BI-RADS 5, four biopsies this week
Hi all, first post. Sadly, I'm no stranger to the cancer community. I had Acute Lymphoblastic Leukemia when I was a kid, that later relapsed and was treated with a BMT.
I had my first mammogram last week because of my own cancer history and family history of breast cancer. It wasn't very conclusive, so I went back a couple days later for another mammogram and an ultrasound. Immediately after the ultrasound I was rushed into a room to set up a core biopsy appointment ASAP.
Findings from my previous imaging:
Ultrasound left breast:
An irregular solid mass is present in the subareolar breast which measures 30 x 10 x 29 mm. In addition at posterior depth in the posterior central breast there is a round solid mass which measures 8 mm in diameter. At 10:00, 3 to 4 cm from the nipple there is a round solid mass which measures 5 x 6 x 4 mm.
Ultrasound right breast:
In the subareolar breast there is an irregular hypoechoic solid mass which measures approximately 18 x 33 x 26 mm. There are tubular protrusions of solid material medially and laterally from the mass which are suggestive of intraductal extension. A solid round mass is present at 3:00, 5 to 6 cm from the nipple which measures 6 mm in diameter. At 3:00, 3 to 4 cm from the nipple there is an irregular solid mass which measures 10 x 4 x 6 mm. At 7:00, 5 to 6 cm from the nipple there is an irregular solid mass which measures 6 x 5 x 6 mm. At 12:00, 3 to 4 cm from the nipple there is an irregular solid mass which measures 12 x 9 x 14 mm, this correlates with the site of architectural distortion in the upper central breast.
Both are BI-RADS category 5. I feel sick with worry; I'm already dealing with a lot of heath issues from my previous cancer and treatment and truly didn't think that this would come for me so soon. I plan on doing a lot of reading between now and my appointment. Just needed to vent somewhere with people who understand.
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Soooo sorry you find yourself here les!!!! You've already been through so much! Just want to send support and best for the biopsies. BIRADS 5 is more likely than not, as I'm sure you're aware, to come back cancer. I'd give you some hope for DCIS though with that many areas that may be a long shot..... Please let us know how the biopsies go and certainly once you hear about results. You already know the waiting is really difficult..... Also ice, ice, ice after the biopsy and even a little the next morning if you can - I found it really helped!
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I'm so sorry you're dealing with this, especially with everything you've already been through.
Even when we have the bad luck of cancer, there's still plenty of chances for good luck. Catching through screening bodes well for it being early stage and treatable, and I hope it will go as easy as possible for you! Ie maybe turn your life upside down for a little while, but not actually shorten it all!
Whatever it is, the reality is often easier to deal with than the unknown dread, so I hope you can start getting some more info and answers soon. And these boards are here for you, and a great source of support.
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I read your post’s title and, for a moment, thought, “Is that my post?” I do not have a history of cancer- aside from a bit of SC skin cancer- but I literally just went through the four core needle biopsies in one go on Thursday; my DX mammo and ultrasound were BIRADS 5 as well. I have one mass in the left breast and three in the right. The radiologist was concerned that so many biopsies in one day would be too much, but honestly, I just wanted to get it all done ASAP. It actually went fairly smoothly and I was able to watch the ultrasound screen as the biopsies were performed. For me, it helped get me out of my emotional brain and into science and learning mode. And for the record, in retrospect, I would 100% do all of the biopsies in one day if I had to do it over.
I have very dense breasts and it got a bit brutal at times when the doctor was trying to create the initial path through to the mass so the automated biopsy “gun” could cleanly fire into the correct area to be biopsied, but since the area was very well numbed, it was more of a pressure sensation- and sometimes like being mauled by a bear. 😬. But the pain was truly minimal. My team used sodium bicarbonate to buffer the lidocaine when they numbed my breasts and it took nearly all the sting out of the injection.
I am quite bruised on the right side where the three were done, but some of my bruising may also be intensified bc they had difficulty stopping the bleeding from two of mine and had to apply extremely firm (think pushing all the way down to your ribs) pressure for 10-15 minutes on each entry point to achieve homeostasis.
As Livin Life said- ice, ice, ice! I kind of arranged my ice packs into a “boob shape” each time when I put them back in the freezer and felt that helped provide more immediate relief bc of better contact. I also used a wide, neoprene back support band that my mom had let me borrow. I would arrange the covered ice pack, then wrap the back support thing over the outside of my shirt to the ice in place and to also apply a bit of pressure to minimize swelling. An Ace bandage would work similarly, I’m sure.
