BI-RADS 4, waiting for biopsy results
I had a biopsy performed on 9/8 and am on pins and needles waiting for the results. I'm 41, no family history of breast cancer, and had my first mammogram on 8/20. I got a BI-RADS 0 because they saw a partially obscured mass on the upper outer left breast. Went for an ultrasound on 9/1 and they talked like it was probably a fibroadenoma, but there's a lot of solid stuff in there that might be old blood and other harmless things, but they wanted to be sure, so they scheduled the biopsy. They also told me ahead of the biopsy that they would first try to aspirate and drain it if it is a cyst, but on the day of the biopsy the doctor performing the procedure said there was enough material in the mass that she wanted to go straight for a tissue sample because it would mean less poking for me.
The ultrasound described it as a multilobulated complex cystic lesion measuring .8 x 1.9 x .8. Most of its margins are smooth and sharply defined. Some of the lobulations appear nearly anechoic suggesting cyst. Other lobulations show diffuse echoes concerning for solid portion versus prominent amounts of debris in a cyst. There are a few incomplete septations dividing it into its separate lobulations. All of the lobulations at some point do appear to be connected.
I know the majority of BI-RADS 4 cases are benign, but I also know I can't rule out cancer. I also know BI-RADS 4 is often broken into sub categories a, b, and c, but they didn't share that with me. The waiting is really awful. I've been trying to keep myself busy, while reassuring myself that if something is wrong I want them to catch it so we can deal with it.
Anyone have similar stories?
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Hi, Rachael!
Sending benign vibes your way regarding the biopsy results you anticipate!
I have a BIRADS 4 story myself dating back in 2018 which came back benign (details below in my caption).
In my case it was a solid mass of 1 cm with partially benign and partially malignant characteristics with a BIRADS score falling between 4a and 4b. The most alarming were its spiculated margins (synonym of cancer) shown in the MRI. I underwent a surgical biopsy under total anaesthesia with a big chunk (the size of a human palm) of the bottom of my right boob ending up on the pathology desk under the microscope! The surgeon performed oncoplasty and the aesthetic result is pretty acceptable, nobody -other than myself- can really tell the difference in size between my two breasts. Thankfully the histology came back benign.
I have to admit that it has been the most turbulent time in my whole life so far and it's not that I'm unfamiliar with cancer scares as I'm also a borderline MGUS/smoldering myeloma patient. I absolutely feel your anxiety through waiting for the results.
I had my annual screening mammo and u/s last week and -as per usual post surgery- it came back stable and same with last year's but always BIRADS 3 due to the post surgical scars and oncoplasty "reconstruction". Had to vent myself! lol
Sending best wishes to put all this behind you really soon, right after you receive your biopsy results.
Love,
Jo
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Hi Rachael2006, and welcome to Breastcancer.org.
We are so sorry for the worries that bring you here, but we're really glad you've found us and decided to join. We're sure you'll find this space a helpful and informative place and we hope you get the support you need -- if it turns out you need it. In the meantime, we're all here for you while you figure out what's going on!
Please let us know if you need any help at all while you navigate the boards. We look forward to hearing more from you soon!
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Hi Rachael! Hopefully you hear back by early to mid-next week at the latest.... The waiting is soooo difficult!!! I hope you have some low key or even enjoyable things planned for the weekend. even if you're preoccupied with biopsy results it will help pass the time.... please let us know when you hear something...
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Thank you so much for the encouraging responses. I just got the raw results this evening online (faster than I expected) but have to wait for the nurse to call to explain everything. They warned me the report would have a lot of unfamiliar terms, and they weren't kidding. I think this looks good, though. I don't know if they'll want me to come in for a lumpectomy or for follow-up sooner than a year or anything like that, but I can deal with those things.
If anyone is familiar with some of this terminology, I'd appreciate your input. If not, I know it will get explained to me next week.Fibroadenoma with florid usual ductal hyperplasia and apocrine metaplasia.
