MRI-guided biopsies...

robinorbit · July 2020

I underwent an MRI on 7/9 to check for the extent of my DCIS, which found it to be 1.1 cm. IDC measured the same as what was shown on mammo and ultrasound. MRI also found a 1.6 cm enhancing nonmass and an a 4mm enhancing focus, both apparently in the same ductal system, but 3cm and 6cm away from IDC, respectively. All are outer left 2:30 or 3 pm. So I get to have two MRI guided biopsies because of suspicion there’s more DCIS. Has anyone here had MRI-guided biopsy? I confess I don’t understand how my breast would be accessible while I’m inside the machine—can anyone explain?

Thanks!

cookie54 · July 2020

So the MR is done the same way a regular breast MR is performed. You will be scanned first to localize, the areas to be biopsied. Then you will be pulled out of machine and the radiologist will place needle for biopsy as you continue to lay on your belly. The radiologist has coordinates off of the scan that they follow to be sure needle is in correct position. It is typically a vacuum type biopsy then the radiologist will place a marker in your breast for future reference. I have had a couple it's not too bad just a little longer than the regular breast MR. Either way I know it's not the most comfortable. Best of luck to you.

FarAwayToo · July 2020

I was initially diagnosed with invasive cancer in the right breast, via US guided biopsy. Left breast looked clean on mammo, but I had pre-treatment MRI and suspicious areas were found in the left breast. There were two of them, both got biopsied with MRI guidance. It's exactly how cookie described above. Because there were two areas, and all the pulling in out of the machine for biopsy, then for marker placement, it took almost 2 hours. Waaay longer than normal breast MRI which usually takes 30-40 minutes tops. Ask the staff to make you as comfortable as possible (pillow under your legs, blanket if you like it). And I hope they won't find any more cancer for you!

robinorbit · July 2020

Cookie54 and FarAwayToo—Thank you both so much for your replies! I need to take Ativan before MRI for claustrophobia, and I almost had a panic attack last time even with the Ativan; but I was able to shut everything out. It may be harder to do that when I’ve being put in and out of the machine a few times—so that’s good to know!

FarAwayToo—Did the two MRI biopsies end up finding DCIS in two spots in your left breast? I’m certainly worried I’ll end up having three plus the IDC, and I’m wondering if they would be able to do a lumpectomy since all are apparently in the same quadrant—kind of lined up. I’ll likely have to wait another couple of weeks for the biopsies, so I guess I’ll have plenty of time to worry.

Thank you both again, and hugs!

R

FarAwayToo · July 2020

Robin, yes, they did find DCIS, but I'm eternally grateful for the fact that they did their due diligence with MRI and biopsies, especially since it was in a different breast than my invasive tumor. Until that point I was thinking lumpectomy, and started to lean towards mastectomy. Once they found DCIS in another breast, the decision to have BMX was easy.

I hope they do not find any more cancer in your case.

robinorbit · July 2020

FarAwayToo, I’m sorry they found DCIS in your other breast. But I, too, am greatful they did the MRI because as soon as I was diagnosed with DCIS which they didn’t see on mammo or US, I was so worried about what else might be hiding elsewhere in the same breast as well as the other. I do feel more at ease now.

I hope you are all healed from your surgeries and tolerating the Femara.

Thank you again for your thoughtful responses.

robinorbit · July 2020

Well, I had the two MRI biopsies today and procedure went fine and was just as described in the posts above.

These are quite a bit more painful than the US biopsy. The radiologist said that's because they take many more samples with MRI biopsies as they're unable to watch imaging while they biopsy as they are with US biopsy. To make up for the lack of precision, they take more tissue samples to ensure they get the right spot. Ouchie. The tech said it looks like I may may have a hematoma as well

cookie54 · July 2020

Robin, So glad you were able to make it through your biopsies ok! Best wishes as you move foward on this journey. Stay strong and be well.

NewAndNervous · July 2020

Thank you for this post, Robin! I'm new to this board and my original MRI showed non-mass enhancement (nearly 5cm) which requires MRI guided biopsy bilateral - scheduled for this week. I am beyond nervous about this test! I barely made it through the first MRI which is clearly much shorter. I am taking Ativan this time (learned the hard way that I should have used that to ease anxiety for the first test).

Has anyone else had a non-mass enhancement of this size (spanining 5 cm)? I think this is a very large area??? If so, could you share your experience - what was the final diagnosis and treatment plan?

Thank you for any replies. I am so grateful to have found this board. I'm still in testing phase with no clear diagnosis yet, but this board helps me feel not so alone on this journey.

Beesie · July 2020

My large area of non-mass enhancement on an MRI turned out to be DCIS. I'd already had an excisional (surgical) biopsy that had found a tiny IDC, lots of DCIS and lots of involved margins. The subsequent MRI confirmed the presence of more "stuff" (yeah, that's the word my surgeon used, saying that until the surgery, we couldn't know for sure what it was) and my MX pathology found it all to be more high grade DCIS.

As a general rule, DCIS tends to be more widespread than IDC, so my guess is that having a large area probably leans the diagnosis toward DCIS rather than it all being invasive cancer, if it is malignant. Apparently, non-mass enhancement on an MRI can turn out to be all sorts of 'stuff':

"A wide variety of benign, high risk and malignant processes can manifest as non-mass enhancement:

fibrocystic changes
pseudoangiomatous stromal hyperplasia (PASH)
apocrine metaplasia
radiation therapy effect
flat epithelial atypia
atypical ductal hyperplasia
radial scar/complex sclerosing lesion
intraductal papilloma
ductal carcinoma in situ
invasive carcinoma of no special type (ductal carcinoma not otherwise specified)
invasive lobular carcinoma"

https://radiopaedia.org/articles/non-mass-enhancem...

