Can a Spiculated mass BI-RADS 5 be a Fibroadenoma?
Hi I’m new here. My mammogram/US were done because I had found a dimpled area under my right breast when I raised my right arm. My report said "abnormality 9:00 position 5cm from the nipple there is a hypoechoic irregularly shaped spiculated mass measuring 1 x 1.8 x 1.4 cm. My BI-RADS score was 5. Two radiologists reviewed the results and agreed. I was sent for an ultrasound guided core biopsy last Wednesday. Today I got the results and was told she was "very shocked" that it came back as a Fibroadenoma. She even went back and talked with the radiologists and reviewed the mammogram and US images again. I have an appointment with the breast surgeon next week.
My question is- is this a common finding that it would only be a Fibroadenoma with those imaging results? Or maybe the area was not correctly sampled? With the imaging I already was prepared that this was most likely cancer, so now I’m just confused. Hopefully the surgeon wants to just remove the mass and we will learn more
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DeeDee, I realize that you've posted this again because your previous post was in a "Diagnosed" forum and this is a more appropriate place for people to see your question and comment.
For the benefit of others reading, I'll repost my previous response from your other similar thread. This gives others the opportunity to add to what I've said, or disagree and post something different.
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On ultrasound imaging, a fibroadenoma is usually a well-circumscribed oval mass, which is pretty much the opposite of an irregularly shaped spiculated mass.
This is why the biopsy finding of a fibroadenoma is surprising. When biopsy results aren't consistent with what would be expected from the imaging, the results are considered discordant. When this happens, usually an excisional (i.e. surgical) biopsy is recommended, to remove the entire suspicious mass for a more complete examination under the microscope. I'm guessing this is why you've been referred to the Breast Surgeon.
Hopefully this does end up being just a benign fibroadenoma; I don't know how likely that is with that appearance on the imaging. Another possibility - not as good for you - is something I've seen just a few times in my many years on this site, which is that an area of cancer grows within a fibroadenoma. The fibroadenoma itself is benign, but it is composed of the same components as breast tissue (well, that's my simplistic layperson's understanding) so just as breast cancer can develop in breast tissue, it can develop within a fibroadenoma. That might not be what's happened in your case, but it's a possible explanation.
Please let us know what the Breast Surgeon says.
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Thank you. I realized I probably posted in the wrong area and I will try to remove it from the other board if I can. I appreciate your feedback
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DeeDee, I'm just putting a comment here to bump this thread back up to the top of the 'active' list so that hopefully others will see it and comment.
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That is interesting. I would want it taken out and tested.
My story didn't quite go like that. My right breast had the oval asymmetry on the outer part. 6 mo follow up was recommended on that report, however, since I was just diagnosed with bc in my left breast, the BS set me up with a biopsy of that area. The day I showed up the Dr. doing the procedure read my MRI and prior us and mammo and said she saw another area (lower) that looked to her to be LCIS. After discussion with the BS, I underwent another biopsy later that day. Both of these came back as fibroadenoma. I cannot recall the reasoning, but I also had an excision of this area during my surgery. That pathology is what came back as LCIS.
I hope it turns out OK, good luck!
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It makes sense that you're being sent to a breast surgeon, who most likely will recommend an excision.
I found the lump in my left breast, and mammogram/ultrasound resulted in a BIRADS 4, as most of the lump appeared as fibroadonomas do: smooth and oval, wider than tall. There was a small area of "shadowing" on one side that looked more "microlobulated", so a biopsy was recommended. I was sent to a breast surgeon, who performed a vaccuum-assisted ultrasound guided biopsy. The results were a fibroadenoma. Because my breast surgeon didn't like the look of the small area she told me I could wait and watch it for 6 months or have it removed. I asked for her opinion and she recommended removal. The excision resulted in a 2.2 cm area of IDC inside a 4.9 cm fibroadenoma. This is very rare, somewhere between .002% and .1% of fibroadenomas.
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Thank you all for your advice. This site is so helpful. It’s a tough spot to be in when you’re told you most definitely have cancer (BI-RADS 5), so “prepare for surgery, radiation, and chemo.” I was preparing for this and thought I was prepared for the next steps when suddenly I’m told “Congratulations! It’s just a fibroadenoma, not much to worry about.” Honestly it eases none of my concerns and although of course I would never want a cancer diagnosis, I’m feeling like it’s just as bad to be in this limbo. I have to wait a week to see the breast surgeon and hopefully she will just want to remove the mass. I don’t want to wait and see
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I was a Birads 5 with a spiculated mass and I did not have chemo. The shape really doesn't have anything to do with post-surgical treatment.
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Alice- can I ask was your biopsy definitive? Mine did not find any cancer so the results did not match my imaging studies
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Yes, and it was further verified by the MRI, a pre-surgical CT, and the post-surgical pathology.
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DeeDee, only about 25% - 30% of breast cancer patients are now given chemo, and radiation isn't needed if a mastectomy is performed with clean margins and negative nodes. If you look at my signature you'll see that I had cancer in both breasts but needed neither chemo nor radiation.