–No in situ or invasive carcinoma identified.Sections of the "left breast mass" show a fibroadenoma slight architectural complexity. Within the lesion there is an anastomosing network of ducts, some which are mildly dilated. There are areas of florid usual ductal hyperplasia and apocrine metaplasia. Foci of cystic change are noted, with individual cysts up to 1 mm greatest dimension. The epithelial elements within the lesion are surrounded by fibrous to fibromyxoid stroma. In 1 core there is a portion of lesion with marked stromal hyalinization. Mild fibrocystic changes noted in the surrounding breast tissue. No in situ or invasive carcinoma is identified.
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Hi Rachel2006, waiting for results is the worst. I had no idea before I got into this whole thing. Hadn't realized that my friends and family who've had cancer were suffering silently through that part. I hope you get your results soon.
I had a quick biopsy 2 months ago on a lump and also some calcifications (in another location). Calcifications were DCIS, but the results on the lump were so weird and inconclusive that I guess they just decided to remove it rather than do a guided biopsy, since they had to go in for the DCIS anyway.
It turned out to be a sclerosing adenosis (= benign) that had been taken over by LCIS (= not a great sign, but benign) that had "grown up around it" (according to the path report). They didn't know how to classify it but went with "florid LCIS" (= more aggressive but still technically benign). I feel like it's some bizarre monstrosity, and thus surely fatal—in fact, the word “bizarre" is used to describe some of the cells—but keep reminding myself that (a) they have taken it out now and (b) they didn't find anything invasive, let alone malignant. Strangely, I keep forgetting that it's actually not there any more, but sliced up on some slides.
Sclerosing adenosis is apparently VERY difficult to differentiate from invasive cancer. Especially so in situations like mine, but apparently even regular sclerosing adenosis looks a lot like cancer on all types of scans. It doesn't usually show spiculated margins, which, as Jo pointed out above, are a bad sign, but neither did yours.
I hope that, if I'm wrong about something here, one of the incredibly knowledgeable women on these boards will jump in and correct me. I'm a newbie. I've learned so much thanks to the generous people here.
I should NOT be encouraging your obsessing over the results… pot calling the kettle black here… But I was curious about the mass and did find the article below, which might help put your mind at ease.
The DCIS turned out to have branched out into IDC, so less lucky there. But it's < 1cm.
Fingers crossed for results soon. I know how bad it is.
I can't post a link, but the article title is "Carcinoma in Situ Involving Sclerosing Adenosis on Core Biopsy" (2020) by Richards et al. It should be freely available but you can PM me if it's not.
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Oops, you posted while I was typing all that.
My surgical path report read a lot like yours… 6 or 7 different ugly-sounding things.
In the article I mentioned, their main point was that if invasive cancer is diagnosed too quickly on biopsy, some women will go on to have a BMX only to find out that the lump wasn't malignant. I guess now you know to keep an eye on it, and you'll get follow-up.
All the best and happy to hear your news!
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Awesome news, Rachael!
Yup the terms are very familiar, the same sort identified in my histology as well.
Dilated ducts and cysts are common in breasts like ours which undergo fibrocystic changes like forever, I read the same sort of report every year in my ultrasound evaluation.
I'm sure you'll have a wonderful, carefree weekend now, enjoy it to your heart's content!
Love,
Jo
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Sounds like good news overall with your report Rachael!! I've had two fibroadenoma's all total and neither needed removal. Others have had really large ones and removal is suggested. I initially had apocrine features with my last biopsy. I'm not sure what will be suggested with your other findings - I'm just not familiar. You will hear soon - others may chime in yet and then of course your doc's office. Let us know what they end up recommending...
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The nurse just called and said nothing needs to be done and I can just continue with annual mammograms. Woo hoo! She said fibroadenomas are often related to hormone fluctuations and to let them know if I start experiencing pain or if it gets noticeably larger (it's so deep I can't feel it, so I'm not sure I'd know). Thank you for all the encouragement and stories, ladies. This site and the message boards have been a great place to find information and reassurance during an uncertain time. Good luck to all of you in your own journeys.
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Congratulations, Rachel!
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Yes, excellent news! All the best!
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Fantastic!!! Thanks for letting us know!
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