Confusing MRI vs. biopsy results - Help!

Hello everyone,

Mom was diagnosed with DCIS Grade 2, some necrosis, ER+ 100%, PR+ 80%, one month ago. Since then we have seen a breast surgeon, radiation oncologist, and medical oncologist. We paid out of pocket for an outside consult after several health insurance denials.

We've had varying opinions regarding treatment. All agree on lumpectomy but there are differing opinions on radiation treatment.

Within her medical group, we were given these choices for radiation: lumpectomy with or without radiation during surgery, followed by 16 or 28 daily radiation treatments.

The outside consult (a leading surgeon), suggested a one-shot radiation treatment during surgery with no follow-up radiation; a targeted 5-day radiation treatment; or a 3-week course of radiation. The consult surgeon strongly disagreed with the 6-week approach, saying it was unnecessarily long. A radiation oncologist acquaintance noted he is doing 3-week treatments.

To all physicians we inquired about another option: lumpectomy followed by the Oncotype DX test to determine rate of recurrence and need for radiation. If radiation is not immediately necessary, we would then take a watch and wait approach to monitor future growths. Mom has a heart condition and ideally we would not want to subject her to unnecessary radiation. All agreed it was a viable option.

We were about to decide on a course of action and set a surgery date. However, we received the results of the MRI and this has thrown us for a loop.

MRI shows no evidence of a cancer tumor - no mass, no nodal abnormalities, bilateral breast MRI essentially negative. There is some "fuzziness" on the scan located near the biopsy site, which could be due to bleeding or a reaction to the metal clip. The biopsy of course showed evidence of cancer cells. Are they hiding behind that fuzziness?

Mom has had other cancer "scares" before. Her mother, who had a double mastectomy, was always convinced that she never had BC to begin with. Mom is concerned that she may not really have cancer, since no mass/tumor can be identified. She's wondering if there was a mixup of the slides, or if they presented falsely.

The docs still want to do an excisional lumpectomy to see what may be present, even if by chance the biopsy itself removed whatever tumor/cancer was present. Mom is resistant to this and what with her heart condition, we would really prefer not to put her under and endure surgery.

Anyone have a similar experience? MRI showing no mass/tumor, but biopsy slides showing cancer cells? According to the doc, this has happened with other patients before, but another oncology acquaintance thinks it is quite unusual.

We need to move forward with a decision on surgery and are uncertain about whether to proceed at this time. Of course, if there is cancer present, we should remove it. But there is no mass showing on the scan. Should we remove the breast tissue at the site of the biopsy, even without a tumor? Again I am worried about the risks of surgery in general, but also worried about missing cancer cells, even if they are minimal.

Does a lumpectomy seem extreme, given the situation? Is there any alternative to a lumpectomy at this time? We requested a repeat MRI and/or biopsy, but they said it would not help. Is there something equivalent to the CA-125 blood test used to check for ovarian cancer?

We would really appreciate any thoughts/insights as this is really hard for mom. She was having a hard time with acceptance and is now back in the denial camp.

Thank you so much.