Spiculated Mass

Hi joanmac52,

Sorry to hear you are going through this--this board is a great place to get support.  

I found out right before Christmas that I had a spiculated mass with a Birads 5 rating.  My surgeon suggested a needle biopsy, which I had and it came back as a benign fibroadenoma. However, my surgeon is not comfortable with the result because fibroadenomas are not spiculated--so I am now going to have an excisional biopsy.

As anianiau wrote, an excisional biopsy would give you a definitive result. I did take my husband with me, which I found helpful.  I was quite nervous and forgot about half of what the doctor said, so my husband was able to fill in the blanks.  The waiting is difficult--I have found it helpful to stay busy with projects around the house.

Best wishes for a B9 outcome!

Hugs, 

A spiculated mass flips the odds that the lump will be cancerous from the 80% benign -- 20 % cancer to 80% cancer -- 20% benign. But that still is a significant chunk of them that turn out benign.

Lori gave a good overview of what happens now. Best of luck to you and hope for a good outcome.

Sorry, I guess I should have posted in the Newly Diagnosed section.  So glad I found this site.

Peg

Hi Joan!  At my place, my routine mammogram was ordered by my OB/GYN.  It was suspicious.  The radiologist recommended a biopsy, but it had to be ordered by a clinician.  My OB/GYN ordered the biopsy.  When I got the results, I was referred to a breast surgeon, who did the excisional biopsy. 

Some people get a breast surgeon involved earlier than this. Then the breast surgeon recommends a biopsy.  At my place, the radiologist can't order a biopsy.  I suspect they want several docs involved in case of law suits.

Whether or not you have an MRI may depend on your situation.  MRIs are not as invasive as a biopsy, but they are costly, and some insurance companies will not cover them.  So sometimes in the process of getting diagnosed, some people have MRIs and some don't.

The radiologist called my OB/GYN (who ordered the initial mammogram/ultrasound) with the results and my OB/GYN ordered the biopsy and referred me to a breast surgeon at a breast center.  The surgeon did the needle biopsy and will do the excisional biopsy at then end of the month.  My surgeon did not suggest and MRI and I did not know enough to inquire about one.  

This site has helped to educate me...I will ask about an MRI.  What I have learned so far is to ask a lot of questions about the process, all options available, why the surgeon wants to do things a certain way, etc.  Then do research--this is helping me to feel more comfortable with the course of action.   

Hi joan,

Don't be hard on yourself-this is unchartered territory.  It is reasonable to get a referral from a physician that you trust and if you desire, you can always opt for a second opinion.  Hope the consult went well.

Penny 

Hi...where I live the follow ups are either coordinated by the radiology dept at the hospital or with a surgeon that your OB/GYN refers you too. I highly recommend the surgeon route. They still work with the radiology dept at the hospital, but I had my excisional biopsy on Tuesday and the surgeon called personally with the results on Thursday (benign thankfully). A week after my benign results I got a letter from the hospital telling me that my mammogram showed suspicious calcifications and I should seek follow up procedures. I was really glad my OB/GYN and subsequent surgeon (who was just a general surgeon, but still great) were so pro-active on my behalf.

nimmich, speculated is never a good word; however most breast masses are benign.  I think whenever we get a breast lump there is concern; howeve you are doing what you can and following up with your health care suggestions ie, u/s and spot compression , from there they will decide if it is concerning enough to get a biopsy. No point worry about what might be until you know. (terrible advice from me who worries all the time). IN the meantime, try to keep busy and I find distraction with friends/ family and chores helps.  I also like to bake!

My compressed mamo/ultrasound was yesterday & my biopsy is today. I was told a spiculated mass, but no more was told. I set an apt. with a breast cancer specialist at Smilow in New Haven for 13 days from today since I was told hormone receptors are needed for a plan of action and these take 5-7 work days. I would find comfort in reading of different approaches in "attacking" this situation. I always teach with a "backward approach"- my visions are set first and then I plan my approach. I'd like to deal with this situation in the same manner & again welcome hearing outcomes and approaches.

You are wonderful to reply. My mass is an 8MM spiculated mass at 12:00 on my right breast. The radiologist said cancer or radial scar. Both will need to be removed. My mind is stubborn and as a "calmer" I need to know what is ahead. I know I have to await for results tomorrow- B9 or malignant. And I know I have to await hormone receptors next week to plan a course of drug treatment if malignant. Can you explain how you chose a lumpectomy? Can you share if you had a spiculated mass? Can you explain why the implant and nipple reconstruction followed, (assuming site of lumpectomy) and if this was can be done at the time of lumpectomy. What confuses me most in your personal surgery history is mastectomy. What made this your final surgery and not first?

