Why Biopsy some but not others

Thank you so much for the incredibly helpful (and kind) responses. I don’t have a report (it honestly did not cross my mind that I could request it). I just had the mammogram Monday and the ultrasound right after. The radiologist “closed-out” following the incidental findings from the first mammogram when I was 40. At the end was when I told her I felt something. She did an ultrasound and then said she wants to biopsy

I received the summary via email (thanks for suggesting that it was an option to ask for a copy of the report).

HISTORY: 43‐year‐old female with history of probably benign mass in the 10:30 right breast 7 cm from the nipple.

COMPARISON: Prior exams dating back to 2/3/2017

FINDINGS: Routine low dose tomosynthesis 3D with reconstructed 2D medial lateral oblique and craniocaudal digital mammographic views of both breasts are submitted for review and compared to prior exams.The mammary parenchyma is heterogeneously dense which may lower the sensitivity of mammography. The probably benign mass in the 10‐11 o'clock right breast appears stable. Calcifying fibroadenoma remains stable in the central posterior left breast. No new dominant mass, suspicious calcifications, architectural distortion, skin thickening, nipple retraction or abnormal lymph node enlargement are seen. There is no significant interval change from the previous exams.

Targeted bilateral breast ultrasound: Ultrasound of the 10‐11 o'clock right breast 7 cm from the nipple reveals an ovoid circumscribed hypoechoic mass measuring 1.4 x 1.8 x 0.7 cm which appears unchanged from prior ultrasound dating back to 2/15/2017.

While scanning, patient reports areas of palpable concern in the 9‐10 o'clock right breast and 2 o'clock left. Ultrasound of the area of palpable concern designated by the patient in the 9‐10 o'clock right breast 11 cm from the nipple reveals a heterogeneous hypoechoic area measuring 1.5 x 1.2 x 0.7 cm. Ultrasound of the area palpable concern designated by the patient in the 2 o'clock left breast 14 cm from the nipple reveals normal‐appearing glandular tissue with no discrete solid or cystic antimony.

IMPRESSION: Previously noted probably benign mass in the 10‐11 o'clock right breast 7 cm from the nipple appear stable from 2/15/2017 and is now considered a benign finding given its stability for over 2 1/2 years. Indeterminate hypoechoic area in the area of palpable concern in the 9‐10 o'clock right breast 11 cm from the nipple. No mammographic or sonographic discrete abnormality in the area of palpable concern in the 2 o'clock left breast 14 cm from the nipple.

RECOMMENDATION: Recommend ultrasound‐guided core needle right breast biopsy for the indeterminate hypoechoic area corresponding to the area palpable concern in the 9‐10 o'clock right breast 11 cm from the nipple. Further management or decision to biopsy the area of palpable concern in the 2 o'clock left breast 14 cm from the nipple should be based on the physical exam and clinical assessment.

This mammogram was interpreted following analysis with Computer‐Aided Detection technology. The patient has been notified of the results and recommendations.

Final Assessment (4): Suspicious abnormality ‐ biopsy should be considered.

djmammo - thank you very much. The sheet the rad handed me called it a “mass" but you helped me feel better. I am going to try to be calm and zen about it and will go in next Thursday for the core biopsy.

I admit I was a little confused when the rad said that I might want to talk to a breast surgeon due to my finding something palpable on the left side. When she looked with the ultrasound she said it looked like normal glandular tissue but that I might want to talk to my GYN and a breast surgeon. This is a new GYN to me and she doesn't know me aside from my first visit to see her two weeks ago,but maybe we will come up with a plan after we get results back from the core biopsy.

Thanks for all the help and support - what a wonderful resource this is!

djmammo - is it okay to ask the radiologist to check the left breast on Thursday prior to the biopsy. I tried a breast self exam last night to familiarize myself with things pre-biopsy and fully understand how confusing this is. To me, the left breast feels way more concerning to me and I feel a palpable area on the left. Is there a way to get a thorough ultrasound of each breast. I see the radiologist mentioned possible follow-up. Would that be with a breast surgeon