Lumpectomy for something that isn't breast cancer?

JaneQPoppy

I didn't know where to post this. Hoped it would get informed views here in the Surgery Forum. Mods, please move if it doesn't belong here.

A friend of mine, Mary Lou (not her name), had a "suspicious" mammogram and then a biopsy. She's my age-- 70-ish. She said that the surgeon did say it was NOT cancer, but that she has dense breasts and that it's "pre-cancerous." She did not use the name DCIS- but she is new to this and doesn't know the alphabet-soup terminology. Who sent her to the surgeon? Not sure-- GP by way of radiologist maybe? She has had a biopsy (as I said) and now she's scheduled for a face-down MRI so the surgeon can get a clear picture of exactly where it is "because it's so small." She's scheduled for a lumpectomy on Nov 22.

Is this a thing now? Lumpectomy for something that isn't cancer? Some of the thinking these days (AIUI*) is that even DCIS may not warrant surgery. Biopsy AND MRI? Does the MRI take the place of the excruciating "wire localization"? Can someone shed some light on this? Sorry I don't have more detail. I don't want to alarm Mary Lou with my uninformed questions or meddle if this is standard procedure that I just didn't know about-- she's in the dark at the moment and has no reason to question anyone. Mary Lou's mother did have breast cancer decades ago. She's gone now, but not from cancer.

[*As I Understand It]

Beesie

An excisional biopsy, which is a surgical procedure similar to a lumpectomy, is often done on benign lesions, for a few reasons. If the mass is benign but large and uncomfortable, it might be surgically removed. If the needle biopsy showed benign tissue but the imaging is highly suspicious, the results would be considered discordant and the area of suspicion would be fully removed surgically for a more detailed examination. And if the results are benign but are a high risk or pre-cancerous condition that is sometimes found together with either DCIS or invasive cancer, then the entire suspicious lesion will be removed in order to ensure that nothing more serious is going on that what was found by the needle biopsy.

It sounds as though your friend's case is similar to my last example. A needle biopsy finding of ADH or ALH, as examples, will usually lead to an excisional biopsy. The risk that DCIS or invasive cancer might be found when ADH or ALH is present is about 20%.

Although this procedure correctly should be called an excisional or surgical biopsy, some doctors and hospitals use the term lumpectomy. I think it's laziness and causes confusion, and I think it's mostly done because it means that the doctor's office and hospital can write up and use one set of procedural documents for both types of surgery.

As for why the MRI, I suspect this is because MRIs tend to show more than mammograms and ultrasounds, and prior to operating the doctor wants to have the best assessment possible of the full extent of the area of suspicion and wants to see if anything lights up that looks like it could be invasive cancer.

JaneQPoppy

That's helpful. Thank you.

MrsThetiger

I am having a lumpectomy on noncancerous high risk changes found under MRI guided biopsy after my original MRI showed right breast tumor in addition to left breast tumor that will require mastectomy. She said once they take it out they will do the pathology again and restate it. It may move to the precancerous stage. Apparently it is common for pathology on the original biopsy for a lobular newly developing cancer to underestimate the pathology. Lobular precancerous changes can turn to cancer to they want them out.

HopeWins

JaneQPoppy - you're a good friend to dig into this. It sounds like her team is giving her good standard of care. I had a stereotactic biopsy, followed by excisional biopsy and they found DCiS. Approx 80% of invasive IDC starts as DCIS, so you don't want it hanging around in the breast. Typical treatment is excision and radiation treatment. If it's hormone receptor positive, your friend may have AIs recommended.

I wish my first BS was more proactive and ordered an MRI before my excisional biopsy. Knowing what I know now, you want to have as much info as possible before you send someone into surgery. Purpose being, you don't want to remove one grenade if there's a minefield in there. You're a good a friend. I'm sure she appreciates you.

JaneQPoppy

Thanks, y'all. She had the procedure last Friday. Took an hour and of course, no lymph nodes were removed. There will be no radiation or chemo, because she doesn't have cancer. I talked to another friend who works in a plastic surgeon's office (and herself had DCIS and a double mastectomy) and she said this prophylactic procedure isn't all that uncommon. So, learned something new!