Help me decide if this sounds acceptable

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Lorri66
Lorri66 Member Posts: 5
edited October 2014 in Benign Breast Conditions

Hello, I am 47 years old. In July my insurance changed and I had to pick a new PCP. I was also due for yearly mammogram and the new insurance didn't require a script if it was just a normal mammogram. So, I went on 8/27/14. On 9/9/14 my new PCP's office called and requested an appointment since I had never been in to them before and they received my results. I went in on 9/11/14 . The Dr. did her new patient exam and said mammogram showed focal asymmetry with heterogeneous breast tissue. Said most likely nothing but wrote script for diagnostic mammogram and ultrasound, along with scheduling a follow up appt in one month's time. She did NOT do a clinical breast exam. Went for diagnostic mammogram and ultrasound on 9/19/14. The mammogram tech assured me that once we did the spot compression we would most likely find that the tissue flattened out and then we would be done. She did the spot compression and said , "it's sill there". So off to ultrasound I went.  The US tech was concentrating on one specific area and at times was putting pressure on my breast, at which point it didn't hurt but there was a little discomfort . Once done they took me to speak to the radiologist . He seemed very concerned and showed me a bright white area of concern that he described as very tiny- marble sized - but irregular border with sharp edges and it was NOT a cyst. He made the statement that in his mother or grandmother's day, by the time they realized it was there it would be too late . His assistant then took me to get scheduled for an image guided core biopsy on 9/23/14. I should mention that this is an imaging/radiology center with 7 locations, several in my town and the rest in neighboring towns. I told the assistant to get me the next available appointment regardless of which location . I just wanted to be over and done with it and know something. The appointment ended up being at a facility I had not been to before and was scheduled for 9/23/14. The US tech seemed to be rolling the transducer over a somewhat different are than in my first ultrasound. It was in the general area but over an inch or so.  The radiologist came in and seemed to be having a hard time determining where to enter for  the biopsy and kept making comments like, " this is challenging" and "this is teeny weeny". He finally chose to go in from the armpit side and took four samples. Upon completion he inserted the clip into the biopsy site and said to the US tech, and I quote, " I think I got it . Yeah, I'm pretty sure I got it. It looks a little different now so I must have." Two days later I called the PCP to see if they had results. A nurse told me yes, it was benign. She then published the report to their patient portal so I could read it myself. Since then I have gotten copies of all reports ( except pathology) from the prior mammogram in July 2013 to now. Please see the following:

7/27/2013 unremarkable right mammogram- annual follow up

8/27/2014 Findings: breast density: heterogenously dense which limits sensitivity of mammography. Focal Asymmetry is noted in the right upper central breast middle to posterior depth. There is no dominant mass, suspicious clustered calcifications or secondary signs of malignancy .

Impression: Focal Asymmetry in right breast. Diagnostic mammogram and ultrasound recommended.

Tech note: Right CC and MLO Compression views. Right true lateral view.

9/19/2014 Right Breast Digital Diagnostic Mammogram 

History: patient recommended for  focal asymmetry in right breast demonstrating mammographic  change. 

Findings: digital images were analyzed by computer aided detection followed by radiologist review. With the spot compression views the area of focal asymmetry persist. It is indeterminate as to the etiology and is anticipated to be at the 12 o'clock position. 

9/19/2014 Right Breast Ultrasound  (completed same day as diagnostic mammogram )

Findings: ultrasound was then directed to that area and in this location is a small hypoechoic structure, taller than it is wide, measuring 8x7x3 mm and is indeterminate sonographically.

Impression: Diagnostic mammogram and ultrasound both confirm a small area of distortion on the mammogram and hypoechoic irregularly marginated low echogenicity area in sonogram. 

BIRADS 4-suspicious

9/23/2014 Ultrasound Guided Biopsy of Right Breast

History: right breast lesion

Comparison: Mammogram & Ultrasound performed 9/23/2014

Biopsy procedure: a limited evaluation of the right breast was performed and demonstrates a vague area of hypoechogenicity at 12 o'clock 3b region. This is best seen in Transverse view and not well seen completely sagitally . An 11 gauge mammotome needle was placed beneath the lesion in question and four core samples were obtained. Following this an 11 gauge u-shaped clip was deployed. 

9/23/2014 Post Biopsy Mammogram 

Two view right breast  mammogram demonstrates the clip to be positioned in close proximity to the lesion on the mammogram in the CC view and slightly superior in nature to the area marked in the MLO view. May be secondary to migration.