Ladyc2020 · August 2020

i just got my mri restults back and they found 2 more spots. Now need mri guided biopsies. Anxious. How bad was it?

robinorbit · August 2020

Hi Ladyc2020,

I did not find the MRI biopsies much different than the 2-breast MRI; I took 1 mg Ativan for both, however. The biopsies were slightly more uncomfortable only because I was required to lay atop the unbiopsied breast during the procedure. The biopsies were completely benign -- great news!

My "recovery" from the MRI biopsies was not good, as I developed a large and painful hematoma, that got infected, and which affected my surgery. The infection cleared after a week of antibiotics, but gave me fever and malaise for three weeks. (Of course those symptoms freaked medical personnel out so I had to get tested for COVID at the time--negative). Today, 6 weeks after the biopsies, the dark bruising all over my breast (even non-biopsied sites) is almost all faded; some redness remains, and the hematoma has shrunken a bit.

My surgery was delayed a few weeks to allow the hematoma to further reduce. Also, I am now required to have wire localization for my lumpectomy (rather than less intrusive savi scout) because the hematoma reduces the accuracy of the other localization method. Finally, my new surgeon (I requested a new surgeon for other reasons) states he will have to surgically remove the hematoma along with my cancer and DCIS. [And fun fact: new surgeon stated that he would NEVER have ordered MRI biopsies based upon the MRI findings. Oh well. It reaffirmed that I was correct to request a new surgeon.)

Of course, imaging staff do take measures after the biopsies to try and prevent hematoma and bleeding, and you can as well, so you're not likely to experience the same thing I did.

I do wish you a smooth biopsy experience with no complications, and good results. Let us hear how it goes for you.

SIncerely.

R.

Ladyc2020 · August 2020

this is very helpful, thank you so much. Do you mind me asking how big the spots were which were found on the MRI? I am of course praying for them to be benign. My surgeon consulted withe the tumor board (30 drs he said) this morning and they decdied Best to biopsy befire choosing which surgery. I had been very hopful that I would just have a lumpecomy, and this is a real blow.

dread2020 · August 2020

So sorry they found spots, Ladyc, but their decision to biopsy isn't necessarily ominous. I had two small nodules detected on right breast ultrasound, in the process of discovering the left breast IDC, and although the radiologists classified those as bi-rads 3 (probably benign with follow-up in 6 months), my breast surgeon said she would go ahead and biopsy them anyway, just to not leave any stone unturned.

Ladyc2020 · August 2020

dread2020 thank you. Did they turn it to be benign in pathology?

MelissaDallas · August 2020

Ladyc2020, the problem with MRIs is that they are very sensitive but also very nonspecific, so yes, they lead to lots of benign biopsies

dread2020 · August 2020

they didn't get biopsied yet, i have my mri scan today which will be followed by biopsies of anything found there and left unchecked from previous ultrasounds. i thought the biopsies would be tagged on to the mri session today, but now i think they might be in a separate visit, so won't know for a while.

Ladyc2020 · August 2020

dread2020 it sounds like we are both waiting on more things, and that is no fun. I don’t have any info on my MRI, location and such... he just said deeper. Am actually nervous to find out.

Have 2 ultrasound core biopsies on this Monday for the found spots and then the next Monday I have 2 mri assisted biopsies. The scheduler said the dr wanted them closer together but there isn’t a radiologist to the do the mri one until a week later.

Has anyone else had both sets of biopsies after finding spots on MRI? He said they were both 5mm

Ladyc2020 · September 2020

I had my MRI assisted biopsy today and it was a pice if cake with 5mg Valium. One of the legions seems to have disappeared and they could not find any trace of it. So just one biopsy.

robinorbit · September 2020

LadyC—

I’m glad it went well! Three cheers for pre-meds!

It’s good news that one of the areas has seemingly disappeared! I hope you recover well from the biopsy. :

Ladyc2020 · September 2020

orbit - thank you so much, yes it was good news!

And I can’t believe people do the MRI biopsy with no meds... or why I was reluctant to try meds.

trishazma · October 2020

Hi everyone. Glad I found this group. I was just advised of the following and am trying to figure out what it means. Any help would be very much appreciated. So here is what is on my report::

INVASIVE LOBULAR CARCINOMA, 1.0 MM IN GREATEST DIMENSION WITH ASSOCIATED EXTENSIVE LOBULAR CARCINOMA IN
SITU WITH ASSOCIATED STOMAL FIBROSIS SUGGESTIVE OF RADIAL SCAR FORMATION, SEE COMMENT.
Comment: Immunohisto chemical stain for E-Cadherin is absent in the small focus ofinvasive carcinoma and in the in situ
carcinoma.Immunohistoc hemical stain for CK5/6 and p63 show absence of myoepithelial cell staining in the small focus of
invasive carcinoma. ER is moderately positive in 90% of the cells of the invasive carcinoma.

note from me: it seem like I dont have cancer. would you guys agree. thanks

MelissaDallas · October 2020

Trishazma, I answered your other post

https://community.breastcancer.org/forum/71/topics/877957?page=1#idx_1

MRI-guided biopsies...

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