Biopsy Amorphous Irregular Grouped Microcalcifications Birad 4

Options
Sherri000
Sherri000 Member Posts: 47
edited October 2018 in Waiting for Test Results

Is a surgical/incisional biopsy as accurate/precise as a vacuum assisted stereotactic biopsy for microcalcifications? I have amorphous irregular grouped microcalcifications that have been labeled Birad 4 (no a, b, or c). I am disabled and have some physical limitations. I have multiple bulging/herniated discs, arthritis in my spine and neck, and Occipital Neuralgia and trigeminal nerve issues. My radiologist recommended a stereotactic biopsy.

I had an appointment with my breast surgeon today and, after doing some research about those biopsies, I explained to her that I would not be able to lay face down on the table with my head turned in order to do the biopsy. She let me know that the radiology department that they use does have the type of table where I would have to lay face down with my head turned. They are getting a different type of table but the ETA is unknown. She is willing to do a surgical/ incisional biopsy instead.

While I was relieved she was willing to do that, I'm wondering if the surgical biopsy is as precise as the vacuum-assisted stereotactic biopsy. Does anyone have any information? I physically can't lay on the table face down with my head turned and unless I want to go to a different center I think the surgical is my only option. I would rather get this all done and over with and I dont have any fears or concerns about having the surgical biopsy. Im not worried about scars or anything. I want to make sure that it's as effective in collecting the specimen of microcalcifications.

Should I be worried that I won't have a good enough sample without the vacuum assistance? She explained with surgical they insert the wire with the hook and yank things out basically. I know they will use the mammogram to place the wire. I'm just wondering if the wire will get as good of a sample as the vacuum. Or should I try to find another breast center with a different type of table where I don't have to turn my head. Thanks for the help!

· Share on FacebookShare on Twitter

Comments

  • Sherri000
    Sherri000 Member Posts: 47
    edited September 2018

    Has anyone had an incisional biopsy in leu of a stereotactic needle biopsy? I'm just interested in learning about anyone's experience with incisional biopsies as well as wondering about if I have any reason for concern of not having the vacuum assisted biopsy. Thanks

    · Share on FacebookShare on Twitter
  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited September 2018

    It’s best to do the stereotactic first. Why would you want an invasive surgical procedure with anesthesia for something that very well turn out benign? The stereotactic are very accurate and they X-ray the sample for calcifications after the procedure to make sure they sampled the right place, plus do a quick mammo following, again to confirm it.

    · Share on FacebookShare on Twitter
  • Sherri000
    Sherri000 Member Posts: 47
    edited October 2018

    I had an ultrasound for pain in the breast and along the side and all was normal. I did a follow up with the BS and we are all set for the biopsy. It's apparently excisional though I was certain she said incisional initially. It is scheduled on October 18th. The office made me a follow up appointment for Oct.31 and told me that they do not give results over the phone.

    That is almost two weeks to wait for results. I'm disappointed in that and will try calling after a week to see if there is any way to bump up my follow up or get a copy of the report.

    I was able to get a bit more information about my microcalcifications. They greatly increased in number from my 2016 mammogram. I was never told about them in 2016 and was never told to follow up in 6 months. They were punctate birad 3 back then and none of this was ever explained to me. So I missed a mammogram in 2017 as I was not under the impression I had any reason for concern. I am disabled and have so many medical issues already and spend so much time at doctors and getting tests done that the mammogram fell through the cracks.

    I have since moved out of the area I was in 2016 so I have new doctors and radiology. They requested the films and notes from the last place so they could compare. They came up with the birad 4 diagnosis this time due to the increase of microcalcifications, though I was not given a number for how many there were before or now. The area now is about a 6mm cluster with well over 10 microcalcifications but the area is very hazy. They listed it as amorphous and somewhat irregular, grouped.