Impression: status post US Guided Biopsy of a vague hypodensity at the 12 o'clock 3b region for  which pathology is pending. 

Pathology Addendum: US guided biopsy of the right breast 9/23/14.

Pathology reports right breast 12 o'clock 3b region- Fibrocystic Changes with dense fibrosis. No malignancy identified. Micro calcifications present.  This is likely concordant with image findings . The area in question in the right breast on Ultrasound did  not keep its morphology when viewed in different axes with the transducer. This would suggest fibrotic tissue rather than a true mass. Would recommend two view right breast mammogram in 6 month's  time to help exclude any possibility of false negative result. 

Ok so if anyone is still with me after this terribly long post, please,please let me know your thought on everything you just read . I appreciate any opinions and/or advice. And thank you for taking the time to read this!

Comments

  • MusicLover
    MusicLover Member Posts: 4,225
    edited October 2014

    Wow, some of this is over my head but based on what the pathologist said while doing one of your biopsy "I think that I got it", I would ask them it a stereotactic biopsy would be better and/or you take that report with you and get a second opinion.

    Best of luck.

  • Lorri66
    Lorri66 Member Posts: 5
    edited October 2014

    Thank you so much for your response . Kind of what I was already thinking but don't know if I'm overreacting or not . As for requesting stereotactic that option is out due to size and location.  Seeing my PCP on 10/9 and will be going over all of my concerns at that point . Thank you so much again !

  • Beesie
    Beesie Member Posts: 12,240
    edited October 2014

    As I read it, I think that there is a lot in the biopsy report and post biopsy mammogram that is consistent and that suggests that you have nothing more than fibrocystic tissue.

    1. From the diagnostic mammo: "With the spot compression views the area of focal asymmetry persist. It
    is indeterminate as to the etiology and is anticipated to be at the 12
    o'clock position.

    2. Biopsy procedure: "A limited evaluation of the right breast was performed
    and demonstrates a vague area of hypoechogenicity at 12 o'clock 3b
    region.
    "

    3. Post Biopsy mammogram: "Two view right breast mammogram demonstrates the clip to be
    positioned in close proximity to the lesion on the mammogram in the CC
    view and slightly superior in nature to the area marked in the MLO view.
    May be secondary to migration.

    Impression: status post US Guided Biopsy of a vague hypodensity at the 12 o'clock 3b region for which pathology is pending."

    Put 1, 2 and 3 together and it sounds as though the biopsy ultrasound spotted something in the same area as what showed up as being a concern on the mammogram, and that's the area where the biopsy was done.  The post biopsy mammogram confirms that by the placement of the clip and the area that shows as having been biopsied.  

    4. Pathology report: "The area in question in the right breast on Ultrasound did not keep its
    morphology when viewed in different axes with the transducer. This
    would suggest fibrotic tissue rather than a true mass.
    "

    5. Pathology report: "right breast 12 o'clock 3b region- Fibrocystic Changes with dense
    fibrosis. No malignancy identified. Micro calcifications present. This
    is likely concordant with image findings.
    "

    In 4, the pathologist is saying that while the ultrasound showed the mass, when the
    area with the mass was evaluated from different angles, the mass was not
    always evident. This suggests that it really is not a mass but simply
    is lumpy fibrocystic breast tissue that sometimes gives the appearance of a lump but at other angles blends in with the rest of the breast tissue. And in 5, the pathologist is saying that the finding of fibrocystic breast tissue is consistent with the appearance on the imaging (further evidence that the correct area was biospied).  From the ultrasound imaging, one would expect a finding of fibrocystic breast tissue, and that's in fact what the biopsy showed.  

    So as I interpret everything, it sounds as though the same area of concern showed up on both the mammogram and the ultrasound, the biopsy was done in the correct area, and the findings were benign and consistent with the imaging.  Personally I'd be happy with that and happy with the suggestion of a 6 month follow-up.  A 6 month follow-up is standard procedure after a biopsy, because there is always a very small risk that the needle might have missed the right spot or that there might be several things going on, and the needle only picked up the benign tissue and not the more concerning cells right next to the benign stuff.  There's always that risk, but from what I've seen over 8 1/2 years here, the follow-up virtually never finds anything of concern.  In fact I would say that I can't think of a single case where a 6 month follow-up after a benign biopsy has yielded something of concern, but then someone will probably come by and say that it happened to them.  But truly, as I go back in my memory, I can't think of a single case. 

