Fibroadenoma Biopsy

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happy-mama-bear
happy-mama-bear Member Posts: 3
edited December 2020 in Not Diagnosed But Worried

I am looking for some advice/comfort. Last week was a horrible week as I saw my obgyn for a breast exam, had an ultrasound, and got scheduled for a biopsy (which isn't until later this month). The radiologist and ultrasound tech who performed my ultrasound believe they found a fibroadenoma in one of my breasts, but they want to make 100% certain.

I have had so many concerns. For one thing, I have been doing research, and am finding that the understanding now is that a biopsy for suspected fibroadenomas can be avoided if all signs in an ultrasound point to it being benign, and the patient does not have obvious risk factors. I am wondering why the radiologist was so quick to want a biopsy? According to him, he likes to get these biopsied because sometimes (although it is rare) cancerous tumors can look like fibroadenomas. Of course, hearing him say this put me into a state of panic! I talked to the ultrasound tech after the radiologist left, as well as my obgyn afterwards, and they both reassured me that it is very common to do biopsies for any solid mass. The ultrasound tech also reassured me that everything she saw looked like a very typical and benign fibroadenoma. (Before the radiologist came in and called it a fibroadenoma, she even said it could be a cyst.)

I am in my late 20's, with no family history of breast cancer. I went in for a breast exam because my breasts were feeling a little lumpier than usual. My obgyn wanted me to get an ultrasound on one breast because it was slightly tender while she was examining it. She said the little lumps felt like milk ducts. Immediately she said "this feels like normal breast tissue, and these are mobile". She felt the little lumps on both breasts, but the side she ordered an ultrasound for was a little lumpier and slightly tender.

I am suspicious (and hoping) that this fibroadenoma has been there for some time without me knowing, and that the lumpiness in both breasts is hormonal or something like that.

I can see how a biopsy would be beneficial so I can have that assurance and peace of mind. But I am also wondering if it could be unnecessary and causing me unnecessary distress? At this point, I am less worried about the actual biopsy procedure and more worried about the reasons behind it being ordered.

I should also mention that the radiologist did say that if we don't do a biopsy, the mass would be monitored every 6 months for the next 2 years. But he did not give me the option of choosing that route. Does that mean he secretly saw something in the ultrasound that looks concerning, that he isn't telling me? He told me I should not stress about this and made it seem like this is protocol- but I am majorly stressing!

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  • Moderators
    Moderators Member Posts: 25,912
    edited December 2020

    happy-mama-bear, we're sorry you're here and worried but wanted to say welcome to Breastcancer.org!

    We can't really help you with your question, but here is good article on Fibroadenomas from our main site that may help you understand the characteristics of this benign condition and diagnosis options, that may help you discuss your particular situation with your doctor.

    Hope you get responses from other experiences members here soon!

    Please come back to let us know how it all goes.

    The Mods

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  • mightlybird01
    mightlybird01 Member Posts: 217
    edited December 2020

    Hello mamm-bear.

    My situation was similar, though I was much older (49), but also no family history of any type of cancer. In my case the mass was found on a routine mammogram (my first), stating a BIRADS 4a rating (meaning only 2-10% chance of it being cancer), confirmed by ultrasound as solid mass. I was automatically scheduled for a biopsy and surgical consult but after talking to the surgeon and looking with her at all my scans where the mass looked rather benign, like a fibroadenoma, I decided to wait 6 months to see if it changed (my Dr. approved of that decision).

    After 3 months of waiting and knowing/feeling that this mass was there (also being a little tender when I was doing my Pilates stretches), I went back to have that biopsy. It turned out it was triple negative breast cancer, although of a very rare type called "medullary". These medullary types can look strikingly similar to fibroadenomas and without a biopsy there is no way to know for sure.

    I honestly don't think that your Dr. saw anything in your scans that suggested to them that the mass would be cancer. It is only their knowledge that yes, it CAN happen in a small proportion of cases (such as mine), that such benign looking masses are indeed cancer. Most likely they just don't want to take that risk.

    I am not telling you this to scare you, just to tell you that there is no way that anyone will know if your mass is cancerous or not without a biopsy. If you have good Dr. and you trust them, I think just go with their advice. You could also seek a second opinion. But Dr. will probably err on the side of caution and always rather suggest the biopsy. Maybe you don't have to wait 6 months, wait maybe 2 months and see if anything changes with respect to the tenderness or size of the mass. That slight tenderness during my Pilates stretches was actually bothering me and the main reason I went back after 3 months instead of 6.