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Thank you- I think the idea of chemo is scarier than the idea of possible mastectomy, but I’m getting ahead of myself. I haven’t been officially diagnosed. I’m wondering if anyone else here had BI-RADS 5 with a spiculated mass, but a negative biopsy like me. Wondering if maybe they just missed the cells with the core biopsy
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Over the years when I've seen someone come through with a BIRADs 5 that has turned out to be benign, usually the finding is a radial scar. Radial scars have a spiculated appearance that makes them look like breast cancer on imaging and usually results in a BIRADs 5 assessment, but I don't think they are considered a "mass" because the center doesn't appear solid (my interpretation here of what I've read).
The following article suggests that 4% of spiculated masses end up benign (scroll about 1/2 way through the article for the section on "Spiculated masses: BI-RADS 5"):
Masses in mammography: What are the underlying anatomopathological lesions?
"Benign spiculated masses
Benign spiculated masses are rare (< 4%). In case of a benign result for the biopsy of a stellar mass, it is essential to make sure of the radiohistological concordance and, with the slightest doubt, take another biopsy with a larger calibre needle (macrobiopsy by suction) or complementary surgery. The aetiologies of benign spiculated masses are varied, essentially consisting of lesions presenting a predominant fibrous component."
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Thank you Beesie- I’ve been feverishly researching the other options that it might be. I just wish my appointment with breast surgery wasn’t a week away. I’m very interested in what she will have to say, and hopefully she will elect to just remove the mass to examine it further. I wish they would order an MRI now so we would have the results and get all of this moving already
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Dee Dee... my breast MRI showed suspicious spots on both breasts. I had many biopsies. The R side came back as IDC and the left they kept finding ADH (this did not coincide with the breast MRI). So I had 4 lumpectomies and on the L side they did find 17 micro tumors of all sorts of different cancers. I’m not trying to scare you, but I felt just like you, I don’t think the biopsy process is accurate enough for these small early stages.
Best of luck with whatever lies in front of you. Fingers crossed it’s benign.
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April0315-
Thank you for the info. You mentioned “microtumors?” The size of my mass is 1 x 1.8 x 1.4 cm- to me it would seem like it would be big enough not to miss 😂. I know they say waiting is the hardest part- and now I know it really is. Wednesday’s appointment with the breast surgeon can’t come soon enough
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yes yours would be hard to miss. My main tumor though on that side was 2cm, so I don’t know how they missed it with the US guided and core needle biopsies. But they did. The micro tumors were .2 mm so that I understood. The excisional biopsy will give you better answers. I’m praying it’s benign.
Stay busy this week and weekend. Time drags if you sit idle.
Best wishes for a great appointment and whatever comes next.
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Thank you for all the info. It’s so hard to concentrate at work, and to try and prepare for a somewhat normal Christmas with my kids- ughhh. I’m just hoping they want to just remove it already and hopefully I won’t have to wait too long
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Dee Dee, hang in there and get that Christmas prep done! That will for sure keep you busy and occupied..
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I know how you feel, the same thing happened to me in 2012.
Birads 5 etc, and then amazingly a benign biopsy result. To cut a very long story short I had to have a second lot of biopsies done, they still showed benign but as it was discordant they wanted the whole lump out.
On final pathology my big lump was actually benign, but within it was an area of DCIS. Hang in there x
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I met with the breast surgeon today and she ordered an MRI. The soonest I can get in is New Years Eve. Then, based on the results, she may want an MRI assisted biopsy- which could be another 3 or 4 weeks. I know she said it's ok if it takes awhile because cancer doesn't grow that quickly, but it's already been 6 weeks since we started this journey and it seems like we're no closer to a solution or a plan yet. It’s just so frustrating
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I'm sorry you have to wait so long, that must be very frustrating!
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I'm sorry you have to wait to so long too. My first abnormal mammogram was last Decemeber, Surgery was not until mid April. I feel like I read 4 months was pretty average.
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Just an update- I was able to get my MRI done last Friday- 2.5 weeks early! They decided my mass looked larger than it did on ultrasound, and also I have a hematoma posterior to the mass. Best guess is when they did the biopsy, they went right through the mass and sampled on the other side of the mass which is why pathology didn’t turn out as expected. I have another biopsy planned for tomorrow morning
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I am glad you were able to get in and that they followed up. Keep us posted. Praying for good news.
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A quick point on size...
Masses can look bigger or smaller depending upon the type of study done as they all see things a little differently so don't interpret this as evidence that it has enlarged.
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DeeDee,
I'm glad you were able to get in for the MRI sooner than expected. Good luck with the biopsy tomorrow. Let us know how it goes.
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thanks everyone
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Hello DeeDee. Understand the challenges of "thinking" at this time. Tough right before the holidays to have to go through this. I had a speculated mass birads 5. Right after my biopsy I was told that if my results were negative seek additional diagnostic options. Sounds like you are, hope all works out, and let us know how else we can help.
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Thank you Monica. I had a repeat core needle biopsy on Thursday where they they took seven more samples. Once again we’re at the weekend so hopefully I’ll have results by Monday, as they said 1-2 days. The ultrasonographer asked me if I’ve decided on a unilateral or a bilateral mastectomy, and if I think I’ll do reconstruction. So many decisions to make, and geez, it’s not even “official” yet
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I got the call a little bit ago- positive biopsy- lobular and invasive ductal. I don't have a copy of the report to see all the details, but I am supposed to call Monday to make an appointment with the surgeon.
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