New masses

Topsy3

Hi all. I keep reading on here that all new masses are biopsied. I had two new masses on my dx mammo and u/s recently, but my previous studies were from 2012. The radiologist gave me a birads 3, saying one of them "may" represent a fibroadenoma, and the other one "likely" represents a fibroadenoma. Now my ob/gyn has called and said she's referring me to a breast cancer specialist. I was just planning on waiting the 6 months, but now I'm a bit confused. Anyways, I wonder if the 7 year interval has anything to do with the birads 3 on new masses, like my recent testa are treated as baseline since its been so long or something. Btw, I'm 47 and postmenopausal. Djmammo was kind enough to comment on my results, but that was before my Dr. referred me, and now that I've been reading more info on this board (not Google, never google).

Long story short, do all new masses really get biopsied or only masses with specific characteristics?

djmammo

Charlian

Every rule in medicine has exceptions, and no rules have more exceptions than those in breast imaging.

If we see a case with fibroadenomas stable over a seven year period, and two more identical masses appear with all the characteristics of a benign FA then we would be more likely to recommend a 6 mo f/u.

It would actually be reassuring to see an example of a stable FA right next to the new one in the same breast. If there were any significant differences between old and new masses (other than the usually findings seen in an aging FA) I am sure they would want to biopsy them.

Topsy3

I get what you're saying, but I think my wording made the situation unclear. I've never had any findings on mammo or us. No calcs, no blips, no nothing. They've always been completely normal with the exception of having dense breasts. That's partly why I went seven years without getting one...well, that and insurance.

So let me rephrase the question. If two masses showed up in breasts that has always been clear, does that warrant a biopsy, or do the masses have to have specific characteristics?

djmammo

Charlian

I see.

FAs have a number of characteristics that give many of them a classic appearance. If they have that classic appearance and there is more than one, and they look alike, it significantly increases the likelihood they are in fact benign FA's and significantly lowers the odds of them being cancer.

The more there are in the breast that look benign and alike the more likely they are all benign. In fact it is taught that if there are two or more masses in one breast plus three or more in the other, they are all considered benign and no further workup is recommended.

If I am convinced something is an FA I give the pt the choice between bx and follow up. Some people choose one, some choose the other option. If it doesn't meet all the criteria comfortably, I biopsy them.

Topsy3

Thanks for your reply. Since my obgyn is sending me to a breast specialist, I guess I will take a copy of my studies and let her look and decide. If bx was offered, I would definitely take it just so I can stop obsessing over this.

I think they should come up with something better than "probably benign"...that just freaks people out. "Probably" just doesn't seem good enough when it comes to cancer.