Radial scar vs malignancy and surgical excision/biopsy.

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thecanos3
thecanos3 Member Posts: 7
edited April 2019 in Not Diagnosed But Worried

Jan 2019, mammogram abnormal with architectural distortion. @ 2cm, spirical. I had follow up ultrasound and 3-D mammogram. Results were in inclusive and the radiologist categorized B-RAD 4 with recommendation to Breast Surgeon for surgical biopsy to determine radial scar vs malignancy. Breast Surgeon decided on stereotactic breast biopsy which was conducted last week-March 2019. It was challenging for technician and Rafiologist since I have dense breast tissue and the spot was deep, close to breast bone Between 1 and 3 position. I have scheduled appointment tomorrow with Breast Surgeon to discuss next steps, however, I had not received results so I called office and nurse said Results were B9 breast tissue but they recommend a surgical biopsy and I think excision. The Breast surgeon still had to confirm results with Radiologist. We’ll talk with her tomorrow. So, I’m assuming they are being extra cautious right? But reading NIH studies, anything over 1cm is high risk for
malignancy. What should I expect with a surgical excision? Is this normal practice. I worried
myself this past week to induce migraines, thought of waiting again is stressful. Are there any questions I should be asking the Breast surgeon? Thanks

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  • djmammo
    djmammo Member Posts: 2,939
    edited March 2019

    thecanos3

    Several things

    When a biopsy is performed to check for A vs B and neither A or B is found, the path results are considered "discordant" and the area is either re-biopsied or removed.

    In your case the A vs B is cancer vs radial scar and since both are routinely removed by a surgeon there's no point in re-biopsy.

    In order for your surgeon to find it since I assume its not palpable a wire localization will be performed by the radiologist using the modality that best demonstrated the finding. Following local anesthesia a flexible wire is placed at the target though a needle that is inserted into the breast guided by that imaging modality. The surgeon removes the tissue around the wire and that specimen is x-rayed to show they got the right area.

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  • thecanos3
    thecanos3 Member Posts: 7
    edited March 2019

    thank you, this helps. I’ll definitely know more today after discussing next steps with Dr. I’m much better today and a bit more rational in my thinking.

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  • buffalowings
    buffalowings Member Posts: 24
    edited March 2019

    I was recently diagnosed with something similar after a core needle biopsy(complex sclerosing lesion, essentially a larger radial scar) and had my consult with the breast surgeon this week. It is going to be surgically removed and as she explained to me (and I had roughly gleaned from reading), they are always removed and fully biopsied to make sure no malignancy is hiding in them. In something like 5-10% of cases there can be a lurking spot of malignancy a biopsy missed. Odds are high (90-95%) if it was biopsied benign from the core needle procedure it will come back benign after the excision, but since these lesions have been found to coexist with cancer in a not-negligible number of cases, they are always excised. Seems prudent to me and I will be happy to have it out.

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  • thecanos3
    thecanos3 Member Posts: 7
    edited March 2019

    thanks, I met with the breast surgeon yesterday and she pretty much said the same thing. It’s inconclusive at this point until they can biopsy all the tissue. It’s in a challenging area as well so the radiologist was afraid they may have missed something. I agree it’s better to be safe and remove it. I have surgery scheduled for early May. It makes it more challenging since I don’t want to share it with my mom since my dad has stage 4 lung cancer w Mets to bone. I don’t want to unnecessarily worry her. But she’s my emotional rock. Good luck too let me know how it goes

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  • thecanos3
    thecanos3 Member Posts: 7
    edited April 2019

    Update-- the pathology report was finally received April 3 surgery is now scheduled on April 23 to have surgical excisional biopsy. I researched all the terms but could not find anything on Multilevel aplasia. however, my understanding is the combination of all the cytology points to an underlining cause.... just hoping not cancer

    pathology report --

    Left breast benign breast tissue with stromal fibrosis. Cystic duct

    dilation. Apocrine metaplasia. Multilevel aplasia. Calcifications in the

    ductal structures. No malignancy identified.

    Radiologist comments: Pathology diagnosis is not concordant with

    imaging.

    Recommendation: Surgical consultation for needle localization and

    excisional biopsy
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  • djmammo
    djmammo Member Posts: 2,939
    edited April 2019

    thecanos3

    Are you sure it says "aplasia" and not metaplasia, hyperplasia, etc ?

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  • thecanos3
    thecanos3 Member Posts: 7
    edited April 2019

    Multilevel aplasia

    Is on pathology report. Maybe they transcribed it incorrectly?

    What I posted above was on pathology report as an addendum. The first report only described procedure and did not have the histopathology.

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  • djmammo
    djmammo Member Posts: 2,939
    edited April 2019

    thecanos3

    That's a new one on me.

    Typo? Radiologists and pathologists in most places make use of voice recognition for reports. The software is not infallible.

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  • thecanos3
    thecanos3 Member Posts: 7
    edited April 2019

    Thanks

    I’ll ask my doctor.

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  • thecanos3
    thecanos3 Member Posts: 7
    edited April 2019

    Update

    So had surgical biopsy yesterday 4/23. Dr called this am and said it was early non evasive ductal carcinoma in Situ She seems to think she removed it. I meet with her May 1 to discuss treatment plan.

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  • marie5890
    marie5890 Member Posts: 3,594
    edited April 2019

    Hi Canos,

    That is DCIS and is the earliest BC is detected at. Many times, it never becomes invasive

    Here is a link to another part of the forum that is an extensive write up about DCIS

    Layman's guide to DCIS

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