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BIRADS category 3.. To biopsy or not?

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Melly81
Melly81 Member Posts: 19
edited April 2018 in Not Diagnosed But Worried

Hi all:

I'm so glad that there's a place to come to and speak with others who may be experiencing similar situations as I am. I am 34, and found a "lump" in my breast. I had read an article online prompting women to do breast self exams. So, I did and found what I thought was a lump. I went to my GP and she states that she thinks it's dense breast tissue. However, she ordered an ultrasound as she knows how much of a worrier I can be. I went to the ultrasound and the radiologist's impression read: Area in the right breast is probably benign. Follow-up in 6 months is recommended. However, patient is requesting biopsy at this time. BIRADS category 3- Probably benign.

With all of that said, I am scheduled for the biopsy on 4/27. However, I'm wondering if this is a bit overkill at the moment. Should I heed the radiologist's advice and just have it rechecked in 6 months? Or should I go along and have the biopsy done. Either way, I'm extremely nervous and scared. I work in the healthcare field and have seen the worst so I tend to expect the worst. My family doesn't have a history of breast cancer, or cancer for that matter. Would it be safe to wait the 6 months instead of having something invasive done? What is the likelihood of BIRADS 3 actually being malignant? Have any of you been given a BIRADS 3 and had a biopsy?

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  • Simms8212
    Simms8212 Member Posts: 2
    edited April 2016
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    I'm glad you found this place since it a wonderful resource. Statistically speaking, a Birads 3 typically has approx. 2% chance of malignancy. From what I have read, that rating is not very common as there is too much uncertainty with it. It may be worth asking about lesion and why it was rated as such if you would feel more comfortable. For me, I was explained that my lesion was a birads 4 because it was hypoechoic (meaning solid) and lobulated.

    With that being said, if the doctor is willing and decided to schedule a biopsy then I wouldn't consider it unnecessary. The risk of complications is very low. Also, you will have a much better idea of what's going on. Like I said before , a lot of radiologists don't use this rating (birads3)as much due to the fact that it falls right in between benign (birads 2) and suspicious for malignancy (birads 4). I think many like to err on the side of caution.

    Hang in there and take care. I know this process is long and tough but hopefully you'll find the answers you are looking for!

  • melissadallas
    melissadallas Member Posts: 929
    edited April 2016
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    Melly, a Birads 3 is estimated as having less than a 3% chance of being cancer. They just recommend follow up to make sure there are no changes over time.

  • dtad
    dtad Member Posts: 771
    edited April 2016
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    Melly81...IMO you would be safe watching it. However you need to decide how much stress that would cause you. Good luck and keep us posted...

  • LisaAlissa
    LisaAlissa Member Posts: 34
    edited April 2016
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    Melly,

    You'll want to verify your insurance coverage before biopsy. Some won't cover a biopsy a BIRADs 3 imaging study.

    And JMO, but I'd go with the advice to recheck in 6 months--or sooner if you notice changes. If you start getting biopsies every time you find a lump (and you have lumpy breasts) , you can end up with a lot of scar tissue that can make future imaging harder to interpret. Perhaps hiding something that definitely should be biopsied.

    HTH,

    LisaAlissa

  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Simms8212:


    This is the actual radiology report:


    ULTRASOUND:
    Ultrasound examination of the area of palpable abnormality in the right breast
    at 12:00, 7 cm from the nipple demonstrated a hypoechoic lobulated lesion with
    internal echoes and areas of increased through transmission. This corresponds
    to the palpable abnormality, measures approximately 9 x 10 x 7 mm, and shows no
    internal flow on color doppler imaging. The finding is probably benign and is
    most likely to represent debris within a dilated duct or complicated cyst.
    However, after discussion with the patient she is requesting biopsy.

    Note, all four quadrants of the right breast were examined as well as the right
    axilla. There are normal appearing lymph nodes in the right axilla.

    IMPRESSION:
    AREA IN THE RIGHT BREAST IS PROBABLY BENIGN. FOLLOW-UP IN 6 MONTHS IS
    RECOMMENDED. HOWEVER, PATIENT IS REQUESTING BIOPSY AT THIS TIME.



    NEXT ORDER(S) NEEDED - US GUIDED BREAST BIOPSY W/HH DEVICE RT (19083)
    ACR BI-RADS Category 3 - Probably Benign


    So, I appeared anxious (I'm sure) and the radiologist said I had the option to recheck or to have the biopsy and not drive myself crazy with all of the what-ifs between now and 6 months from now. He felt the area, states that he's felt many C lumps before and mine did not feel like it had cancerous characteristics and he said by looking at the ultrasound its characteristics are that of a benign lump as well. I'm constantly thinking about this situation and thinking about my options. Did I open up a can of issues by asking for the biopsy? I'm feeling like I should have left it all alone, but it's the fear of the unknown that's killing me.

