Wrong lump biopsied?

Fran68 · January 2021

I read my Ultrasound report and was expecting the surgeon to do a biopsy close to my nipple but the lump she ended up aspirating was about 2 inches away. Here is the report:

Comment: Ultrasound of the left breast was performed with attention to the periareolar tissues. The study is compared to previous mammogram dated 1/13/21 and earlier studies dating back to 10/23/06.

In the 1:00 position at the areolar margin, there is a circumscribed hypoechoic solid mass with parallel orientation. It measures 1.3 x 0.6 x 1.1 cm. This corresponds in size and location to the mass seen mammographically.

Ultrasound-guided biopsy is recommended.

Incidental simple cysts are also noted. There is one in the 11:30 position periareolar margin which measures 4 x 3 x 5 mm. There is another in the deep retroareolar tissues measures 10 x 7 x 7mm.

The is a solid hypoechoic circumscribed mass with parallel orientation in the 1:00 position 6cm from the nipple. It measures 7 x 2x 7mm. It demonstrates hilar vacularity and is likely a small intramammary lymph node.

Six-month ultrasounds follow-up recommended.

Impression:

1. 1.3 cm solid left breast mass in the 1:00 periareolar breast. Biopsy is recommended

2. 0.7 cm mass in the 1:00 position 6cm from the nipple which is most likely an intramammary lymph node. Six-month ultrasound follow-up is recommened.

Final assestment BI-RAD Category 4 - Suspicious abnormality - Biopsy should be considered.

Should I be concerned the wrong lump was addressed or do you think I am over analizing? Follow up in 6 months.

MelissaDallas · January 2021

I think you omitted the report part ofyour post.

Also, it is hard to know how to respond since you started a new thread-without finding your other post(s) it is hard to know what the context is.

Fran68 · January 2021

Hi MelissaDallas,

The report didn't post but I did go back and manually type it. My previous post was just about the anxiety of having been called back so many times and having previous biopsies and aspriations that have always been benign. - it's always just a roller coaster.

Thanks,

Beesie · January 2021

Fran, there is nothing in what you posted here that suggests that the wrong lump was biopsied. What you copied into your post is just the imaging report. The biopsy report which would indicate where the mass was that was biopsied. Why do you think the wrong lump was biopsied?

And did you have a core needle biopsy or a simple fine needle aspiration?

And I do agree with MelissaDallas. It's always helpful for those of us responding to see the entire history of posts together so that we have the whole picture when we are responding. The fact that you've had previous biopsies - which I assume were all benign - is important since it means that your breasts tend to develop benign things. And my question about the type of biopsy might be addressed already in your other posts.

Fran68 · January 2021

Hi Beesie,

I started a new thread because I thought my issue today was unrelated to my other post. I am worried the wrong lump was addressed do to the location. It looked like I had 2 areas of concern according to the US report. 1. at the periareolar margin and 2. 6cm away both on the 1:00. The surgeon was supposed to do a FNA on the mass closest to the periareolar margin but she seemed to focus on the lump a couple inches away - this turned out to be a cyst which she was able to aspirate and of course is benign. My concern is she didn't focus on the lump closer to the nipple and hence the wrong area of concern was addressed. My question is does anyone think this is something to be concerned about or should I just wait for the 6 month follow up and ask then?

I do have a history of benign issues and of course dense breasts - but it does not stop the worrying that this time may be different.

Beesie · January 2021

Usually a BIRADs4 biopsy on a solid mass is not a FNA. Usually it is an ultrasound-guided or mammogram-guided (stereotactic) core needle biopsy. So the dots aren't connecting for me between what the imaging report says (biopsy recommended for a solid mass) and what you were expecting.

And yes, if the wrong mass was biopsied, then that is a concern. Was imaging done prior to the needle placement? Sometimes a needle is inserted in a very different location from where the mass is, as a way to get more secure access to the mass with the needle. This tends to happen with masses that are close to the surface.

If I can ask, why did you have a surgeon doing the biopsy, and not the radiologist who assessed the imaging? Radiologists are trained to needle biopsies - this is in their area of expertise - whereas surgeons are expert at operating; for surgeons, needle biopsies are a side line. I'll admit that in my time on this site I have seen quite a few situations where people have had to go back for a second biopsy with a radiologist after a first biopsy done by a surgeon, so I'll always recommend a radiologist over a surgeon for a needle biopsy. Not saying that this will be an issue in your case, of course.

Fran68 · January 2021

Hi Beesie,

Thanks for replying. Yes you are correct, this was supposed to be an ultra-sounds guided biopsy on a mass. My surgeon prefers to do them herself (not sure why but the coordinator was aware when she scheduled me).

While she was numbing me up and getting ready for the biopsy she noticed the fluid moving away from the needle indicative of a cyst and not a mass- she asked for a 20gauge and drew thick fluid out. She did send the fluid away and of course it was benign, She said to follow up in six months where she will do another ultra-sound.

Maybe it was just needle placement that makes me believe it wasn't the right spot. I was so relieved that it was a cyst when the original US said mass that I kinda hightailed it out of there! It's just with 2 areas of concern but at 1:00 I hope she didn't mix them up. I called the nurse practioner in her office and left a message - just to run it by her.

Do you think I may be over-reacting and I would be ok if I waited the 6 months? Have you ever heard of this scenario?

Harley07 · January 2021

Fran

If it were me, I'd see what the NP says and if you don't hear from her, I would call or message again. My experience a few months ago was that my first biopsy came back benign but it was because not enough tissue was removed to make a determination. The second biopsy was high risk benign due to ADH however the biopsy marker was placed 2cm from the area of concern on the mammogram, so the Dr didn't biopsy the correct area.

Better safe than sorry

Good Luck!

Beesie · January 2021

Ultrasounds are usually very good at distinguishing solid masses from fluid-filled masses. The ultrasound report noted that it was a solid mass that was supposed to be biopsied; how did something seen on imaging to be solid suddenly became fluid?

Personally I think most surgeons who do their own needle biopsies do it to generate extra revenue. My recommendation is that you ask for a new ultrasound - to be assessed by the same radiologist who assessed your imaging originally - to see if the questionable mass at 1:00 is still there or if it's gone. Hopefully it's gone, but if it is still there, have a radiologist do the biopsy.

Fran68 · January 2021

The NP just called me back. When I left the message I just left my name and phone number but she knew exactly why I was calling! She spoke to the surgeon and the surgeon is confident she got the correct area. I have a follow up US in 6 months followed by an appointment with the surgeon.

I guess I will accept that everything is ok - the majority of lumps are benign and my breast are very busy. So we'll see what happens in 6 months.

Thank you all for listening and responding.

Wrong lump biopsied?

Comments

Categories