    By the way, as a second opinion, a PCP may not be the best choice.  Often PCPs are not all that familiar with these types of subtle issues and the one thing I've seen a lot of on this board is PCPs who over-react to screening or pathology reports (because they don't fully understand them) and who needlessly frighten women who really have nothing to worry about.  My suggestion is that you call and ask if the original radiologist can review the findings - since he is the one who had the biggest concern, it would be helpful to know if he is satisfied with the pathology report and post-biopsy findings.

    Edited for typos/grammatical errors only.

  • Cowgirl13
    Cowgirl13 Member Posts: 1,936
    edited October 2014

    Beesie, you are amazing!

    Liz

  • Lorri66
    Lorri66 Member Posts: 5
    edited October 2014

    Beesie-

    I would like to thank you for the careful consideration you gave my post. This is all new to me, I'm very scared, and having someone  who has been there ,done that and come out on the winning side listen to me makes  a difference . I am focusing on the negative instead of seeing the positive . I just keep hearing the radiologist saying "I think I got it" and seeing the line on the pathology report about false negatives. Add to that all the "research" I've been doing on google and I'm driving myself nuts! So,  thank you for helping put things in perspective . 

  • Moderators
    Moderators Member Posts: 25,912
    edited October 2014

    Hi, and
    welcome to Breastcancer.org.

    It sounds as though your medical team is being responsive and
    acting properly to assess what they've found, and that's a great. Anyway, we
    recommend you to read the article What
    Mammograms Show: Calcifications, Cysts, Fibroadenomas
    , from
    our main site. It reinforces that there are many other benign masses, including
    some that are especially common among young women.

    Also Beesie's advice is, as always, very well informed and worth listening to.

    The Mods

  • Outfield
    Outfield Member Posts: 1,109
    edited October 2014

    Lorri, I am a PCP and I agree with Beesie - contacting the first radiologist would be my first thought.  If it were me, I would have done that after receiving the biopsy report.  If I were a patient without the doctor-to-doctor leverage, I would try to contact the first radiologist.  I would call first and find out how the site would best suggest I do that.  A PCP is probably going to be able to understand the reports, but simply won't have the experience base to be able to talk about them the way a Radiologist or a person who was actually there doing the ultrasound would.  

    Overall, it sounds that they think you are most likely OK but are going to be conservative and re-image.  That's a very, very, very common strategy for all sorts of problems because time tells a lot.

  • Lorri66
    Lorri66 Member Posts: 5
    edited October 2014

    Mods, Outfield,  thank you all for your input! This site, like all you wonderful ladies here, is amazing . I came here because last year without you even knowing, you all helped me through a stereotactic biopsy on my other breast for micro calcifications . I learned so much the last time, without joining, just reading,  that this time When It all seemed scarier to me I came back . I am definitely going to try to contact the original radiologist and see if they will let me speak to him. It makes perfect sense. Thank you all again for  your advice and encouragement. You truly are amazing ! 

  • Anonymous
    Anonymous Member Posts: 1,376
    edited October 2014


    First - I am NOT a doctor, and I don't even play one on TV.  I tried only to place myself in your position and see what I'd feel if I had these tests/results.  I think I'd feel great.  It sounds like your team really went through all the necessary precautions and testing and you came up one lucky gal.  I am the type that tends to RUN from the office each time I get an "all clear," and not think about that place for another year. I'm feeling like the only thing that is nagging in your mind is "did the biopsy actually get a sample of the questionable area"?  If so, perhaps you'll feel more comfortable with your next mammo (etc) in 6 months instead of a year?  All he best.

  • DocBabs
    DocBabs Member Posts: 775
    edited October 2014

    Sounds like your biopsy is negative for any cancerous lesion and a 6 month follow-up mammo would be SOP.I probably would go back to the same facility where you had the biopsy done. Any further findings would warrant a visit to a breast specialist.

  • Lorri66
    Lorri66 Member Posts: 5
    edited October 2014

    thanks all for your input and advice. Tried to call original radiologist as suggested but I couldn't speak to him, only my doctor can apparently . So I got in touch with her and she in touch with him and I have a follow up appt today at 3:30 to review what the first radiologist thinks of the procedure and biopsy I had at the different facility. Most likely he will say its concordant with his findings so, i will know shortly. Thank you all again

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