Hypechoic - Biopsy > What questions to ask

chicagogirl52

Hello Everyone,

I am in awe of the amazing support on this forum, after searching and googling the last few weeks finally decided to post. A little bit about where I'm at....Had my mammogram on 10/4, decided to go to a new center so they had to wait for my old films for comparison. I received a call back that I needed a digital mammogram/ultrasound due to a focal symmetry and architectural distortion in the right breast. Again, wasn't that worried as I had been called back a couple times in the past for ultrasounds. At the ultrasound, they found a mass and scheduled me for a biopsy. I was caught off guard and didn't ask a lot of questions and didn't bother to ask for a copy of the report. I called the nurse navigator and she stated that the ultrasound report said that it was a hyopechoic mass measuring 1.6x1.4x1.1 cm BIRAD4, no other descriptions. A couple of questions:

Wondering if the combination of architectural distortion, hypoechoic and what seems like a large size mass points to a higher probability of malignancy?

My biopsy is scheduled for this Thursday Nov 11th, the nurse navigator said I wouldn't have results until next Tuesday. Are there questions you all would recommend I ask during the biopsy? I'm sure depending on the radiologist they may not say anything and tell me we need to wait for the results.

Thanks so much for reading and best wishes for everyone!

Moderators

chicagogirl52, we're glad you found us. The waiting can be very difficult.

Very likely they will not be able to share any information at the time of the biopsy, but looking to hear from others. You're doing the right thing by educating yourself, and reaching out. We're all here for you and truly hoping for a benign result.

Salamandra

The only reliable way to know about risk is the birads rating. If they had chosen to give it a 4a, 4b, or 4c, that might narrow it down. But really 4 just means they think it could be cancer and need to check to make sure. Most birad 4 is not cancer. If they think it is most likely cancer, and need the biopsy to confirm, they will give it birads 5.

This beginning time is so so so hard. Really, the odds of malignancy at this point don't matter. There's nothing you could do with that information and the whole point of the biopsy is to tell you for sure one way or the other. Our brains try to trick us that if we could just make a more accurate prediction, we would feel some greater sense of ease or preparedness. But it's a red herring. In this situation, pregaming is not useful.

Hoping you are among the majority of 4s that come back negative! But also sending good vibes that even if not, cancer discovered through regular screening is much more likely to be early stage and treatable, and chances are you'll still end up dying of something unrelated!

AliceBastable

Birads 4 also has to be used to get insurance to pay for a biopsy. It won't be approved for a Birads 3. So it could just be a coding thing since there wasn't an A, B, or C.

chicagogirl52

Thank you for everyone's reply. I went in to yesterday's biopsy appt trying to think positive, hey birad 4 80% turn out to be benign. The radiologist doing the biopsy was the same one that did the ultrasound, on the ultrasound the report only stated hypoechoic and the measurements. The radiologist went on to tell me yesterday that the mass was spiculated, irregular along with hypoechoic. I then asked her why she wouldn't have rated it as a birad5, she then said its nice to see someone that knows their birads. It took them almost 3 weeks to get me in from the ultrasound to the biopsy....it just feels so wrong.... She ended my appointment asking if I knew what breast surgeon I wanted to go to. All I can think is, I've been getting the run around since 10/4 while the cancer just continues to grow. Just curios once you get a diagnosis how long did it take everyone to get an appointment with a breast surgeon?

Salamandra

Hi chicagogirl,

Ugh, that's such a frustrating non-answer. It sounds like you should prepare for a diagnosis though.

It took a couple of days to get my imaging to the cancer center I wanted. They called and offered me a sooner appointment (about 4 days out) with a male surgeon or a further away appointment (about 10-12 days out iirc) with a female surgeon. I opted to wait.

On the one hand, I'm glad I did, because I really liked my doctor and her team. On the other hand, those were the longest days ever, and my first exhalation and real feelings of hope came after the meeting with the surgeon. If I had to do it over again, I think I'd still wait, but I'd get some ativan sooner - and join the boards like you've done and hopefully learn that my odds were very high for an early stage treatable cancer. I was wondering if I'd need to start planning my funeral, and I was too terrified to even look online for something like these forums.