I’m so sorry you have to go through this situation, but please feel free to reach out with any questions or just to vent a bit if you need to. You are not alone! We are all here to support you through this process.
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Thank you all for your kind words. I will definitely remember to ice! I'm already a little bruised from the mammograms so I want to be more proactive this time around to prevent more pain and soreness.
It's true that the waiting is the hardest. I don't want to read too much into what's "next" before I have an official diagnosis but it's hard to get my brain to focus on anything else.
I appreciate the advice. I will report back on how it went. Fingers crossed I can do all four biopsies at once (multiple nurses and schedulers spent like 15-20 minutes trying to find a place to fit me into the schedule and it still needs approval, otherwise I'll have to go back to do the other one a few days later.) I also have an unrelated skin biopsy this week too on a separate day.
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I'm only a few days ahead of you in this part of the process. I have to say, after the biopsies were over, I had a good cry, then felt this kind of surreal feeling of calm. I told my husband I think it was the fact that I FINALLY felt like something proactive had been done to get us to the next steps. It was kind of nice to have a couple of days of feeling relief more than worry. I hope you will find comfort in being able to mark the biopsies off your list.
Now, of course, the waiting begins. I am supposed to receive my results sometime this week, so it's a whole new set of stress. I feel like I just took one of the most important tests of my entire life, but there was no way to prepare or “study" and now I'm just waiting for my “grades" to post so I can find out where I'll end up next. It's maddening!
Oh- I did get a prescription for a couple of Valium to take if needed the day of my biopsies. I wasn't sure if I would need them. But wanted to have them on hand. Well, when I got there and my blood pressure was 183/100, the nurse strongly encouraged me to take them! I do think they helped keep my thoughts from racing and they definitely brought my BP down. If that's something you think you may need, it may be worth a call just to get a couple to have with you just in case; you don’t have to actually take them if you don’t end up needing them, of course
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lesmisarahbles love how you spell your name. Even through the tough times, you have your sense of humour.
I had Hodgkin's lymphoma 10 years ago and now just diagnosed with breast cancer two weeks ago, I can relate how that feels, when the first one was hard as it is and you were so young too. So sorry that you have to go through the diagnosis stress again. Two things I'd like to write to you, first until pathology says cancer, it is not. Secondly, you already successfully survived a cancer, even if the unthinkable diagnosis happens, you can do it again.
As for now, just enjoy your days, try not to google/read/think too much, save your energy and worries for later, in case it turns out that you need them.
I will be thinking about you, please keep us posted.
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lesmisarahbles - We're sorry you have to be here, but you've come to the right place for support as you go through this. Let us know if we can be of help. We're thinking of you!
The Mods
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I had my biopsies yesterday. Luckily they were able to fit all four into my appointment slot so I don’t have to go back. The procedure wasn’t too bad, especially after we finished one side and I knew what to expect.
I took a tylenol yesterday as I felt pretty sore afterwards, but surprisingly I feel pretty okay today? None of the soreness from yesterday and no bruising yet. Hoping it heals quickly (and that I don’t have to wait for news over the weekend.
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Update: TLDR it was all benign
Shockingly to both myself and everyone I’d interacted with at the imaging clinic, all four biopsies came back benign. I’ll post the details below. Very very thankful that I don’t have to face cancer a third time yet. They did note LCIS and want to discuss my case with more doctors, I’m assuming to figure out what further imaging and tests may be needed and how closely to follow me as I may develop BC later on.
Thank you all for your tips and kindness this week, it was incredibly helpful.
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A. LEFT BREAST, SUBAREOLAR, ULTRASOUND ULTRASOUND GUIDED CORE NEEDLE BIOPSY FOR
A 4.3 CM MASS WITH IRREGULAR MARGINS (WING CLIP):
Fibroadenomatoid changes, adenosis, microcysts, usual ductal hyperplasia, and
dense stroma are present (additional levels are evaluated).
Immunoperoxidase studies for E-cadherin, estrogen receptor, and cytokeratin 5
do not identify an atypical cell population.
Note: Specific histologic features of a mass forming lesion are not seen.
Radiologic correlation is suggested to ensure that the biopsy is representative
of the targeted lesion.
B. LEFT BREAST, POSTERIOR CENTRAL, ULTRASOUND GUIDED CORE NEEDLE BIOPSY FOR A
0.8 CM MASS WITH INDISTINCT AND CIRCUMSCRIBED MARGINS (RIBBON CLIP):
LOBULAR CARCINOMA IN SITU, classical type, is present. Immunoperoxidase studies
confirm the absence of E-cadherin and estrogen receptor positivity. A multiplex
study for p63/keratin AE1/AE3 study shows myoepithelial cells at the periphery
of the involved ducts, as well as intermingled with the lobular cells.