  • LisaAlissa
    LisaAlissa Member Posts: 34
    edited April 2016
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    Hi Melly,

    That report almost reads as if a biopsy now would be AMA (against medical advice). I'd really want to make sure your insurer would pay...or that you're happy covering the cost yourself.

    Do you have a PCP you trust? Why not set up an appointment to discuss the findings with him/her and get their advice? If they don't suggest a biopsy at this time, they could advise you about what sort of things you should be looking for during the wait for the recommended follow-up imaging. Things that should send you back sooner than the next scheduled imaging. Or they could refer you to a breast specialist if the two of you decide that's warranted.

    In any case, you shouldn't spend six months worrying yourself silly. Try some "mindfulness" meditations (there are some free ones on-line from UCLA or you may be able to find in-person sessions locally).

    HTH,

    LisaAlissa


  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Hey LisaAlissa:

    My primary physician actually is the one who ordered the biopsy after she read the radiology report. So, I would assume that it's covered by my health insurance. I work as a registered nurse and am fully covered by my employer. I asked my primary what she thought about the chances of my "lump" being BC and she said, " Taking into consideration your age, lack of risk factors, and radiology report, It's most likely benign but we will have a definitive answer from the biopsy". So, that's what she thinks. The radiologist said he had an overwhelming suspicion that this was benign but I'd rather be safe than sorry. I have tried to meditate but my mind is on overdrive. Also, as a nurse I take care of patients who have gone through mastectomies etc, so it's easy for me to fear the worst... Thanks for talking with me.

  • Simms8212
    Simms8212 Member Posts: 2
    edited April 2016
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    I agree with others that a birads 3 may not be coverered by insurance for biopsy. If it were me and my radiologist had recommended a 6 month follow up then that is what I would have done. But I can't say how I would have felt with anxiety and such because I do like having answers and knowing for sure.

    Ultimately, no one can tell you what to do or what it is best. Of course, your doctor is your best resource but maybe you would feel more comfortable if you got a second opinion confirming that the area looks benign?

    I'm an RN also so I can totally relate to how you feel. We always have to consider/ be prepared for the worst since it's an important part of what we do.

    In the end, you just have to do what makes you feel most comfortable. It is your body and your health and as long as the physician agrees that biopsy is acceptable then I wouldn't worry about it.

  • marie5890
    marie5890 Member Posts: 111
    edited April 2016
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    Melly,

    Based on the report that you posted, esp with it saying "shows no internal flow" (meaning no blood flow, which is needed for cancer) , I would be very comfortable waiting the 6 months follow up.

    Remember, a radiologist is an MD with a specialty in reading all kinds of imaging, including mammos and U/S. This is something your primary physician is not; IE a specialist in this area.

    In my view, a biopsy is overkill based on the report. Seriously. Also you must keep in mind that anytime a biopsy is done, scar tissue is formed, which can impact further imagining as you grow older.

    I would trust the radiologist recommendation in this (again, the expert in reading U/S's ) over your PCP.



  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Thanks Marie5890,

    That's exactly what my husband had mentioned to me. However, I'm worried about that <0.8% chance that is might be something else and I wouldn't want to have to deal with the possibility of it getting any larger than it already is. I am aware of the potential of scar tissue build up, and am also concerned about the titanium clip being left in place after the biopsy is completed. I'm so glad that I found this site and am able to talk to people that have been in this situation or something similar. It's definitely better than "googling" everything and getting scared of all the what-ifs. My biopsy is scheduled for 4/27 and will take the next week to think about everything involved in the waiting and watching versus the biopsy. I figured, if I still feel like continuing with the biopsy, perhaps the radiologist can do another ultrasound prior to the biopsy and take another look. Perhaps since I had gotten the initial ultrasound done 2-3 days after my period ended and I was poking and prodding at my breast the day before and day of that things could have gotten irritated and inflamed. Maybe time, and steering clear of caffeine will have caused the lesion to decrease in size, proving that it's just a benign lesion. At least, that's what I am hoping and praying for. Thanks so much for your input. I will take all of the input that I can get from everyone on this site. It's truly appreciated!

  • chisandy
    chisandy Member Posts: 11,332
    edited April 2016
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    You're worried about a 0.8% (not an 8%) chance it's not benign? Life is fraught with far greater uncertainties than that! It sounds like you are trying to control for every eventuality--and I strongly suspect that a needle biopsy confirming it's benign might still not definitively reassure you and you might end up demanding an excisional biopsy. Granted, a core-needle biopsy is not major surgery and is a relatively minor procedure with little downtime. But it's not like an ultrasound either--it's invasive, there could be complications and some pain, it might carry a slight risk of error, and it almost certainly would be expensive (and probably not covered by your insurance).