I am 63. I am an identical twin and there is no history of BC known in my family. The apt.I set is at Smilow in New Haven (nearby my home town) and with N. Horowitz a breast cancer surgeon.

So, my stats are a bit out of order (which certainly adds to your confusion, but I've never figured out how to 're-order' them). I did not have a spiculated mass. I found what felt like a tremendous lump (but, of course wasn't all that big) that looked on images like a sunburst. It was a complex cystic mass, which the radiologist was unconcerned by (there was a fluid filled component), but he was a protocol follower so he did give me a surgical consult. The breast surgeon immediately "didn't like it" and asked if he could aspirate some fluid right then; which I of course agreed to. We got back the cytology report in a couple of days (cytology is done on fluid and is less precise than pathology which is done on tissue) which indicated adenocarcinoma. At that point, we knew I had breast cancer, but no more than that. So he asked me what I wanted to do, a biopsy or an excision (lumpectomy). I just wanted to remove it, not knowing if it was fast growing and aggressive or not. So he scheduled a lumpectomy and sentinel node biopsy at the same time - in case it turned out to be invasive and we needed to see if I had nodal involvement (to limit my surgeries, if possible). I got very good news with my pathology report - DCIS (and of course, no node involvement). I had my initial consult with the RO (radiation oncologist) and planned my rads treatment. I also sent for a second opinion on my pathology to an expert on DCIS, as my small local hospital might have missed something. The day before I was scheduled to go in for my rads mapping and tattoo, I got back the second opinion path report indicating I should get an mri as the architecture of my dcis tends to present itself as multi-focal disease. (MRIs are very commonly used now, but this was 14 years ago) I had the mri, which did in fact, find 2 more areas that were biopsied and proven to be DCIS, in a different quadrant of my right breast. At that point, the recommendation was for mx, as doing multiple lumpectomies in various quadrants does not result in a "good cosmetic outcome" and I was only 38, so they wanted to be sure and remove all of the DCIS. After the mx, I had several reconstruction surgeries (instead of just a couple, because I got a pretty good hematoma after my lx), TE placement, exchange surgery and then nipple reconstruction. I think that answers your questions. Please do ask if you have any others. ((hugs))

This week will forever be embedded in my mind- a repeat mammo with my first breast ultrsound, followed by a biopsy, markers and another mammo. Viewing of a 8mm spiculated mass at 12:00 and entry into the journey of cancer. Without a plan, which is the "control" I strive for, I am finding tremendous solace in this site and the amazing ladies who have reached out to me and truly touched my heart. I will find strength to pervail thanks to you!

i am assuming by that last post she just did find out the results. Hugs to you

Just received word that a lumpectomy is in order. So far the biopsy report from the spiculated mass show "atypical ductal hyperplasia". My appointment with a breast surgeon is June 26th. My receptors are not in yet so any drug regimine is not known at this time. Also I am told that the mass and surrounding area will be biopsied after the lumpectomy. Continue hugs and good thoughts, and information/experiences as well.

MTwoman & evry other community friend...

I reread my posts and see utter confusion. I guess that, confusion, is par for the initial journey through a breast cancer diagnosis. As you now know my initial pathology report following my biopsy was misread at a local hospital. That is where my initial benign diagnosis ("it's not cancer") and ADH was termed and I was told myoepothelial cells were present. It was at the breast cancer surgeon meeting that the BS had Yale rerun the pathology and the diagnosis turned to invasive mammary carcinoma & complete absence of myoepithelial cells.

My lumpectomy and sentinal node biopsy was 5 days ago. I was told by the surgeon that she removed a wide area of margin and 3 tiny nodes. I was also told that there was not enough tissue for an oncotype. I really had hoped for the assurance of an oncotype to help guide decisions that are forthcoming. I will ask if perhaps tissue from the original biopsy can be used for this when I meet with the BS next week

I went for genetic counseling the day after my BS appointment. It was at the BS appointment that receptors were in fact ordered (due to the mis diagnosis they were never completed). I was tested following the genetic counseling meeting for BRCA 1 & 2, and a variety of other genome tests were ordered after the BRCA1 &2 were reported to be negative the day before surgery. My receptors to date came back as 100% Estrogen +, low progesterone +, and so far HER NEU was -. The fish score has not returned as yet.

Now it is time to heal a bit and brace myself for further surgery if either margins or nodes are positive for cancer. I have a meeting with the BS in a week to get results. I have a meeting with the radiologist in 2 weeks, and in 3 weeks with an oncologist. I am hoping these doctors will work as a team to take the best care of me.

Sherry