Fibroadenomatoid changes, at least 1.2 cm.
Note: The fibroadenomatoid changes likely correlate with the targeted mass. The
LCIS is an incidental finding.
C. RIGHT BREAST, 12:00 (3-4 CM FROM NIPPLE), ULTRASOUND GUIDED CORE NEEDLE
BIOPSY FOR A 1 CM MASS WITH IRREGULAR MARGINS (WING CLIP):
Fibroadenomatoid changes (at least 0.4 cm; additional levels are evaluated).
D. RIGHT BREAST, SUBAREOLAR, ULTRASOUND GUIDED CORE NEEDLE BIOPSY FOR A 3 CM
MASS WITH IRREGULAR MARGINS (RIBBON CLIP):
Dense stroma with pseudoangiomatous stromal hyperplasia (PASH), at least 0.8 cm
(additional levels are evaluated).
Note: Specific histologic features of a mass forming lesion are not seen.
Radiologic correlation is suggested to ensure that the biopsy is representative
of the targeted lesion.0 -
What wonderful news! Congratulations and best wishes
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Wonderful! Wow.
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Sooo happy for you! I'm assuming (?) they may want to remove the LCIS? Let us know once you've had follow-up on next steps....
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I am so glad to hear the news. Made my day :-)
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Small update: I’m having an MRI and another biopsy next week. There’s still an area on my right breast they’re concerned with and want more imaging and samples of. Will update again when I get those results
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Back with another update and still no clear answers. I had an MRI and stereoscopic biopsy last week and this was what I found in my online chart. Basically they still don’t know what’s up 😭 and likely I’ll need to have a lumpectomy. Haven’t heard from the doctor directly yet, and honestly the waiting and back and forth this last month has been so difficult mentally.
PATHOLOGIC DIAGNOSIS:
A. RIGHT BREAST, UPPER CENTRAL (12:00), STEREOTACTIC CORE NEEDLE BIOPSY FOR
ARCHITECTURAL DISTORTION:
Atypical epithelial proliferation (see note).
Stromal fibrosis and multinucleated giant cells, possibly representing biopsy
site changes.
Sclerosing lesion, up to 0.3 cm.
Intraductal papilloma, 0.15 cm.
Usual ductal hyperplasia.
Apocrine metaplasia and cysts.
Columnar cell change.
NOTE: Multiple levels were examined. A small (0.3 cm) tissue fragment consists
of a florid epithelial proliferation with foci of squamous differentiation,
spindled stroma, and associated osteoclast-like giant cells. Several mitoses
are present within the proliferation. p63/AE1/AE3 and SMMHC/AE1/AE3
immunohistochemical stains demonstrate the presence of a myoepithelial cell
layer within the lesion and suggest that there may be underlying papillary
architecture. Weak p53 reactivity is also noted in scattered cells within the
spindled stroma. The epithelial proliferation is positive for GATA3 and CK5
(diffuse) and largely negative for estrogen receptor (rare weakly positive
nuclei). The findings are unusual and cannot be further characterized in this
limited biopsy sample. This lesion would be best evaluated by excision.0 -
Back again! Still playing the waiting game. Due to my medical history and all the mixed results I’m scheduled for a surgical biopsy on my right breast. It was supposed to happen last Friday but due to being understaffed I got bumped and won’t have the procedure until mid January. Truly the waiting is the worst part of all this. It’s been months of tests without a definitive yes or no.
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Good grief, that wait time is ridiculous. I hope you can find enough fun things to do to keep from constantly thinking about it.
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Finally had surgery two weeks ago after it getting delayed twice because of staffing shortages. 💀 I believe they didn’t find anything of concern, and I’ll have another MRI in April to check everything out again.
FINAL DIAGNOSIS:
A. Breast tissue, RIGHT, radioseed guided excision:
1. Complex sclerosing lesion (1.0 cm) with associated epithelial hyperplasia,
intraductal papilloma (0.4 cm) and calcification.
2. Columnar cell changes with calcification.
3. Biopsy sites x2.
4. Margins inked and examined.0 -
great news - hope the April follow up is a non event
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Dear lesmisarahbles,
Thank you for continuing to update us on your results. It is very helpful. Best wishes to you. Hope you can catch a breath.
The Mods
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Yes, thanks for sharing your good news. Congrats. Hope you will be able to put your worries away now.
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