Lumpectomy to get a diagnosis?

Hello Did you have a biopsy? Or was that not offered before lumpectomy. I'm new on here, so all of this is new to me.

Praying!

I am in the boat right now. Had DCIS right breast in 2013, DCIS left breast 2017, and now FEA and ALH in the right. I am waiting for a date for an excisional biopsy. If DCIS again, or worse, I will have a mastectomy, but I am now wondering even if not upstaged, if a mastectomy would be the best choice due to the risk.

Mamaofthree

A small but important point of information: Technically, since you don't know what it is, you've had an "excisional biopsy". The term "lumpectomy" is reserved for removal of a known cancer. If this is benign, and in the future you put "lumpectomy" on a history sheet they may think you have had cancer. It will at least confuse matters.

Mamaofthree

That is odd for a couple of reasons. Is this a general surgeon or a surgeon whose practice is limited to breast? Maybe he feels very sure its benign?

I have not yet worked with a fellowship trained breast surgeon who would remove a solid mass without first obtaining an image guided biopsy to know how to plan the surgery. When doing it without having a tissue diagnosis first, you run the risk of needing a second surgery for wider margins and a sentinel node dissection.

I suppose you could do a frozen section in the OR and change the procedure if it comes back cancer but then you haven't had the Nuc Med injection necessary for a sentinel node dissection. I'm a little confused.

I have had 2 excisional biopsies and both times in the OR when they make you say what you're there for I said "excisional biopsy" and they wrote lumpectomy and told me that is what they considered it. I always thought it was for a known cancer too, but interesting; I wonder if the terminology varies place to place.

Mamaofthree, now that you've explained more about your situation, it actually makes perfect sense.

You had a needle biopsy, as would normally be expected when something suspicious shows up on imaging. The results of the needle biopsy were discordant. This means that the imaging showed one thing but the biopsy results showed something else. In other words, from the imaging, it appeared most likely that the suspicious area was "ABC" but the biopsy found "XYZ". It also appears that the needle biopsy sample was small, which can happen if the area of suspicion is in a location of the breast that is hard to access with a needle, such as near the chest wall or up against the skin. With a too small sample, it's possible that the area of suspicion wasn't adequately sampled, which could explain the discordant result.

The normal next step after a discordant or incomplete needle biopsy is to follow-up with an excisional (surgical) biopsy, which is what you've had done. This is still a biopsy, but to ensure adequate sampling, the entire suspicious area is surgically removed.

As for your procedure being called a lumpectomy, as djmammo noted and as I mentioned in my earlier post, the more accurate/correct term for your surgery is an excisional biopsy, since the objective is to biopsy the suspicious tissue to determine whether or not there is any cancer present. In my years on this site, I have seen situations where insurance companies, doctors and hospitals sometimes call an excisional biopsy a lumpectomy. This can be confusing to the patient, and as djmammo points out, it can be confusing to other doctors in the future if they see the word "lumpectomy" on a medical history for a patient who has never had breast cancer. From what I've seen, the term "lumpectomy" is usually used only for administrative ease. Although the objective of each operation is different, the basic surgical procedure is the same, so by using one name for both operations, a facility only needs to prepare one procedural document and doctors, nurses, anaesthesiologists, etc. only need to be familiar with only one set of processes.

Over the years, I've had 3 excisional biopsies, although I honestly don't know what any of those 3 hospitals called the procedure. Two were benign and one found cancer.

Good luck with your results. Hope it's benign

The definition should not vary. Breast specialists in all disciplines use the definition below from the National Cancer Institute.

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/lumpectomy