Hang in there! For me, the fear was by far the worst part, much harder than the reality.

exbrnxgrl

Chicagogirl,

I am sorry that you're going through this and remember that the initial period of uncertainty is very stressful. You seem to be worried about the timing of appointments. Please know that bc is not considered an emergency in the same sense as a heart attack or stroke. It is urgent and certainly you need to be moving forward in terms of tests, biopsies, tx plans etc. The reality is that breast cancer is relatively slow growing and has probably been growing in your body for quite a few years before it grew large enough to be detectable. Your timing so far seems perfectly reasonable. However I understand that emotionally you just want this thing out now! Again, something we have likely all experienced. Take this time to practice relaxation as this will serve you well as you go along. Take care

*I was recently chastised for saying that bc is not an emergency because my stats make it look as if I went from stage II to stage IV in just about 6 weeks. This is not the case but it is a very long story and the signature line has no room for a lengthy narrative!

tntnsd

Hi Chicagogirl

Your timing is between ultrasound and biopsy is about right. Mine is about 2 weeks, but I am sure they were trying to get me in, give me some answer prior the holidays last year ( I got the news from my doctor on my morning walk 12/31/2020).

Once I got diagnosed, there is a nurse navigator who called and explained the steps, set up appointments and surgeon, radiologist, oncologist. Everything is moving faster at that point. I saw both breast surgeon and radiation doctor with the first or second week after diagnosis. Since I did not want reconstruction; and I felt comfortable with my team doctors, I was able to get my mastectomy in early February.

All I am saying is the first initial couple weeks are worse. Don’t hesitate to reach out to your doctor for some help or call them to facilitate appointments, asking for nurse navigator. wish you the very best

exbrnxgrl

tntsnd makes a good point. Timing of surgery or any other tx will be dependent on some choices you make. Particularly true if you choose reconstruction which then involves two surgeons. Also, switching doctors may delay things but I urge everyone to find doctors they feel comfortable with and have confidence in. Any delay caused by these things is likely to make no difference in terms of cancer growth. Take care

chicagogirl52

Hello everyone,

Thought I would log on here and let everyone know my results. I was diagnosed with Invasive Ductal Carcinoma ER+/PR+/HER2+ (grade 2). The PR+ was only 30% positive so my dr that ordered the biopsy gyn/ob wasn't sure if that still was considered positive.

I have my first appt at Northwestern with a breast surgeon tomorrow.

Not that I can do anything about the past I am a little annoyed by the radiologist that did the ultrasound and biopsy (same radiologist). All the ultrasound report indicated was that it was hypo echoic leaving me a tad bit of hope. When I was laying on the biopsy table I asked her if it was spiculated or irregular. She said yes, its both of those things. I asked her why should would not have rated as a bi-rad5 her response, 'well someone knows their bi-rads I would say it was a birad 4c or 5' Well had she provided that information I probably could have gotten in sooner and not wait 3 weeks for a biopsy appointment. My one piece of advice from my journey so far is make sure to ask lots of questions. The nurse that was scheduling by biopsy appt had said to me we don't have to get you in sooner because it doesn't say spiculated or irregular your not a birad5.

My new favorite quote 'Yesterday is history. Tomorrow is a mystery. Today is a gift. That's why its called the present." Wishing all you ladies and gentlemen a great Thanksgiving!!

Nikko1963

Thank you for this post. I myself am going for a biopsy today. Similar situation to the author of this thread. I keep trying to guess what the result will be which, of course, is a waste of time. Your response makes the most sense to me. What I will say is that one of the things that has created the most panic is the dynamics of the ultrasound team. I got this vibe that they think they know. It was kind of weird because I have had another abnormal US and had surgery, but I never got that weird vibe from the radiologist and her team. This situation really did cause me to panic.

Anyway, I go for the biopsy in about an hour. One more step to figuring out what this is.

Sending positive thoughts to all others who are waiting.

chicagogirl52

I'm so sorry, I didn't mean to cause any panic. Best of luck to everyone!

LilLee

Hi all, I had a follow-up ultrasound and mamo on 11/9. My biopsy isn't until 11/26 and the waiting and worrying is unbearable. Everything I have read has been very concerning. Has anyone has similar findings and if so, what were your results?

BREAST ULTRASOUND: Targeted ultrasound of the left breast was performed at 3o'clock 8 cm from the nipple. There is a 0.6 x 0.7 x 0.6 cm round circumscribed hypoechoic mass with internal vascularity corresponding to the mammographic finding. Ultrasound-guided core biopsy is recommended.
RECOMMENDATION(S): Ultrasound-guided core biopsy of the left breast mass.
BI-RADS: 4B Suspicious - moderate suspicion for malignancy.

Salamandra

Hey Chicagogirl,

Sorry to read of your diagnosis, but hopeful for your journey anyway. For what it's worth, I don't think the weeks will make any physical difference, but it's frustrating when you know they could have made a real psychological difference!

Good luck with your appointment tomorrow - I felt much much better after my first meeting with the surgeon. Though in retrospect I have learned that they don't always know as much as they sound like they know, she sure knew a heck of a lot more than my gynecologist who had sent me for the mammogram. Just starting a plan helped so much too.

Thinking of you!