Confusing results

Gapeachy

so pathology reports comes back as negative for malignancy which is Awesome! However doctor who did biopsy recommends another mammogram/ultrasound in 3 months and says that after reviewing all mammograms and ultrasounds he cannot rule out malignancy. Huh? What does that even mean? I thought you either tested positive or negative. I'm so confused.

DorothyB

Maybe he is concerned that there is more than what was included in the biopsy?

Gapeachy

I suppose that could be a possibility. I think I was so focused on the pathology report I didn't even think of what the doctor might say.

gb2115

Maybe he's looking at another area that wasn't biopsied??

HopeWins

did you have an excisional biopsy or a needle/stereotactic biopsy? Sample size is small with a needle biopsy, so he might want to keep a watchful eye to see if anything changes in that area that would indicate more than what the pathology report showed.

Not trying to alarm you, but I think I read that 20% of pathology results change from the needle to the excisional biopsy/mastectomy. It happened to me. I was told I had ADH (not cancer) but that they wanted to do an excisional biopsy of the area. Pathology came back as DCIS (stage 0 bc)

Beesie

HopeWins, it is true that approximately 20% of needle biopsies that find a high risk condition, such as ADH, will end up with cancer being found once a larger surgical biopsy is done.


Since Gapeachy is not being called back for an excisional/surgical biopsy, but just for a mammogram and ultrasound in 3 months, my guess is that her results were totally benign, with nothing like ADH found. This is quite different. Most stereotactic/core needle biopsies are accurate - something like 98%, I think.

Gapeachy, a short term follow-up is normal after a needle biopsy. The biopsy only sampled a portion of the suspicious breast tissue, so the follow-up is just a double-check to ensure that there are no changes afterwards that might suggest that something was missed. This is always done, or should be.

Gapeachy

thank you for your responses! I'm trying to stay positive and see this as the doctors your being extra vigilant which I do appreciate.

djmammo

Gapeachy

Can you post the report of the biopsy procedure? It should have an addendum that was dictated after the path report came back, with the recommendation for followup, and the reasoning behind that recommendation. Look for the words "concordant" and/or "discordant" and also a description of the location of the marker placed after the biopsy.

With a biopsy result deemed concordant, it is routine to get imaging (usually at 6 months) to look for complications of the biopsy and to establish a new baseline when the immediate post-biopsy changes have fully resolved. When discordant, re-biopsy or surgical excision is usually recommended. Having follow up at 3 months with the comment "he cannot rule out malignancy" makes me curious.

=======

There is a spectrum of abnormal histology seen on core biopsy from normal cells to cancer cells in this order:

Normal cells---->ADH (the atypias)-------->DCIS----->invasive ductal ca. (Calcifications can accompany any step in this spectrum that can be similar in appearance)

When a cancer is examined in pathology it is often accompanied by the items to the left on this timeline in the surrounding tissue. If ADH is found in the core(s), it cannot tell us where we are along this spectrum and that is why there is always an excisional biopsy to follow.

If ADH is the most abnormal thing seen in the surgical specimen then that's the final diagnosis. Sometimes there are cancer cells found in the specimen which would cause an "upgrade" in the diagnosis, but since they are not forming a mass, it remains invisible on imaging making a pre-biopsy diagnosis of cancer impossible.

Gapeachy

hi there, here is What was listed in the addendum.

Details

ADDENDUM:

PROCEDURE(S): BI US GUIDED BREAST BIOPSY LEFT, 9/26/2019 3:02 PM

CLINICAL HISTORY: 40-year-old female with left retroareolar mass underwent ultrasound guided core biopsy on 9/26/2019.

Surgical pathology has been made available for review:

FINAL DIAGNOSIS: The final diagnosis by pathology report is usual ductal hyperplasia without atypia. Negative for malignancy. Dr. McCormick the interpreting cytopathologist.

RECOMMENDATIONS:

Recommend 3 month mammographic follow-up.

ACR BIRADS: 3 - Probably Benign

Addended on 10/2/2019 9:44 AM

April0315

My story is similar to HopeWIns, needle biopsies, steretotactic biopsies are such a small area and they can miss the target. repeating in 3 months sounds prudent. Hope everything keeps turning up benign!

HopeWins

Beesie - 98% of stereotactic biopsies are accurate?! That's what I had. Just another reason to be bitter about that experience.

I'm so sick of being a medical 2%er! If only this worked with my lottery tickets-lol!