Question about Discordant Results

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Sunnygurl
Sunnygurl Member Posts: 15
edited December 2020 in Waiting for Test Results

When I met with the breast surgeon prior to my biopsy, he mentioned that if there was discordance between imaging and biopsy results, he would want to perform surgery to remove the suspicious area of micro calcifications. I was a little surprised as I just assumed that a benign biopsy result would be the end of this scare. Or at worst, maybe that would require just another test. Is this typical? Has anyone else had benign biopsy results and still needed surgery to remove the area? (As an aside, no palpable lump has been felt

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited December 2020

    Sunnygurl, do you have, or can you access on a portal, your radiology reports? It would be really helpful to know specifically and exactly what they say. Additionally, it is a good practice to obtain and keep copies of all imaging and reports for future reference and if you should ever need them for comparison purposes at another facility in the future.

    That said, it sounds like the surgeon strongly suspects there is a non-benign process going on, and that if the (always) limited number of cores don’t reflect that he wants it investigated further. Are their benign things that tend to look “ominous” on imaging? Yes, a few. It absolutely does happen that benign biopsy results do not agree with what the imaging appears to show, in which case an excisional biopsy is performed to resolve the discordant findings. Excisional biopsies are also done when needle biopsies reflect atypical findings like atypical ductal or lobular hyperplasia or lobular carcinoma in situ (high risk condition) because about 20% of the time on wider inspection DCIS or invasive cancer are found around or within the sampled area. Does this absolutely mean you have breast cancer? No, too early to say that. If it is any consolation, I found my surgical biopsy to be easier than my stereotactic one

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  • sasamat
    sasamat Member Posts: 53
    edited December 2020

    I got the same "pep" talk, but from the radiologist, after a recent stereotactic core biopsy of 2 sites (no palpable lumps, BIRADS 4a, microcalcifications). She prepared me for discordant results, because they could not clearly see microcalcifications in the cores they were getting from one of the sites. She predicted I would need a repeat core biopsy at a different facility, with a better table, that afforded a better approach to a difficult site.

    However, this became a moot point because cores from that site showed atypical ductal hyperplasia (one of the lesions MelissaDallas mentions), which apparently always merits an excisional biopsy (happens next week).

    They could see microcalcifications in the cores from the other site and the pathology came back as fibrocystic change, among other stuff. They are content with the benign result there and it needs no further follow up. Hopefully this is what happens for you!

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  • peggysmom
    peggysmom Member Posts: 50
    edited December 2020

    Hi, so your breast surgeon performed the biopsy? Not sure if breast surgeons who perform their own biopsy can comment on radiology-pathology concordance.

    Radiologists usually comment on concordance. When biopsy path results comes back radiololgists re-review the case to determine "concordance" (does it all jive? i.e. imaging findings match what the pathologist saw under the microscope) and radiologists then make a path addendum with recommendations.

    Anytime there are discordant findings (usually the scenario is imaging looks suspicious & pathology came back benign) sugical excision is the next step. A surgical excision gives the pathologists a bigger chunk of tissue to look at under the microscope and do special stains on.

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  • Sunnygurl
    Sunnygurl Member Posts: 15
    edited December 2020

    The radiologist performed the biopsy but I met with the surgeon that same morning of the procedure.

    Ok, so I understand that I should ask for all of my medical reports (I have an appt with the breast surgeon in 2 days so I will ask then). I also feel more comfortable now that any discordant results which would lead the doctor to perform a surgical excision biopsy is simply just a more thorough investigation of my breast. And that is a good thing and reassuring to me. Thanks for your input!

    I am baking Xmas cookies to keep me distracted...I will have to make cookie deliveries (since covid has prevented us all from having Xmas get togethers!)


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  • Sunnygurl
    Sunnygurl Member Posts: 15
    edited December 2020

    I just wanted to update (since I really appreciated hearing about other members' updates while waiting for my tests and results). My biopsy results came back benign (very big sigh of relief) and after consulting with the pathologist and radiologist, instead of removing the area in question, the surgeon said he is comfortable putting me on a 6-month monitoring plan!

    Thank you to everyone who offered info and support! And best wishes to everyone with their journeys through screening and treatment, especially during this trying time of covid. Stay safe everyone!

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  • sasamat
    sasamat Member Posts: 53
    edited December 2020

    Great news, Sunnygurl!

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

    That's good news that your medical team is in all agreement on a 6 month follow-up, Sunnygurl. Thanks for letting us know!

    We'll see you in 6 months, hopefully with the news that everything is stable and looks good.

    Enjoy the holidays!


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  • LivinLife
    LivinLife Member Posts: 1,332
    edited December 2020

    Soooo happy for you Sunnygurl!!!

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