The results of my biopsy (For those awaiting results)
Hi all,
A few weeks ago I went in for my annual mammogram and ultrasound screening (I have dense breasts). I was 5 mos overdue because of COVID. I got called back for an "indeterminate" area. After waiting almost another week, I went back in for a diagnostic mammogram and ultrasound. I was there for almost four hours, as I kept getting called back in for more ultrasound images. Finally, the radiologist came in herself and scanned me. The area in question had very malignant features- irregular margins and irregular shape, hypoechoic with posterior shadowing. The BIRAD given was 4B (moderate suspicion for malignancy) and I was told I would need a biopsy. They couldn't get me in for almost another week (last week), and that waiting was one of the hardest of my life. I am 53 and on topical HRT, and I was worried sick. In between the crying spells, I was despondent. I scoured everything I could online to better understand what I may be facing, and I found comfort in reading posts from women in a similar situation. I was surprised not to find more related posts, and vowed to return to post in the hopes I may bring some peace to those also waiting. I am very fortunate in that my biopsy showed stromal fibrosis, a benign finding.The vast majority of biopsies do turn out to be benign, but this seems to be little comfort when you are the one in limbo. My heart goes out to all of you who are scared and feeling lost, and to all of the courageous women who stare down this diagnosis. Be strong, and feel free to ask any questions if I can provide any support.
Best,
WL
Comments
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Great news!!! Thanks for sharing your story. I am one waiting in limbo after a callback and really having a hard time. Your story gives me hope
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Sending you positive thoughts, CU Gym. 🙏.
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Thank you WhiteLinen for sharing your story. The waiting is indeed mental torture. Keep us posted, CUGymGirl!
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I am so happy all turned out well.
Thank you so much for sharing with us all.
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Hi, I am new here but have read the posts for a while now. I feel that I have been put through the mill these past two months and at a very prestigious Boston breast center. Two months ago I got a callback for my right breast. but couldn't get in for the diagnostic tests for a month. This hospital has a 25-year record of all nature of my mammograms and ultrasounds. After the diagnostic mammogram and ultrasound, the radiologist said I needed a biopsy to examine a 4mm irregular mass, which didn't show at all on the mammogram. It was designated birads c, so not good. The very young radiologist looked like she had seen a ghost. The stereotactic biopsy was scheduled for two weeks later.
At the biopsy, which was conducted sitting up, standing up and finally sitting, took two hours from start to finish. The radiologist kept saying they couldn't find it and that I would need a closer look by a breast surgeon. I said, Do you know what you're doing? Why don't I just see the surgeon rather than continue on here? This was an hour in. She kept maneuvering and her assistant kept squishing until she was satisfied that they could grab the area and proceeded to take 10 core samples. The actual biopsy itself was nothing compared to the smashing and squishing.
After the biopsies were being prepared, the radiologist warned me again, that they may not be adequate and she may not be happy with the results. It was clear from the start that she couldn't get good biopsies because the area was just under the skin. After more mammograms and the insertion of a metal clip I was sent on my way to wait for my results.
After the weekend, I received a call from my internist's office with the good news, that the tissue was benign. We were all relieved here and I thought I could just carry on. But no, the radiologist chased me down two days later, with the news that the pathology report was discordant with was she was expecting to see: some type of malignancy that didn't show up. I got a number to another affiliated breast center to see a breast cancer surgeon on Monday.
Now, I ask you, anybody, doesn't the fact that my private physician's office would call me with good news, which now sounds as though it isn't, just weird and wrong? I had asked the radiologist, What did you do--miss? She said, Well, not all of it and at least these samples of the area show that whatever it is isn't spread throughout. My husband thought this biopsy and the "results" and the need for further investigation just smacks of ineptitude and plain bad medicine.
Hopefully I will know more on Monday.
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Hi, TheAgedP,
Sorry you find yourself here.
I think you just got the “bad luck” of the draw on this one and it wasn’t truly incompetence on the part of the radiologists. It is my understanding that stereotactic biopsies are extraordinarily difficult to do on masses that are very close to the skin or surface of the breast, the reason being that “tunneling” beneath a fair amount of breast tissue is what “holds down” the instruments and makes fine control to hit little masses possible, so yeah, what you had was probably really hard to hit. As to your internist getting the initial “benign” report, a second read amended report would have been the one that states the “discordant” information.
Hopefully the surgeon can refer you for a different kind of biopsy (maybe MRI guided), or perhaps just do a surgical biopsy, though optimally, a needle biopsy of some sort is done before any kind of surgical removal.
Sorry this is shaping up to be such a headache. Let us know what the surgeon decides should be done next. You might want to consider starting your own thread in Not Diagnosed” forum
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Welcome TheAgedP! I too feel for what you went through. The last stereotactic I had was a tremendous amount of squishing and "rolling" which was much more uncomfortable and frankly maddening than the actual biopsy itself. They finally went in another way which made all the difference.... wish they would've done that sooner
I too hope you will start your own thread if you haven't already - I haven't seen many of the new posts yet today - just starting to see these as I signed in this morning. Think about the news you received from both your primary care and the radiologist. Then consider questions you have for the surgeon, esp. given you want a different experience with any additional biopsy. Please let us know how that appointment goes...
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TheAgedP,
I agree with MelissaDallas. I don't think there was any "ineptitude and plain bad medicine", I think you just were unlucky and drew the short stick. It happens. It happened to me.
