Why additional images/ultrasound vs. biopsy?

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Jetcat
Jetcat Member Posts: 64

Hi all- what is the reason for additional diagnostic mammogram and ultrasound? Why not go straight to biopsy? I’ve had DCIS twice on left breast—first had lumpectomy and radiation and 2 years later they found more DCISand I then had left mastectomy one year ago. Today I got the call to come back for another mammogram and ultrasound on right breast. This torture of tests/waiting starts again! Why can’t I go straight to biopsy?

Comments

  • jhl
    jhl Member Posts: 333
    edited April 2021

    Hi Jetcat,

    I think they may need more images to actually see where the best place might be to do the biopsy.

    Jane

  • Moderators
    Moderators Member Posts: 25,912
    edited April 2021

    Jetcat, yes, they are probably unsure of the image(s) and need additional detail to see if it is something (or not) and if yes, where.

    It's probably the most comprehensive and least invasive way to make sure they know what is there (or not).

    Please keep us posted,

    The Mods

  • Jetcat
    Jetcat Member Posts: 64
    edited April 2021

    Thank you. I’m stunned to be back in this situation again. My 2017 DCIS doesn’t show up in my profile but I’ve been down this road twice before. Luckily I was able to get the follow up appointments booked for tomorrow morning. The women on these boards are so brave, it helps me to not fall apart.

  • Beesie
    Beesie Member Posts: 12,240
    edited April 2021

    What does the imaging report say? If the area of concern is something like architectural distortion, it could be a simple as the image being a bit wonky because of how your breast was squished in the mammogram machine. The diagnostic mammo and ultrasound might show that there is actually nothing there and nothing to biopsy. Or if the mammogram visualized a round mass, the ultrasound might show it to be fluid-filled simple cyst, which is benign, harmless and requires no follow-up.

    In fact, only about 25% of callbacks result in the need for a biopsy - the rest are satisfactorily resolved with the additional imaging. For this reason, it would be irresponsible to go straight to a biopsy after a screening mammo, without doing the diagnostic imaging first.

    image





  • Jetcat
    Jetcat Member Posts: 64
    edited April 2021

    I haven’t seen the imaging report yet as mammogram was just yesterday. I go back tomorrow for diagnostic and ultrasound. Everything you said makes perfect sense —I’m not being rational right now I know.

    You have been my hero since I started reading these boards in 2017! So, if you have a minute, would love to get your thoughts.

    2017 diagnosed with grade 3 DCIS. It was ER/PR+. Had lumpectomy and lab results showed no DCIS in excision—surgeon said it was all removed at biopsy. I was advised that radiation was optional and I decided to get radiation as extra precaution. I did opt out of hormone therapy.

    2020 (it wasn’t 2019 and I have to fix my profile) diagnosed same breast with grade 3 DCIS that turned out to be triple negative. Mastectomy was recommended which I did have last April with no reconstruction.

    Why did it come back so fast especially since I had radiation? Maybe no answer to this question but also wonder if there is any significance to second DCIS being triple negative? Does all of this bode badly for having cancer in right breast?

    I haven’t had genetic testing but my sister did and it was negative for BRCA.

    Thanks in advance Beesie



  • jhl
    jhl Member Posts: 333
    edited April 2021

    Hi again Jetcat,

    Do you have your HER+ status for either of your 2017 or 2020 occurrences? As people so often say here, breast cancer is not often familial. Of course, you will have to go through the diagnostics on the right breast, but it might be worthwhile to have a second opinion after that information has been obtained. Do you live near an NCCN center?

    Jane

  • Beesie
    Beesie Member Posts: 12,240
    edited April 2021

    Jetcat, thank you!

    Question for you: Was your second DCIS diagnosis in the same area of the breast as the first? With a different ER/PR status, might the second diagnosis have been a new primary rather than a recurrence? For any of us diagnosed one time, our risk to develop a new breast cancer (separate and different from a recurrence) is greater than the breast cancer risk faced by the average woman who has never had breast cancer. That said, sometimes cancer cells change hormone status so having ER+/PR+ the first time and ER-/PR- the second time could still be a recurrence.

    Does the second cancer being hormone negative bode badly for the right breast? Well, yes and no. No from the standpoint that there would be no connection between a breast cancer in one breast and a breast cancer in the other. They would be two completely separate events. But to my earlier point that we are all at greater risk to develop a new primary after a previous diagnosis, there are certain factors related to a first (or in your case second) breast cancer that further increase the risk that someone might develop breast cancer again - and having a triple negative breast cancer is one of those factors.

