Ultrasound couldn’t find area of concern so biopsy cancelled

Judsonla · March 2018

hi, I’m very new to this site but feeling quite anxious. I attended an appointment last Thursday following concerns regarding left breast, no lump just uncomfortable feeling and slight pain . Had mammogram which was ok, then ultrasound which showed one cyst - not worried about that but sonography said was concerned st small mass, her manager then looked and after talking to doctor all agred on core biopsy booked for today. Told it could potentially be cancer. Attended today for biopsy, but when having ultrasound different sonograher could not find the mass, after talking to different doctor it was decided to cancel biopsy and bring me back in 3 months to rescan as it was small. I’m worried sick, lots can happen in 3 months, would a mass just disappear? I don’t know what to do?

djmammo · March 2018

Unfortunately this scenario is not all that unusual in practice.

US is rather "operator dependent". If you have ever taken a look at the dashboard of the US machine it looks a bit like a 747's instrument panel. Every control on there can effect the image. They are used to optimize the image of each body part being examined. There are different settings for liver, breast, blood vessels, spleen etc. The transducers also vary in frequency and they are tuned for different organs at differing depths in the body. Images of a body part can look very different depending on how these controls are adjusted and which transducer is being used. You need a good "pilot" doing your scan. The best breast sonographers are board certified in breast ultrasound.

There are times when you can adjust the machine so that a normal structure in the breast can look like a small solid nodule. The more experienced breast sonographers learn how to ignore these phantom nodules and adjust the machine appropriately and experienced radiologists know what to look for on the live screen to confirm.

Three months may seem like a long time but remember that most follow up scans are done at 6 months.

wallycat · March 2018

Can you have a breast MRI? My ultrasound showed a tiny shadow of something but no one was alarmed. Mammogram had been clean for over 8 years. I insisted. Something lit up on the MRI. I went back for the ultrasound biopsy but the ultrasound showed zero, zip, nada...not even this initial tiny shadow...so back to the MRI and they used that to do the biopsy. My radiologist was convinced it would be nothing; they were wrong. My breast surgeon said I saved my life.

djmammo · March 2018

wallycat

How big was your cancer measured on the MRI? Do you still have the report?

wallycat · March 2018

The MRI showed 7mm but the actual tumor turned out to be 1.8cm. I could probably get the report from the hospital, but I'll be starting year 12 in a few weeks and don't want to relive it!

djmammo · March 2018

wallycat

The info you supplied is fine. Thank you.

wallycat · March 2018

You're welcome. I do remember that the radiologist (a woman) laughed at me...the MRI image was not spiculated and she kept saying it would be extremely unlikely it was cancer. I insisted on the biopsy because in my gut, I just knew it was. She actually said, "boy, sounds like you want to get cancer..." idiot lady doctor. She wept when she phoned me with the news. SHAME on her!

Recap · March 2018

Wow-that is quite a comment to make to a patient!

I believe forums like this should be part of the curriculum in medical school, which needs to be longer than 3yrs (not including residency/fellowship years.) A little bit of gray in their hair before they begin practicing on us :-)

(My mom's dr also cried, bedside in her hospital room, post-mastectomy. He had told her to "watch" her lump for the year prior (many many years ago-they know better now?)

djmammo · March 2018

Medical school is 4 years, after 4 years of college.

A diagnostic radiology residency is 4 years.

A fellowship is then another 1-2 years after that for subspecialty training.

=======

There is a fine line to walk when offering an imaging opinion. You cannot be 100% definite in your statements since there is so much variation in the appearance of cancers of the breast. No one can be 100% sure until the pathology comes back. One should certainly never laugh at a patient.

On the other hand you have to sound sure enough of your diagnosis so that patients and other physicians will take you seriously and follow your recommendations. I try to stay away from "never" and "always" when I can. You can only really tell people what is more likely or less likely.

Maybe its like a batting average, judge your doc by how often they are correct but expect a few strikes?

Egads007 · March 2018

I had a varied experience during my walk down cancer lane. My Onc was helpful, supportive, and listened to all my concerns. She did sometimes leave me wondering. For instance, when she spoke about switching from Tamox to an AL I asked about SEs. She replied "You don't even want to know!" I had no alternative but to reply "Well yeah I do!". All in all I can't complain, I'd say she is a very dedicated, caring doctor.

My Onc BS well that was a different story. He was dismissive and curt (but never outright rude), to the point that I felt like I was a big pain in the a&$ (lol yeah I know, whats the common denominator here?). I will say he was and is a brilliant surgeon that took his work seriously. Who the heck am I to complain that he didn't wrap me in flannel blankets, he saved my life!

My best experiences have been with my radiation team and radiologists on an ongoing basis. Unfailingly pleasant, supportive and understanding. They haven't pulled any punches with me and are startlingly aware of my apprehension. They've always dealt with me in an honest supportive way.

No doubt some here have had awful experience, unacceptable even . At the end of the day the medical community are after all human. Probably pushed to the edge with busy departments and climbing numbers of cases to diagnose and treat. This doesn't excuse being laughed at or treated in a sarcastic manner. Good or bad I'm very grateful and I guess lucky not to have encountered the occasional bad egg. My hat is off to them...with a birads of 5, if hats off had a birad scale.

wallycat · March 2018

I realize doctors are human beings/people and the only difference between us is that they invested time and money for an education and hopefully, wanting to do good. I would think even an uneducated person would not accuse someone of "wanting cancer."

Egads007 · March 2018

Wallycat, please don’t think I’m disagreeing with you or suggesting that you’re being overly sensitive...what was said to you was unacceptable, heartless and ruthless! The person who said that (and the other things) to you should rethink career choices, and in my opinion is far from being human! My post was just relaying my ups and downs with my walk with treatment. As I said I guess I was lucky to not experience some of the cruel and thoughtless things you and others have had said to you. My sincere apologies if I offended you and the others in any way.

Recap · April 2018

Reading these forums is an amazing education. Every poster shares valuable lessons. We all remember the tv show MASH. The concept of MASH humor is demonstrated every day amongst health care employees. I am sure it is quite easy to slip and say those comments to a patient.

ps-I think my age is showing. Med school used to be 3yrs, I did not know it is 4 now. I have the highest respect for radiologists and your post-med school years of training are quite impressive. It sounds like a very enjoyable career. It must feel like you are unwrapping surprise packages. I was very impressed with the radiologist and resident who performed my core biopsy. I especially was impressed that you have allowed a patient to scan themselves with the ?transducer? since I desperately wanted to do that myself during my session with a tech.

Ultrasound couldn’t find area of concern so biopsy cancelled

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