    I think only you can decide if you are willing to have that biopsy and get peace of mind, or you can live with that question over your head of whether it is cancer or not for the next 6 months to 2 years. You are very young to have breast cancer, so that does speak in your favor too.

    Good luck with your decision!




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  • Beesie
    Beesie Member Posts: 12,240
    edited December 2020

    happy-mama-bear,

    To my understanding, masses that appear on ultrasound to be fibroadenomas more often than not are not biopsied in younger women (teens, 20s) but usually are biopsied in women who are older than that. The reason is simply that as we age, our risk to develop breast cancer increases. This means that in younger women, what appears on imaging to be a fibroadenoma is virtually always a fibroadenoma. But as we get older, the risk increases (although still remains very small) that something that appears to be a fibroadenoma might be something else. mightybird certainly was in the age group where fibroadenomas are usually biopsied, and she ended up being one of the rare situations where cancer was found.

    You are not quite into that "usually biopsy to confirm" age group, but you are close to it. So it sounds to me that you just have a very conservative radiologist. That's my guess. Do you have a copy of your imaging report? If there are any suspicious features associated with this mass - anything that suggests that it could be something other than a fibroadenoma - that should be noted on the report. Also on the report should be a BI-RADs assessment. Since the radiologist has recommended a biopsy, it's probably a BI-RADs 4, maybe specifically broken down to BI-RADs 4A. Usually for insurance purposes, a BI-RADs 4 is necessary to warrant a biopsy. But since the radiologist mentioned 6-month monitoring, it's possible that he assessed a BI-RADs 3 but is recommending a biopsy anyway.

    As for going ahead with the biopsy, the radiologist might not have offered up a choice, but it is up to you. You get to decide what tests are done on your body. As you said, having the biopsy now might be beneficial to get assurance and put this behind you. But if you would prefer the 6 month watch-and-wait approach, I'd suggest that you take a read through the report to ensure that there is nothing to indicate any concern that this could be anything other than a fibroadenoma, and then talk to your obgyn.

    Hope this helps!


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  • happy-mama-bear
    happy-mama-bear Member Posts: 3
    edited December 2020

    Beesie,

    Thank you for your response! It does help. I have been thinking the same thing- that the radiologist is being conservative. I just saw the official ultrasound report, and they categorized it as 4. This sent me into a panic at first, but as I am reading up on the BI-RAD scale, I'm thinking I was probably bumped to 4 because I am over 25? I am waiting to hear back from my obgyn today so I can ask her more questions about the ultrasound. I hate that the report says "suspicious abnormality Category 4". But am hopeful that this is a technicality? I am also going to ask to see my ultrasound images myself, because I am just going off of the couple minutes I saw while it was being done! Everything I am looking at online though suggests to me that it is a typical fibroadenoma... oval, small (it's less than a cm), hypoechoic. It looked really dark and not fuzzy. Maybe the radiologist could see some calcifications, which is also not uncommon for a fibroadenoma?

    Thank you again for your help! :)

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  • happy-mama-bear
    happy-mama-bear Member Posts: 3
    edited December 2020

    Mightlybird01,

    Thank you for your response! I am sorry to hear about your diagnosis. I am so glad you went and got the biopsy sooner than planned!

    I am going to go ahead and get the biopsy. I just saw the official ultrasound report today, and my mass was categorized as a 4. (I am waiting to talk to my obgyn about this, to see if it was 4a.) I hate that it was categorized this way, but am hopeful that it is a technicality since I am over 25? (I'm 27.) Everything I am looking at makes me hopeful that it is a benign fibroadenoma.

    It is frustrating that I still have to wait a week and a half to get my biopsy... so the waiting is torture right now.

    Thanks again and take care!

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  • Beesie
    Beesie Member Posts: 12,240
    edited December 2020

    One reason it would be categorized as a "4" is because a "3" might not get approved for the biopsy, and the radiologist, for whatever his reasons, is recommending the biopsy. Here is an explanation of BI-RADs categories. As you can see, a "3" does not come with a biopsy recommendation, which is why it could be refused by an insirance company.

    image

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