"Difficult" Biopsy Needed
Radiologist says I need a biopsy that will be difficult to do. That makes me nervous.
I did a regular screening mammogram (I am 67), and they noticed a small "density" that wasn't on my mammogram from 18 months earlier. I have very fatty breasts so things show up easily. I was called back today for a diagnostic mammo and then they did an ultrasound.
The radiologist worked hard but couldn't find anything on the ultrasound. The small density is on the left side of my right breast very close to where my breast meets my chest. He said it is very small and is very close to the surface. He looked for any skin lesion and found nothing. He kept trying with the ultrasound and finally found a place that he says might be the spot on the mammogram, but might not.
He said that they would do a stereotactic biopsy, but that due to the location they might have difficulty. He said if that didn't work then they would try to biopsy the place on the ultrasound that might possibly be the place on the mammogram, but it might not be.
He then said that this biopsy would be very difficult to do and maybe it would easier to do a surgical biopsy and remove the entire place. But, then he asked me to make an appointment for the stereotactic biopsy. I said I wasn't sure where I wanted to have the biopsy done and would get back to them.
Even before I got there, I had been undecided if I would have the imaging center do the biopsy. I don't really know much about them except my PC physician sent me there for my screening mammos. His stating that the biopsy would be very difficult and might not even be possible as a needle biopsy didn't help. I am not unhappy with him telling me this, of course. I appreciated his candor.
Many years ago I had surgical biopsies at MD Anderson after my first mammogram (both were benign). At that time I lived in Houston. I now live about 4 1/2 hours away. Anyway, I called to get an appointment with their undiagnosed breast clinic. Apparently they will get my records then will use them to evaluate what I need and will do my biopsy on the same I come in for the consultation (well if it is a needle biopsy). I haven't heard back yet to get an appointment time but am told it is usually within 7 to 10 days and they will call by tomorrow to schedule.
This might be overkill to go there at this point. But, the radiologist has already said this will be a difficult biopsy. Given that, I am inclined to go to the place that I trust even though it probably means a night in a hotel beforehand.
The radiologist didn't really say much about what he thought this was. He just said it was new and that it couldn't say it wasn't cancer. I am going to get a copy of the report but it wasn't done yet when I left today. Will probably go tomorrow and get it.
Question
Has anyone had a small place very close to both the skin and very close to the chest. Does that make this higher risk?
Comments
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If you have the time, ability and desire to travel to get the biopsy - I don’t think it’s overkill at all.
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Especially because this isn't a simple biopsy, I would go back to MD Anderson. Sounds like an excisional biopsy could be of help. A night in a hotel for peace of mind.
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I would definitely go to the super-specialists who might just say, "Oh we can do that, and here is the best way, and this is why, and don't worry, we got this." Who does the biopsy, their skill and experience, can make a big difference. Totally worth traveling in my opinion.
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My biopsy was very difficult to obtain. My mass was very close to my chest wall but unlike you I had very dense breast tissue. My tumor didn't show well in imaging, but with the MRI reports, the team used an ultrasound to finally pinpoint for biopsy. It took them about 20 minutes just to identify the area. The biopsy itself was not really painful but felt for lack of a better term violent because the radiologist had to really push deeply through tissue to get to the chest wall. I was pretty bruised after and kind of worn out. I think you will have a much easier time with the biopsy with having fatty tissue. I agree with the other posters in support of you going to a team you have history with, and who are highly experienced. My work was completed at a Breast Center, so their level of experience definitely helped me get an accurate biopsy from a difficult case. Best of luck on the biopsy, hope it is just a benign little spot.
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I thought I posted a response but I think I must have only selected preview. Anyway...
Thanks for the responses. I have an appointment at MD Anderson in their undiagnosed breast clinic for next Friday morning. They ordinarily will do a breast exam, may do a mammogram or ultrasound and, if time, a biopsy. But stereotactic biopsies are done only in the morning, so they won't that if I need it that day unless they decide in advance to do it. They wanted 5 years of all my films and reports. I've been in my current area (4 1/2 hours away) since 2018. Before that, I was in Houston and MD Anderson was reading my mammograms.
The mammography center I've been going to since then originally had paperwork saying it would take 3 to 7 business days to get my records. I went over to their office and they say they can get them to me Monday. MD Anderson said that they might decide after looking at them to schedule the stereotactic biopsy. If not, if I need one I will have to come back.
