Biopsy scheduled - questions

Rachael - it's best if you start one thread and stick with that thread so people can get to know you. But I'll answer on this one.

There are lots of of threads about the different types of biopsies. You can search by that name. Are they really cutting? Or is it a punch biopsy or needle biopsy? If you're unsure, take your copy of your mammo & ULS films and go find another doc for a 2nd opinion

But yes, you do want a clip so they can keep track of what has already been ruled out.

I requested no clip because it's possible I have a metal allergy (not tested but various doctors have been cautious and assumed I have one). The biopsy area still showed enough for the MRI and surgery. Plus, the radiologist, nurse, and ultrasound tech were delighted to have an unused clip to examine and dissect.

When you add a new post, it bumps that discussion thread up to the top of the active list. People who've responded previously will notice it, and those who didn't reply earlier will havethe benefit of getting all the information and seeing the previous responses.

Do you feel that this lump has increased in size since you first noticed it two years ago? If not, I wouldn't think that a biopsy is necessary. And I don't know how an ultrasound guided biopsy can be done if the mass isn't showing up on an ultrasound.

Do you have copies of the mammogram and ultrasound imaging reports? If not, get them. You need to know what they say to decide if a biopsy is warranted. Since the referral was optional, my guess is that your imaging has a BIRADS 3 rating, which usually means a 6 month follow-up rather than a biopsy. But without knowing what the report says, it's all speculation.

Okay, I didn't want to say it, but your comment "is she just out to make money" is what I was wondering too.

Maybe she does want to get to the bottom of what this lump is that you've had for several years, but why not an MRI before the biopsy? If the MRI shows the mass, it will be easier to do the biopsy.

Given that you've had the mass for years, given that if feels soft (which might suggest it's just breast tissue - I always had what felt like a lump that was just a natural part of my breast tissue) and which would explain why nothing is showing up on your imaging, if you are uncertain about having the biopsy, I don't think a delay would be a problem at all, if you need to delay in order to get a second opinion.

Nvrachel19 et al

There is a lot to "unpack" here. I'll try to reply to all the key comments

"I've had a lump that is sometimes painful for a few years now. Had an ultrasound two years ago, showed nothing. Had my first mammogram and ultrasound two months ago, showed nothing. I haven't noticed it or symptoms changing though through the years." "The ultrasound and mammogram both say BIRADS 1: negative."

If we see something on a mammogram or US that we think is benign, we follow it up. If there is no change in 2 years we leave it alone. In your case nothing was seen.

"I really don't want metal in my body if it is somewhat optional."

It is not optional. It is an important part of the diagnostic process. If the lump needs to come out, the marker comes out with it anyway. If benign, it acts as a do not disturb sign for future exams. It can be removed after a benign diagnosis if you want but you will need to tell every imaging center from now on about its removal.

"What I can tell you is that a vacuum assisted biopsy is a needle biopsy, not a surgical biopsy, so there will be no cutting into your body."

In essence the vacuum assisted device is like a hand held stereo biopsy unit. They are automated/motor driven and much smaller now than in the past and battery operated. The hospital bought us one as they can bill more for a biopsy done with it than with the usual spring loaded gadget. They are good at what they do but for me they take longer and are not ergonomic enough, my wrist aches after using them.

"Did the surgeon specifically say that the plan is to do an ultrasound guided biopsy, or is the lump palpable in which case no guide is necessary?"

Is the surgeon a 100% full time breast surgeon or a general surgeon who also does breast? How many image guided biopsies do they do a year? None of the full time Breast Surgeons I have worked with did their own biopsies, they were too busy in the OR.

"The doctor specifically said ultrasound guided and vacuum biopsy."

Unless specializing in breast I can't imagine a surgeon's office having the proper US equipment for breast imaging and if it's not for guiding the biopsy I can only think it would be for the required documentation, that is images taken of the needle in the breast to prove it was done.

"Originally the radiologists said not to worry and check again next year. Then I got a letter in the mail with an optional referral to see a specialist"

The comment about the specialist may have been part of a form letter and not a specific recommendation.

"But even with the BIRADS 1, they still want the biopsy because of being able to feel a lump."

I assume this is the surgeon's office talking.

"Does anyone know how often both mammogram and ultrasound would miss a tumor?"

For a palpable lump the size you are describing it would be very odd for it not to be seen on 2 exams done 2 years apart.