    "BIRADS 3" is something for which nearly all of us here would have given our eyeteeth. I am in agreement with those who urge you to go with the advice of an expert like your radiologist who knows what cancers feel, look, and behave like on ultrasound, not your PCP who is not skilled at that. You have a long life ahead of you, with crises almost certainly in the offing. Why go looking for a forest fire when all you can smell is a BBQ? Do you get a MRSA test every time you get a paper cut or hangnail? Do you automatically think “Zika" or "West Nile" with every mosquito bite? (All those things are far more likely than the chance your lump is “something more” than benign). Don’t catastrophize--it’s a waste of time, money and emotions.

  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Thanks ChiSandy,

    I was under the impression that the biopsy is a fine needle biopsy rather than a core biopsy. Yes, control or the lack thereof is what is the driving force between me waiting the 6 months to have a recheck and having the biopsy performed. Also, I've been reading more on this site and have come across a few women who were graded a BIRADS 3, ended up waiting those 6 months and then being diagnosed with BC at the end of their 6 months. I am planning on starting a family with my husband this year, and I just want to be sure that all is well with me and my body before even thinking about having children. I also don't know how much that specific radiologist knows about breast U/S, characteristics of said lumps etc. That is why I have worked myself up about this entire situation.... I appreciate you providing me with insight regarding my situation and reminding me not to expect the worst. I wasn't always such a worrier but for the last 6 months have become the biggest worry wart. I appreciate the time you're taking to talk about this.

  • marie5890
    marie5890 Member Posts: 111
    edited April 2016
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    Melly, what kind of biopsy has your primary set up for you? A fine needle or core needle? Do you know...? Have you asked to be sure that the biopsy is covered by your insurance with a BIRAD 3? (Don't assume anything with insurance. Check)

    If you have mental health struggles with anxiety and worry etc, and a biopsy will be the only way of handling it, then do what is best for your mental health.

    You don't need anyone's permission here to have a biopsy. :) If you are looking for us to validate your desire to have one, mostly likely you won't find it here, either, with a BIRAD 3. Like Chi said, the most of the women here would have given their eye teeth for a BIRAD 3 with 6 months follow up. 6 Months is not a long period of time.

    It sounds like you want to go ahead with the biopsy regardless of what our input is. So do it. :) Again, you don't need our permission.


  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Marie5890:

    I'm not positive about the type of biopsy that they ordered as they weren't specific. That is why I'm thinking about it for now and looking for input/advice from those with experience. I sent an e-mail to the radiologist to ask all sorts of questions prior to even arriving to the biopsy appointment. I'm not looking for permission, just some advice and a little reassurance. Sorry if I'm coming across strongly, just worried is all. Thanks.

  • LisaAlissa
    LisaAlissa Member Posts: 34
    edited April 2016
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    "Also, I've been reading more on this site and have come across a few women who were graded a BIRADS 3, ended up waiting those 6 months and then being diagnosed with BC at the end of their 6 months. "

    About those...this is a breast cancer site, so the women who stay around to tell us about how the "something" that was graded BIRADS 3 turned out to be cancer are among the 2% of BIRADs 3s which are expected to be cancer. That's why they were told to return in 6 mo. for additional imaging--so that those cancers would be found! And they were.

    Ninety-eight percent of those with BIRADS 3 either never came here or told us their good news after their 6-month follow-up and left. They aren't still posting on a breast cancer site. They've returned to their normal lives!

    " I am planning on starting a family with my husband this year, and I just want to be sure that all is well with me and my body before even thinking about having children. "

    On waiting to start a family. There are no guarantees. No one can promise you that your future (near or far term) has no "bad" surprises. There's always a chance that the future will hold something bad, so If you wait until you're sure that it won't, you simply won't have a family. That's a call for you and your husband.

    My very best wishes to both of you!

    LisaAlissa

  • marie5890
    marie5890 Member Posts: 111
    edited April 2016
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    LisaAlissa does point out a very important thing to remember. Most of the women here have been Dx-ed with BC. That is why you have found those very few who had a BIRAD 3. Most who have that, were fine.

    Most of the women who come to the "Not Diagnosed but Worried" forum are not Dx-ed with BC and go on with their lives, so you won't get their input.

  • new_direction
    new_direction Member Posts: 40
    edited April 2016
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    Hi Melly

    sorry for your situation. When I read your post I thought you seemed like the opposite of me - I went in for mammogram with no worries what so ever, when I was given the birad 4 I was a little troubled but convinced it would probably be carcinoma in situ. I'm not writing to cause further anxiety but just to say I wish I had been more cautious like you. In my case there were no question whether or not to do the biopsy.