I did pick up paper copies of my reports from this past few weeks.
The screening mammogram (5/21) said:
There is a density in the right breast at 5 o'clock middle depth
The report then recommends additional imaging.
The diagnostic mammogram (6/2) says:
There is a 4 mm irregular focal asymmetry in the right breast at 5 o'clock anterior depth 6 cm from the nipple
The report then recommends the ultrasound.
The ultrasound was immediately done and says:
There is a .3 cm subtle hypoechoic area in the right breast at 5 o'clock anterior depth 6 cm from the nipple. This finding may correspond with the mammography findings.
In talking to the radiologist, he didn't seem totally convinced that this area really existed and if it is where the place is on the mammogram. The report goes on to say:
The irregular focal asymmetry in the right breast is suspicious for malignancy. A right breast stereotactic biopsy is recommended. Given its location, this finding may not be amenable to stereotactic biopsy. In this scenario, recommend ultrasound guided biopsy of the subtle hypoechoic area in the right breast at 5 o'clock with post clip mammogram correlation.
The radiologist told me that either of those biopsies would be very difficult and maybe it would be easier to do a surgical biopsy. But, he did want to try to do the above. He just wasn't at all confident on it.
I was glad to get an appointment next Friday and hope they can do the biopsy then although if I had to come back that is OK. The biggest negative, though, is that I also have to come there on Wednesday. I had planned that we would drive there Thursday afternoon and see our kids in the Houston area then do the appointment Friday and come home. But....MD Anderson requires all new patients to have a COVID test even if fully vaccinated. I understand why and I'm fine with. But, I was told that they only trust tests that they do and they don't do rapid tests. So I have an appointment Wednesday for the Covid test and then my actual appointment on Friday. It won't make sense to drive home Wednesday and come back the next day so that will be two nights in a hotel. That is fine and I understand it. I do wish I could a COVID test here, but I do understand they want to be very cautious.
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I had my biopsy on Friday, so this is an update on that. I did go to MD Anderson and I'm glad that I did it. They were extremely thorough and everyone I dealt with radiated competence. They looked at my all my images and reports (they went back several years) and did not end up repeating the mammogram.
They did repeat the ultrasound. The radiologist felt she was able to identify on the ultrasound the same spot on the mammogram. Her main point was that even if what she saw on the ultrasound was a different spot than what she saw on the mammogram that the ultrasound place would still need to be biopsied.
After doing the ultrasound, she felt that the two main possibilities are either fat necrosis (I had a breast lift about 5 years ago and these sometimes happen after breast surgery) or a small cancer about the size of half a grain of rice. Her report gave this a BI-RADS score of 4B.
She then did a core needle biopsy. She commented afterwards that the area sampled did not feel like cancer to her because it was so soft. That said, she said that there is a form of breast cancer, mucinous breast cancer, which is soft although that type is rare. When she did the biopsy she placed a clip and then I went off to mammography and it was in the location shown on the mammogram. My main anxiety during the procedure was that since the place was so small that the biopsy might miss the actual spot or that the spot on the ultrasound would not be the same as the place that showed up on the mammogram. But, apparently, it was.
They expect results between Wednesday and the end of the week.
The experience was quite different from the ultrasound I had on my mammogram callback. The radiologist at MD Anderson was much more confident about how to handle the biopsy and was much better at explaining everything. It made the 2 nights in a hotel worth it.
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Koshka I am so glad to hear that all went well, and that you received your biopsy. Praying for a benign result for you!
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Following up on this. It seems mostly good news. The biopsy was benign. The tissue was described as lymphohistiocytic infiltrates which the nurse practitioner said was something inflammatory. At first she said I could go back to my annual mammograms. But, the radiologist was on vacation and she needed to look at it.
So the following week the radiologist returned. She said that I should come back in 6 months for a mammogram and an ultrasound. The nurse practitioner said that the biopsy was benign and the place could not become cancer. I did ask if I needed to be concerned about it or something similar for the future. I wasn't so much worried it would become cancerous, but that it might be some benign problem that would need attention.
At that point, the nurse practitioner said I didn't need to be concerned about it, that it was benign and it couldn't become cancer... but I should come back in 6 months so they could check to see if it was growing. I'm not quite sure what that means, but I will be going back for the follow up in 6 months.
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Yay!!
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Really good news Koshka! Soooo happy for you!! Thanks for coming back to let us know....
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