How trustworthy are (discordant) biopsy results?

LMoon

I had a stereotactic biopsy for multiple areas of concern in my left breast (BIRADS 4C and a BIRADS 4B)

The results came back as discordant. I was told the entire breast center was going to have a conference and bring up my case, because they did not believe that my masses are actually benign despite the biopsy saying they are. 2 days later I got a call telling me that they are going to accept the biopsy results, and they do not believe it is cancer (perhaps atypia, but they didn't give me a concrete answer on that) but I need to come back every 6 months.

So... I still don't feel great about this. I had no idea that pathology is actually subjective, and when I spoke to the doctors about my discordant results they seemed very insistent that the biopsy results were incorrect and they just got a bad sample. I'm looking through the reports now and I just don't feel good about this.

Thoughts?

MelissaDallas

I'd take my imaging and pathology to a different facility, ideally a university medical center for a second opinion. What do your path reports say

LMoon

Yeah I think I'm going to do that. I went to a university for all of this testing, but I've read/heard that it's not the best place for breast care. It doesn't make me feel good that one day they were so not convinced of the benign biopsy results, and then 2 days later after their meeting they're like "oh yeah, it's benign, no worries" and I said "it's not even atypia?" and they said "well we do not believe it is malignant" which wasn't even a straight answer. The entire interaction and situation hasn't left me feeling confident at all.

This is my path report:

TECHNIQUE:
Mammography Stereotactic Core Biopsy Left

PROCEDURE:
Site 1 (upper inner posterior fine calcifications): The patient was placed
prone on the biopsy table. The grouping of fine calcifications within the
upper inner breast posteriorly was localized and targeted under
stereotactic guidance via a superior approach. The skin of the breast was
cleansed and prepped. 1 mL of 1% lidocaine and 10 mL of 1% lidocaine with
epinephrine was used for local anesthesia. A 9 gauge needle with a vacuum
assisted biopsy device was advanced into the breast and 9 core specimens
were obtained. Specimen radiography demonstrated the targeted
calcifications. A venus marker clip was then deployed at the biopsy site.

Site 2 (upper inner coarse calcifications): The patient was remained prone
on the biopsy table.The grouping of coarse calcifications within the upper
inner breast was localized and targeted under stereotactic guidance via a
superior approach. The skin of the breast was cleansed and prepped. 1 mL
of 1% lidocaine and 10 mL of 1% lidocaine with epinephrine was used for
local anesthesia. A 9 gauge needle with a vacuum assisted biopsy device
was advanced into the breast and 6 core specimens were obtained. Specimen
radiography did not show the targeted calcifications. The site was
retargeted and 3 additional core specimens were obtained. Specimen
radiography demonstrated the targeted calcifications. An X marker clip was
then deployed at the biopsy site.

The patient tolerated the procedure well with no immediate complications.

Post-procedural digital mammographic views of the left breast demonstrate
the venus and X clips at appropriate position.

PATHOLOGY:
Final Diagnosis
A. Left breast, upper inner quadrant, posterior, with calcifications,
stereotactic core needle biopsy
(BI-RADS 4C):
· Breast tissue with fragments of fibroadenoma, secretory change, and
usual ductal hyperplasia.
· Microcalcifications are associated with benign breast tissue and are
present within the epithelium of the
fibroadenoma.
B. Left breast, upper inner quadrant, posterior, without calcifications,
stereotactic core needle biopsy
(BI-RADS 4C):
· Fragments of fibroadipose tissue.
C. Left breast, upper inner quadrant, with calcifications, stereotactic
core needle biopsy (BI-RADS 4B):
· Breast tissue with fibroadenomatous change, usual ductal hyperplasia,
secretory change, and dilated
ducts.
· Microcalcifications are associated with benign breast tissue.
D. Left breast, upper inner quadrant, without calcifications, stereotactic
core needle biopsy (BI-RADS
4B):
· Breast tissue with fibroadenomatous change, usual ductal hyperplasia,
and microcysts.