Issues with Biopsy and results Spiculated spot

As I interpret it:

1. The “infiltrative cancer” is what they suspected it might have been, but more likely simply what they were looking for. “ICD 10” is the current (as of 2015) national standard system of billing coding for insurance &/or Medicare reimbursement, and in order to get coverage for a procedure, they have to say what the procedure is seeking to diagnose, using the proper specific diagnostic “code"--hence the “code N63” (anyone here who does billing coding, I’d appreciate clarification). It doesn’t mean that is the actual diagnosis, but rather the suspected diagnosis--without that, there’s a chance that they would not be reimbursed. “Inflitrative,” synonym for “invasive,” means that they weren’t looking for a tumor in situ, e.g., DCIS--they expected that were they to find something it would be invasive (more common, BTW, than in situ).

2. The DNA analysis does not test for “the breast cancer gene” (which is a misnomer anyway--the correct terminology would be “genetic mutation,” which is a defect in a gene that causes cells to keep dividing and form a tumor, instead of dying off at the end of their lifespan like normal cells do). If by “breast cancer gene” you mean such a mutation (e.g., of the BRCA-1 or -2, CHEK 2, PALB 2, etc. genes), that is done by taking a blood sample (sometimes saliva sample if you can’t give a blood sample or you can produce copious saliva uncontaminated by other stuff in your mouth), because those genes--and their mutations--are evident in all your cells and the blood is the most reliable way to test for them. It is done independently of biopsy, after a genetic counseling session--and usually only if there is a reason such as a close family history of breast or related cancer, other family members who tested positive for such a mutation, or a pre-existing breast cancer diagnosis coupled with an ethnicity (e.g., Ashkenazi Jewish) in which such a mutation occurs more frequently than in the general population. The "DNA analysis" the report mentioned is to analyze the biopsy sample itself to determine the nature of the tumor cells, which is another measure besides appearance to distinguish benign from malignant.

3. The findings say “benign” because even though they were looking for invasive cancer, cancer isn’t what they found. (That doesn’t mean they expected to find it, but rather, as in 1 above, they had to say that’s what they were looking for in order for the tests & procedure to be covered).

4. My core needle biopsy was quick, painless and easy. The radiologist (not the same one who did the diagnostic ultrasound that revealed the mass) used the diagnostic film as a guide as to where to put the probe, found the mass and hit her mark right away. She specializes in breasts (as did the diagnostic radiologist) and nothing but, and it was in the Center For Breast Health of the hospital which also has Kellogg Cancer Center. Sorry your experience was not as good.

5. The mass was bigger than the core samples, and removing it would have been a surgical procedure. Even minor surgery carries risks (anesthesia, infection, clotting, pain, etc.), so diagnostic procedures tend to be as minimally-invasive as possible. No need to put you through the equivalent of a lumpectomy only to find you don’t have cancer.

6. Tumor measurements usually include the whole enchilada, including the “spider legs;” but another reason to do just a core needle biopsy rather than a surgical excisional biopsy--because were they to remove the entire tumor, they’d have needed to take a wider margin to make sure that they got it all.

7. What you should expect from the BS depends on the BS’ preferences. You would probably receive an explanation of the results and his/her opinion about what if anything to do about them--most likely, confirmation that periodic non-invasive diagnostic surveillance is advisable. It would also depend on how much faith the BS (and perhaps the MO who disagreed with the radiologist) has in the pathologist who examined the core biopsy samples; it’s possible that the BS might suggest a second opinion (rather than putting you through another biopsy) from another pathologist or lab, using the samples already taken. MOs don’t usually call the shots about whether a tumor is or isn’t malignant, but rather how to treat it once it’s removed and confirmed to be cancer. A good way to go would be to get an opinion from a facility that actually has a “tumor board” of surgeons, MOs and pathologists--and perhaps this BS is part of such a facility. If not, request such a second opinion that has such a board.