    I'm having the excisional biopsy because due to my medical issues I can't turn my head and therefore can't lay on the table required for the stereotactic vacuum biopsy. I have mixed feelings about this as it is a significant difference and possibly for nothing if its b9. But on the other hand, Im hoping that the BS will get a good sample and if there is anything to find possibly she will have gotten enough out that maybe nothing else will need to be done. I don't know if that is realistic of not though.

    I'm not one of those people who can't stay away from researching. I need to know all of the information. For some that causes more stress but for me knowing the information alleviates my worry. So I've been reading everyone's posts and learning so much. I'm so thankful for everything everyone has shared. I thought I would share a bit too in case anyone searches for birad 4 amorphous grouped irregular microcalcifications.

    It's helpful to read about other's stories especially if they have similar things going on.

    Good luck and best wishes to everyone. I will update this after my biopsy.

    Sherri

    · Share on FacebookShare on Twitter
  • Recap
    Recap Member Posts: 120
    edited October 2018

    Ask your surgeon if they will be imaging the contents of what they have surgically removed, before sending it to pathology. Presumably they can then count the calcifications/clumps in the sample(s) and compare that count, to your previous imaging counts.

    I felt great peace of mind to see my before and after biopsy images and count for myself that their tallies matched. Less peace of mind that 6mos later I now have new calcification clusters which apparently don't need to be biopsied...which is illogical in my mind. (Since I've only had one ultrasound overall, I also do not have peace of mind that the tiny lump found 'adjacent' to the calcifications is gone, or same size, or God forbid, larger.)

    · Share on FacebookShare on Twitter
  • Sherri000
    Sherri000 Member Posts: 47
    edited October 2018

    My surgeon did say they will image the specimen to be sure they get the microcalcifications. They keep me under while they check in case they need to take more out. That was how it was explained to me anyway.

    Are your new calcifications a low birad score? I'm guessing that its going to be a very frustrating journey if every time there is microcalfications there are more hoops to jump through and more waiting and seeing.

    · Share on FacebookShare on Twitter
  • Recap
    Recap Member Posts: 120
    edited October 2018

    Basically I was told they must be benign, because the previous ones were benign, so this new report says 4b. ( I would have to tell some serious lies to get another ultrasound done any time soon.)

    Re-imaging is never without influence/prejudice. Birads scores can be influenced by prior knowledge-markers, reports, previous images, someone else's opinion, education, experience, and even having a bad day.

    This all may sound disrespectful of healthcare providers, and I really am not, but I never forget they are just as human as the rest of us.

    · Share on FacebookShare on Twitter
  • Sherri000
    Sherri000 Member Posts: 47
    edited October 2018

    I would get a second opinion. 4b isn't something to ignore but I don't know how it works with these situations. A second opinion wouldn't hurt.

    · Share on FacebookShare on Twitter
  • Sherri000
    Sherri000 Member Posts: 47
    edited October 2018

    After an abnormal EKG I thought my biopsy was going to be cancelled. I was referred to a cardiologist and got cleared for surgery, thankfully. I went in this morning and the wire placement was a little uncomfortable and they needed to add more lidocaine. Overall it was fine. They were having some issues with their mammogram machine and also a little trouble locating my microcalcifications in one of the views so that part of the process took a little longer than I had expected.

    They moved me up for surgery prep and then we had a little drama. I'm generally a bad stick, meaning my veins tend to run away. I often have issues getting blood drawn or getting any kind of IV. Well, given I wasn't able to drink any water this morning that problem was amplified. It took three nurses and eight sticks before they were able to get any needles to stick. They even tried the backs of my hands and one in my palm just under the base of my thumb. That one was epically painful.

    The surgery part went without issue and they said they got the microcalcifications so that's as good as it gets. Now the waiting begins. I don't have my follow up with the BS until Oct.31! Almost 2 weeks. I will probably call their office after 1 week and see if I can get an earlier appointment.