As Melissa said, it is difficult for a radiologist to retrieve good samples when the area of suspicion is close to the skin. I was warned about this when I went in for one of my stereotactic biopsies. I had two areas of concern - and with great difficulty, the radiologist managed to get a small sample from one area but couldn't get anything from the other area. The sample that was retrieved was found to be ADH, which is a high risk condition. Usually with ADH, an excisional (surgical) biopsy is required because in about 20% of the time, DCIS (or sometimes even IDC) is found in the same area as the ADH. So when ADH is found, it's recommended that the entire suspicious area be removed. That headed me into surgery, but I would have been going there anyway because I had that second area that the radiologist had not been able to sample. As it turned out, the pathology from my excisional biopsy found I had high grade DCIS in both areas of concern, and a microinvasion of IDC in one of the areas.
As an FYI, radiologists are doctors who are trained to do these types of biopsies. Surgeons are not trained for this - they are expert at surgery, not needle biopsies. I will always choose to have a radiologist do a needle biopsy rather than a surgeon. The reason you now need a closer look by the surgeon is because the needle biopsy was unsuccessful and that's just something that happens sometimes. When a needle biopsy can't retrieve a good sample, usually because of the location of the area of concern, or if the results are discordant, a surgical biopsy is the normal next step.
With regard to the discordant results, keep in mind that the needle is retrieving just a small sample of the tissue from the suspicious area. Areas of breast cancer often include lots of stuff that isn't breast cancer - my pathology report mentioned the microinvasion of IDC, lots of grade 3 DCIS with comedonecrosis, some grade 2 DCIS, the ADH, and a list of about 7 or 8 other high risk or fibrocystic conditions. My stereotactic biopsy only pulled up the ADH. When someone has a needle biopsy and the results are benign, if something has been retrieved by the needle that explains the appearance on imaging, then the results are considered concordant. Usually 6 month follow-up screening is done to ensure that the area of suspicion hasn't changed to become more worrisome - this is the confirmation that the biopsy was accurate. In your case, with a BI-RADs 4C, the expectation would be that something concerning would be found, maybe not breast cancer but something to explain the appearance on imaging. Since nothing was found that explains your imaging, your results are considered discordant, and more investigation is necessary. Again, this isn't the fault of the radiologist, but just could be that the needle pulled from an spot within the suspicious area where nothing was there.
As for your physician's office calling you, as Melissa said, it could be that there was an addendum to the report. Or it could be that your physician simply looked at the benign results and thought everything was fine, without understanding that the results were discordant. PCPs are not experts on this stuff and in my time on this site, I've seen lots of PCPs jump to the wrong conclusion about imaging and pathology reports.
Good luck with the surgical biopsy. Hopefully in the end you do have a benign result.
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TheAgedP - I'm so sorry for what you've gone through the last two months. I had a similar experience earlier this year. My feeling is that diagnosing breast cancer is mostly science and a little bit of an art. My perception based on my mom's diagnosis in the 1980's and my previous biopsy in 1999 was that if a diagnostic screening found area(s) of concern, then a needle biopsy was performed and a clear cut diagnosis was made. Unfortunately, breast cancer can be sneaky and there are benign conditions that can mimic cancer so a clear diagnosis after a needle biopsy is not always possible. I completely understand the frustration at initially receiving benign results only to be told a few days later that the results are discordant. The positive side to this is that the breast center did their job, noted the discordant results and quickly contacted you.
Hoping for a quick resolution and benign results for you. Please keep us updated.
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Of course, I know that my internist's office was not to blame for giving me "benign" results. But, when I look at the time that the pathologist signed off on the "final results" and the time that the radiology department must have called the PCP's office for his secretary to call me when he did--well, it was immediate! Too immediate, obviously. The radiologist hadn't had time to see the discordant results. You all must realize the anxiety that their misinformation has caused me and my family. What troubles me the most is that the radiologist who performed the stereotactic biopsy told me BEFORE she began that awful two-hour procedure that she knew she wouldn't get good biopsies. After an hour of fruitless efforts, I suggested I just see a breast surgeon, already. Here is where I made a mistake and allowed her to continue. If I had been my own best advocate, I should have followed my instincts and insisted that I be released from that vice-like grip. All of the ensuing angst could have been avoided and I would have been on my way to the appointment I finally arranged for tomorrow.
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Radiologists and surgeons generally prefer to do a needle biopsy rather than a surgical biopsy. So even suspecting that it might be difficult to get a good sample, usually an attempt is made at doing a needle biopsy before signing the patient up for surgery, which is a much more serious procedure. I knew before my stereotactic biopsy that the odds weren't good that it would be successful, and the radiologist mentioned that again during the procedure. I appreciated the honesty, and appreciated that the effort was being made to try to avoid surgery. As for the procedure itself, it was long and difficult and I almost passed out at one point - I remember the cold compress on my forehead and the nurse holding a juice box for me to sip so that I could get some sugars into me. So a pretty awful experience but all these years later what I remember most about the procedure was how kind and caring everyone was.
As for your PCP's office calling too quickly... the biggest complaint on this board is when doctor's offices have results and don't call immediately, making patients wait longer than necessary. It seems you have an excellent doctor who does call immediately. There is no way that the doctor could have known that there would be an addendum to the report highlighting that the results were discordant - that's not what usually happens so it wouldn't be built into the process. These days, many of facilities have patient portals; at my facility reports go onto the portal as soon as they are released. So even without a call from my doctor, if there was a report and then later an addendum, I would see the initial results, not knowing an addendum is coming, and then I would see the addendum later. Not ideal when the addendum is a negative addition, but to me, it's still better than anxiously waiting days for a call as I used to do.
I appreciate that you are upset about what happened, and I understand why. I am just offering up my perspective, as someone who went through pretty much exactly the same thing.
Good luck with your appointment tomorrow. I hope it goes well. Please let us know.
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