    But... don't got there yet. At this point the odds are still very much in your favor that this could be nothing.

    jhl, since Jetcat mentioned that her second diagnosis was triple negative, it sounds like she did find out the HER2 status for that DCIS. But as an FYI (which you may already know), HER2 status often is not determined for DCIS. Unlike with invasive cancer, there are no treatment difference for HER2+ DCIS vs. HER2- DCIS, and there is no difference in prognosis. And interestingly, about 40% of DCIS is HER2+, versus less than 20% of invasive breast cancers. So it's hard to read anything into the HER2 status of DCIS.

    Jetcat, good luck with the callback. I hope this turns out to be a false alarm.


  • jhl
    jhl Member Posts: 333
    edited April 2021

    Bessie,

    Thank you!

    Jane

  • Jetcat
    Jetcat Member Posts: 64
    edited April 2021

    So I have to get a biopsy but the radiologist said that the calcifications are benign in appearance, however they have increased in number since last year. She emphasized that these calcifications are nothing like the ones on my left breast which were fine linear and branching. She said Birads 4 but didn’t have a, b or c rating. I’m going to remain optimistic. I still have to get my reports from last year as I was diagnosed on a Mon and had surgery that Thursday due to COVID —-they were stopping all nonessential surgery and my surgeon didn’t want me to have to wait indefinitely so she rushed me through (I was grateful for that). It happened so fast that I didn’t ask for copies

    Thank you for listening and answering questions. Beesie— I wish my oncologist took lessons from you!

  • Beesie
    Beesie Member Posts: 12,240
    edited April 2021

    Jetcat,

    If the calcs are benign appearing, it sounds as though it's probably a 4A biopsy, with extra caution being taken because of your history of breast cancer.

    Good luck with the biopsy. I hope the result is good news! Let us know how it goes.


  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    I have biopsy this coming Fri. I met with surgeon yesterday and I have a 1.8 cm lesion at 12:00 position. It has spiculated border so doesn't appear obviously benign. I did have a small non melanoma skin cancer removed in late March with internal stitches about 4 inches above this area. Surgeon thought there was a possibility that the breast lesion was caused by surgery but she thought it was a little far away and deeper.

    I came across a DCIS article in Harvard Health publication fro Jan 2021. (Can’t post link). Rather than recommending less treatment for DCIS, it says more is better regardless of grade. I had lump and radiation but still had recurrence less than 2 years later. This latest scare is making me lean toward mastectomy of right breast —whether prophylactic or to treat whatever they find. I don't think I want to fool around with lumpectomy and radiation again. But, I'm getting ahead of myself!






  • LivinLife
    LivinLife Member Posts: 1,332
    edited May 2021

    Geeezzz Jetcat that you are going through this again... amazes me to see so many recurrences in the short time I've been on this site even if it is a breast cancer site.... I feel for you dealing with this again and this really painful part of the process. Hopefully it ends here for you after biopsy though you won't know until you know....

  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    Thank you-your note means a lot to me. I’m definitely in the anger stage today because I live in the #1 healthcare state in the US and have three different healthcare portals but cannot seem to get a copy of the recentradiology report or any of my prior BC records for that matter. I’m furious. For this I pay $600/month plus $1,500 deductible? My primary care only wants to talk about cholesterol and tells me to see MO about BC stuff. The 2 oncologists I’ve seen are horribly dismissive I guess because I just have DCIS. My current MO made me wait in the exam room for 1.5 hours at last appt. I was actually leaving when she breezed in. Believe it or not, she just told me to lift up my shirt/bra for her little 2 second exam. I do like my surgeon. Regardless of Fri outcome, I am taking control of my care starting with finding a new PCP and MO.

    Yes, the reality of recurrence is definitely different than what I heard the first time around. Take good care.

  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    Biopsy results = benign. I am so grateful. I haven’t seen the pathology report yet but radiologist who did the biopsy clarified that there were only new calcifications which caused a shadow on ultrasound—he couldn’t see any associated mass. Maybe fat necrosis

  • edj3
    edj3 Member Posts: 2,076
    edited May 2021

    So happy for you--and thank you for updating us!

  • Moderators
    Moderators Member Posts: 25,912
    edited May 2021

    Jetcat, we're very glad to hear that! Thank you for letting us know!

    The Mods

  • Beesie
    Beesie Member Posts: 12,240
    edited May 2021

    Great news, congratulations! And what a relief for you!

  • LivinLife
    LivinLife Member Posts: 1,332
    edited May 2021

    Great news on biopsy results! I hope you still find a new PCP so you are comfortable with all of your care! Best to you!

  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    Thanks so much and yes, I need to make positive changes out of this experience. I think my primary care physician is a good doctor but I hav to have easy access to my test results/records at the very least. I think the pandemic has taken a financial toll on a lot of the small family physician offices because she seemed very stressed. I wish her the best but it’s time for me to move to a larger, more integrated health system. So thankful that I found this site!

  • Salamandra
    Salamandra Member Posts: 1,444
    edited May 2021

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