    What did the mammogram say? your chances are good but I understand 6 months is a long time to wait... now with the chance of a biopsy you dont even need to ask for it sounds like a good idea to get it done and give the mind a break.

    best wishes
  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Justt found out today that it's going to be a fine needle biopsy. It's to be done with an ultrasound. Have you ladies had this type of biopsy? Can I anticipate it being pretty painful?

  • chisandy
    chisandy Member Posts: 11,332
    edited April 2016
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    You should expect it to be no more painful than draining a zit. That they’re going with a fine needle rather than core needle tells me they expect it to be no worse than a cyst. But get it in writing from your insurance company that they WILL cover any biopsy following only a BIRADS 3 classification. You don’t want a four-or-five-figure nasty surprise while you’re getting ready for a baby.

  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Will do ChiSandy. Thanks bunches

  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    ChiSandy,


    I called my insurance company and found out that this fine needle biopsy is covered and I'll be responsible only for the co-pay of $20.00. I am so extremely nervous at the possibility of this BIRADS 3 being malignant even though there's only a 2% chance. BC doesn't run in my family but I have the unfortunate tendency to think the worst of these kinds of health problems (if any).

  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Hey NewDirection! I did not have a mammogram, but I had an ultrasound performed and it revealed a BIRADS score of 3. Typically, this is a wait and watch type of thing but being a nurse and having major health anxiety is not going to go well if I had chosen to wait 6 months. My doctor gave me the option to have the biopsy and so I am having that done this Wednesday 4/27/16...

  • Momof6littles
    Momof6littles Member Posts: 7
    edited April 2016
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    I was told by my insurance company that if the language reads that the patient is requesting it, they will deny the claim, even if it's something they would normally cover. I have an HMO, so maybe that's different. I just thought I'd put that out there.

    I wish you luck on your biopsy and hopefully peace of mind! I've had breast issues for years, so I understand.

  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    hey momof6:

    I specifically asked them if it was covered and it was. Anyhow, I'm still on the fence about the biopsy scheduled for this Wednesday. I know they say BIRADS 3 are typically benign but the what-ifs are probably going to drive me nuts for 6 months. We'll see..

  • awb
    awb Member Posts: 213
    edited April 2016
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    A BIRADS 3 has only a 2-3% chance of malignancy, they usually do not order a biopsy until you get to a BIRADS 4. They generally recommend a 6 month follow-up to see to look for stability or any change. the radiologists are specialists in reading mammos, US, MRIs, and they are usually pretty cautious, so if they said it was OK to wait 6 months, it's pretty certain it's OK to wait. I know it's hard to turn over that control to them,. I've been in that position before, but at some point, you have to trust your medical team.

    anne

  • melissadallas
    melissadallas Member Posts: 929
    edited April 2016
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    I 'll add that over the years here I've seen lots of women demand biopsies for Birads 3 rather than just doing the recommended recheck and I can't think of a one that came back with other than benign findings.

  • singlemom1
    singlemom1 Member Posts: 260
    edited April 2016
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    melly81

    I think you need to do what YOU think is best! Most likely you will be fine, but it seems that you will be filled with anxiety until you know for sure. I also don't want to scare you, but if I listened to my gut over the medical teams (considered top doctors) opinion, I may not be in the situation that I currently am in. I don't know if it just your anxiety or if your gut is telling you something more, all I do know is you need to do what YOU think is right.

  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    hanks ladies. I'll keep you posted. Praying that it all comes back benign. Talk to you all soon. Hope you're all having a wonderful weekend!

  • rleepac
    rleepac Member Posts: 193
    edited April 2016
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    I'm one of those that had a low BiRads mammo and ultrasound but turned out to be cancer. I had a 2.1 cm mass that was palpable but did NOT EVEN SHOW UP on mammo or ultrasound. My mammo was BiRad 2 (due do breast density) and ultrasound was BiRad 3 (because of a slightly abnormal looking lymph node). Radiologist's recommendation was to recheck in 3 months. However, the hematologist/oncologist I was seeing at the same time for low iron said 'no way...that needs to come out now'. It probably wouldn't have changed anything if I had waited 3 months and then gotten a dx but I'm glad I pushed for the biopsy. I say if your insurance covers it, just do it...you'll feel better knowing for sure.

  • Melly81
    Melly81 Member Posts: 19
    edited April 2016
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    Rleepac:

    Was your biopsy a fine needle biopsy? My "lump" is 9x10x7 mm. I have been told by some that a titanium marker is left inside the breast following the biopsy. Did they leave a marker inside following your biopsy as well? My insurance does cover it so I'm thinking I will get it done and over with. It's the fear of the unknown that's driving me crazy...