have to prove you have breast cancer before you do! Keep us posted. We are all here for you.

Aliceinchains

Very well said dtad

NotVeryBrave

The radiologist who did my biopsies wrote on the report that a benign pathology would be considered "discordant" for both the breast lump and the enlarged lymph node. The lump came back positive, the node - negative.

It haunts me sometimes and makes me wonder about staging and treatments. In my case, it wasn't going to change the initial plan of TCHP chemo. And the chemo had removed all of the cancer by the time of surgery. Still - I really wish that "discordant" word hadn't been used.

Second opinions should be standard in my opinion. Even if they don't change the diagnosis or plan of care - the piece of mind can be priceless.

Lboquist

My doctor and I finally came to the conclusion that I would get another mammogram and the breast center in a neighboring big city, and obtain the second opinion. I won't be able to get in for about a month so I'm in for a little more wait and see. A good thing is that I am learning a lot about breast cancer and the different types - and some really big words! Lol!!! I so appreciate all your comments and support!

Here is my pathology report, which might explain why this is all so strange - it seems to say that there was nothing suspicious:

FINAL PATHOLOGIC DIAGNOSIS: Right breast, 2 o'clock, core biopsy: - Breast parenchyma with intraductal papillomas and fibrocystic changes including usual ductal hyperplasia, cyst formation, fibrosis and apocrine metaplasia. - No microcalcifications identified. - No atypical hyperplasia, in situ or invasive carcinoma identified (see comment). COMMENT: A smooth muscle myosin heavy chain stain is performed on a section of the right breast biopsy at 2 o'clock, and it is positive in myoepithelial cells surrounding the irregular-appearing ducts, which is against the presence of invasive carcinoma and consistent with the above diagnosis. As part of Incyte Diagnostics' Quality Improvement Program, this case was reviewed by another member of our pathology staff. NRT:KPS:cml:C2NR MICROSCOPIC EXAMINATION: Histologic sections of all submitted blocks are examined by light microscopy. These findings, together with the gross examination, support the pathologic diagnosis. Immunohistochemistry: An immunohistochemical stain for smooth muscle myosin heavy chain is performed on a section of the right breast biopsy at 2 o'clock, with an appropriately positive control, to evaluate for the presence of invasive carcinoma. Irregular-appearing ducts are surrounded by smooth muscle myosin heavy chain- immunopositive myoepithelial cells, which is against the presence of invasive carcinoma. GROSS DESCRIPTION: Received in a formalin-filled container labeled with the patient's name, date of birth and additionally labeled "right breast" are multiple irregularly shaped fragments of pale yellow soft tissue measuring 2.6 x 1.0 x 0.4 cm in aggregate. The specimen is entirely submitted between sponges in 2 cassettes (A1, A2). na:NRT:cml ADDITIONAL NOTES: Immunohistochemical and/or in situ hybridization studies were performed on this case with the appropriate positive controls that react as expected. This test was developed and its performance characteristics determined by Incyte Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. This test is used for clinical purposes. It should not be regarded as investigational or for research. Incyte Diagnostics is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) as qualified to perform high complexity clinical laboratory testing. Diagnostician: Nicole R Turner MD Pathologist Electronically Signed 03/01/2018

Lab and Collection

Surgical Pathology Exam on 2/23/2018

Narrative

SPECIMEN(S): A RIGHT BREAST AT 2 O'CLOCK SPECIMEN SOURCE: A. RIGHT BREAST AT 2 O'CLOCK CLINICAL HISTORY: No preop or clinical information is given on requisition. FINAL PATHOLOGIC DIAGNOSIS: Right breast, 2 o'clock, core biopsy: - Breast parenchyma with intraductal papillomas and fibrocystic changes including usual ductal hyperplasia, cyst formation, fibrosis and apocrine metaplasia. - No microcalcifications identified. - No atypical hyperplasia, in situ or invasive carcinoma identified (see comment). COMMENT: A smooth muscle myosin heavy chain stain is performed on a section of the right breast biopsy at 2 o'clock, and it is positive in myoepithelial cells surrounding the irregular-appearing ducts, which is against the presence of invasive carcinoma and consistent with the above diagnosis. As part of Incyte Diagnostics' Quality Improvement Program, this case was reviewed by another member of our pathology staff.