"I asked about doing MRI or thermography and she said it wouldn't help."

This statement regarding the MRI is false. Thermography is a scam.

"Neither does it make sense that a surgeon is doing this procedure on a Saturday - in her office. I don't know any "established" docs who work on Saturdays."

It does seem odd. Is the location of the biopsy the same as the location of the office you visited or somewhere off-site?

"She just said an MRI wouldn't help because if the MRI doesn't show anything, I need the biopsy."

This is a completely false statement. Although false positives are common, the negative predictive value of a normal breast MRI is somewhere around 98% especially in light of both a neg mammogram and neg ultrasound.

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You can Google any physician and find out their training and qualifications as well as their area of specialization fairly easily if you have any doubts (and yes I actually recommended Googling something). You want to see that a doctor was educated at a reputable institution, trained in the specialty that applies to your specific health problem, are licensed in your state and accepts your insurance. Some sites will also tell you if the doc has been sued for malpractice which is a valuable piece of information if it relates to the service they intent to provide to you.

If the images really show nothing, a review of them by a different radiologist would not help, you would have to have another set of images done somewhere and ins may or may not cover that. If you could get your ins company to cover an MRI that would put this question to rest. The wording of the request coming from your PCP or Gyno would be critical and have to say something like "pre-op mri for suspicious lump not defined on Mammo or US" or something to that effect to convey to the ins company that it is medically necessary. Good luck. Keep us in the loop.

I would high tail out of there if it was me. You need another opinion. Take your reports to one of the larger cancer centers. surely there is one in Vegas. Good luck to you.

Here's the thing. Officially there is no such thing as a "Breast Surgeon". Breast surgeons are General Surgeons who specialize in breast surgery and ideally exclusively perform breast surgery and nothing else. Some doctors use the title "Breast Surgeon" but it means little, since there are no specific qualifications that designate a surgeon as being a "Breast Surgeon". I'd guess (or hope) that most surgeons who use the title "Breast Surgeon" are honest and have in fact trained in breast surgery and focus much of their practice on breast surgery. But a surgeon who does only 5% of his surgeries on breasts could still call himself a "Breast Surgeon". On the other hand, my surgeon, who exclusively does breast cancer surgery and is head of the Breast Surgery department at a leading cancer hospital, uses the title "General Surgeon".

What you want to look for is training, not title. Through his/her medical education, did this surgeon specialize in breast surgery, perhaps having a fellowship in breast surgery? You want to look at focus. What areas does the surgeon list that he/she works on? Just breast surgery or only two or three areas, or a long list of areas? And you want to look at reviews. Are they all for breast surgery or are most for other types of surgery?

I'm sure you can find true breast specialists in Vegas, but it might take a bit of digging to figure out who's who. I'd say it's worth looking, and worth cancelling/delaying your Saturday appointment for the biopsy. You can always reschedule later if it becomes apparent that a biopsy is advisable, and that this doctor is a good choice. At this point there is nothing that sounds urgent about your situation, nothing that says you should go ahead with the current biopsy plan despite your questions and concerns.

My surgeon is listed as a general surgeon, but she and another general surgeon have their offices in the breast health clinic at the hospital complex I use. They only do breast surgery. Most hospitals have breast health areas and that would be a good place to start with inquiries about finding a breast specialist. At the mid-size hospital I used, it was all seamlessly connected: mammogram, then notification of follow-up needed with ultrasound and possible biopsy. The u/s findings showed I did need a biopsy, and that was done on the spot by a dedicated breast care interventional radiologist. From there, I got an appointment with the surgeon, in the same location. I guess I could have gone outside that clinic if I'd asked for a different doctor, but I liked and trusted everyone in that breast center. The MRI, surgery, and radiation were in the main hospital building.

AliceBastable: I would say you were lucky that your breast center care was so seamless. Although I went to a designated breast care center for a follow-up mammogram and an ultrasound, the radiologist who performed the ultrasound scared me half to death and he physically barred the door so I could not leave the room. He insisted I was not able to leave the department until I had made an appointment with a breast surgeon. I found this to be an utterly useless waste of my time since they knew they needed to biopsy what they had found on ultrasound. However, they did get to charge for a surgeon visit pre and post biopsy. If I had been able to think clearly or had better direction from the nurse navigator, I might have had a more positive experience. It left me wondering what the nurse navigator's role was since I had little if any direction here.