Benign Biopsy Results, Excisional Biopsy Required

Island_gal · August 2018

I am not sure if this is the correct area to post in, so please forgive me if I have gotten it wrong.

My Bi-Rads 5 lesion has come back with a benign pathology report. I had an US guided core needle biopsy on the 1.4 cm lesion. 6 samples were taken, plus some additional smaller ones.

The diagnoses:

Benign hypoglandular fibrous breast tissue with focal usual ductal hyperplasia and rare intraluminal calcifications, otherwise unremarkable.
No atypical epithelial hyperplasia, in situ or invasive carcinoma.

My GP has said this is encouraging new, but there are still some red flags considering the feel of the lump during physical examination and because the initial US images showed "shadowing" (mammogram showed nothing). There is also a note at the very bottom of the report that reads:

There is no histologic evidence of a mass-forming lesion from the multiple levels examined. Thus, this sample may not be representative of the targeted lesion. Correlation with radiographic findings is required.

My GP has recommended excisional biopsy and I have been referred to a surgeon. Despite my case being marked as urgent, the consultation is still 3 weeks away. I'm not sure how long it will then be before I have a surgery date.

I've been told that the only way to know for sure whether a tumor is benign or malignant, is to "stick a needle in it." Well, we've done that and the results were favorable. I guess what I am wanting to know is can I still hold out hope? Is there still a possibility for the lump to truly be benign? Or should I just prepare myself again for a cancer diagnoses?

Outfield · August 2018

Whoever told you the "stick a needle in it" thing wasn't terribly accurate. The smaller the piece of tissue taken during the biopsy, the lower the chance it will give you the answer you need. FNA isn't as accurate as core biopsy, which isn't as accurate as excisional. The only reason we ever bother with "needle" biopsies is that they're less invasive.

I'm sorry you have to wait, and sorry you have to deal with this at all. For most breast cancer, a 3 week wait isn't going to make or break things in terms of how you do in the long run, but it's torture.

Statistically, you can still hold out hope (you can look up numbers on the internet, but they will be a range because, if tested everywhere, they will vary center to center), but it makes sense to be shoring your psyche to hear a cancer diagnosis. Other than that, there's not a whole lot you can do to "prepare" other than getting the names of good oncologists and surgeons. If it turns out you don't need them, that will be great and I hope that's what happens.

Island_gal · August 2018

Thanks Outfield. There were multiple pieces of tissue removed ranging from 2mm to 17mm. Not sure if that makes a difference.

I think what I should have asked is there actual potential for “hypoglandular fibrous tissue and rare intraluminal calcifcations" to cause benignmasses to develop the breast?

Outfield · August 2018

They almost always remove multiple pieces during biopsy like that. It increases the chance of a useful result when doing an imperfect test

I don't know if the answer to your question is out there. It doesn't strike me as the type of thing that would pull research funding, but I may be wrong. A breast pathologist might have an idea just from experience, but I don't know how you'd find one to ask. I'm sorry you're having to wait with this uncertainty.

Island_gal · August 2018

Thanks for your response Outfield. I'm not sure if you or any others are following my story, but here is an update:

I have now received an addendum to my biopsy report, stating the pathology is discordant with imaging (which I understand is standard practice in this type of circumstance) and that an additional ultrasound guided core biopsy is recommended. Strangely, the addendum includes an adjusted Bi-Rads from 5 to 4C – I wonder if the initial benign biopsy result has influenced this change? I won't be moving forward with another core biopsy, as my GP had already referred me to a surgeon for excision biopsy. She believes the lump to be malignant, although she did say that the initial benign findings were 'encouraging.' Unfortunately, I still have another week to go before they are able to fit me in for consultation.

In addition to this, around the same time I discovered the lump, I began experiencing pain on the same side in my shoulder, neck, upper back, down the arm and into my hands. My hands are achey and my fingers tingle from time to time. The pain worsened over the past weeks, and just as I thought I was finally beginning to feel some improvement, I fell asleep on the couch for several hours, and then woke up in pain. I'm hoping I simply tweaked my neck at some point, and sleeping on the couch re-aggravated it – and really, really hope that it's not related to the lump. I've addressed it with my GP 3 x times now, but her focus has been on the lump and she mentioned during my last appointment to bring it to the attention of the surgeon, in case there is some connection.

On top of this, I am only several weeks into a brand new job and still in my probationary period. I've been extremely distracted and have had to miss days / leave early, etc. multiple times already. I have been very open with my line manager about what's been going on, and she seems to be supportive but I can't stop myself from thinking that I will soon find myself unemployed with a cancer diagnoses. I live in an extremely HCOL city so this has added to my distress.

Ken1018 · August 2018

I'm sorry to hear your diagnosis Island_girl.

I am going thru similar situation with the pain you mentioned. I have it in the same places - arm shoulder hands fingers and even in my neck. I don't know if it's all related because I do have other health issues.

I hope it works out to your benefit.

Be strong everyone! 😀🌻.

Benign Biopsy Results, Excisional Biopsy Required

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