    I'm still numb but am having some pain. I'm not looking forward to tomorrow. Hopefully the pain will be manageable. I have been icing that breast as instructed. I will update again if there are any note-worthy issues or when I get the results.

    · Share on FacebookShare on Twitter
  • Sherri000
    Sherri000 Member Posts: 47
    edited October 2018

    While my follow up isn't until Wednesday I was able to access my pathology report via the hospital patient portal. Some people may have been able to resist looking at it but I'm not one of those people. I'm very relieved and can breath easier now. I know it's not completely without concern but at least the waiting is over. ADH diagnosis it looks like. I don't know if the other information has any meaning or significance so I'm going to post it in its entirety. If anyone wishes to comment about their thoughts I welcome your comments. I will see what my breast surgeon has to say on Wednesday.

    With ADH, is there anything listed on my report that would indicate borderline/ low grade DCIS, or would that be listed as borderline on the report? Thanks for any help!

    Pathology Report:

    Specimen(s) Received

    A. BREAST TISSUE RIGHT WITH WIRE-LONG STITCH LATERAL, SHORT STITCH SUPERIOR

    B. ADDITIONAL BREAST TISSUE RIGHT-SUPERIOR/RETROAREOLAR MARGIN

    Clinical Information

    MICROCALCIFICATION RIGHT BREAST, ABNORMAL AND INCONCLUSIVE FINDING ON DX IMAGING OF BREAST

    Gross Description

    Part A is received in formalin, labeled with the patient's name, medical record number, and "right breast tissue with wire", and consists of a 5.5 (medial to lateral) x 3.0 (superior to inferior) x 2.0 cm (anterior to posterior) rectangular portion of tan-yellow, lobulated fibroadipose tissue. The specimen is oriented with sutures as follows: short stitch superior and long stitch lateral). The specimen is inked as follows: superior blue, inferior green, anterior yellow, posterior black, medial red, and lateral orange. There is a silver metallic needle localization wire protruding from the lateral aspect. The specimen is serially sectioned from medial to lateral. Within the breast tissue there is a 2.7 x 2.0 x 1.4 cm hemorrhagic area. The hemorrhagic area is 0.1 cm from the superior margin, 1.0 cm from the inferior margin, 0.2 cm from the anterior margin, 0.1 cm from the posterior margin, 1.6 cm from the medial margin and 2.5 cm from the lateral margin. No discrete lesions are identified. No biopsy clips are identified. The remainder of the breast parenchyma shows a stroma to adipose tissue ratio of 35:65. The specimen is submitted in its entirety as follows:

    Block 1A Blocks - Perpendicular sections of the medial margin.

    A2-A13 - The specimen in sequential order from medial to lateral.

    Block A14 - Perpendicular sections of the lateral margin.

    The specimen was collected and placed in formalin on October 18, 2018 at 1:30 p.m. and will receive 30 hours of fixation time including processing.

    Part B is received in formalin, labeled with the patient's name, medical record number, and "additional right breast tissue superior/retroareolar margin", and consists of a 2.2 x 1.5 x 1.4 cm dome shaped portion of tan-yellow, lobulated fibroadipose tissue. There is a suture that designates the superior-retroareolar margin and the adjacent tissue is inked black. No atypical lesions are identified. The specimen is serially sectioned and submitted in its entirety in cassettes B1 through B3.

    The specimen was collected and placed in formalin on October 18, 2018 at 2:15 p.m. and will receive 28.75 hours of fixation time including processing.

    Final Diagnosis

    1. Right breast, excisional biopsy with wire-guided localization:

    •  Focal atypical ductal hyperplasia, cribriform pattern, with associated calcifications, in background of columnar cell change and columnar cell hyperplasia, no present near margin.
    •  Proliferative fibrocystic changes with usual hyperplasia.

    2. Right breast, additional superior/retroareolar margin, excision:

    •  Benign breast tissue with proliferative fibrocystic changes with usual hyperplasia.

    · Share on FacebookShare on Twitter

Categories