Worrisome 6 month follow up MRI results.
Hello, first time poster here
In November I had a follow up breast MRI as a management course to my previous MRI of a radial scar with then a MRI guided biopsy which was b9. This current MRI is showing doubling in size and more linear clumped non mass enhancement. It says the CADD was progressive. I've read that that usually means b9 except for like 9% should I be worried? I'm scheduled with my surgical oncologist on Dec. 6th to discuss my excisional biopsy. What are some good questions to ask?
I'd like to know if it's possible to switch from the excisional biopsy to mastectomy if it's something bad right then and there or is that something that needs to be rescheduled. I hate waiting and I don't have alot of time I can take off of work for multiple surgeries. Is pathology done right on the spot?
Thanks in advance for any knowledge. I like to go into things prepared.
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I doubt if they could switch on the spot, due to the amount of time a mastectomy would take compared to a simple scar excision. It would throw other patients' scheduled surgeries off. And unless you have other things going on, like genetic testing that shows a breast cancer risk, I'm not sure a surgeon would agree to a mastectomy for a benign condition.
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I will add to what Alice said. Some pathology info is available almost immediately, but my understanding is that is mainly to check margins. That being said, I’m not certain if this happens during an excisional biopsy (it does happen with a lumpectomy). Complete pathology reports take a bit more time, evena few days, so your docs would not have a complete pathology at the time of the biopsy. Take care
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Thanks for your quick replies. I'm also certain they wouldn't do a mastectomy for a benign condition which is why I wondered about the pathology during the procedure. It was my understanding too that an excisional biopsy is a lumpectomy. Is that incorrect? So much to learn when you're given these circumstances. I just wanna know already. I'm just anxious about the growth and change in appearance of it in 6 months time I guess. I'm sure I'll feel silly if it turns out to be nothing. But the mind has a way of creating scenarios of worst cases. So I'll just keep trying to distract myself 😕 until I know for sure.
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Yes, an excisional biopsy is essentially a lumpectomy but that doesn’t mean it’s easy to convert to a mastectomy on the fly (in addition to incomplete pathology and insurance issues). It is very difficult to wait. We have all been there but you want to base any potential decisions going forward on the complete path report. Try to stay present and don’t borrow trouble.
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bearlythere: Everyone is correct when they are advising you to save the worry until the path report is complete. I've been down the radial scar route, however, so I'm telling you about my experience so that you can ask your surgeon questions. There is a lot of controversy about the significance of RS and how they should be treated. RS themselves are classified as benign lesions but the tissue environment in which they form seems to be a good environment for malignant lesions to occur as well. I'm not a doctor but from my research and what doctors have told me a tumor does not develop from the radial scar itself but grows close to it. Currently an excisional biopsy is recommended since a core needle biopsy does not remove enough tissue and can miss malignant cells. There are many conflicting studies which give the rate of malignancy from 0 - 40%, more likely in those over 50. There still seem to be many unanswered questions about radial scars.
When my mammogram showed architectural distortion due to radial scars I was put on a six monthly mammo schedule since observation was the recommended protocol at the time. For two years everything was stable, but at 2.5 years calcifications showed up in the same location and I went from birads 3 to 4c. A core needle biopsy showed DCIS. The breast surgeon did her own ultrasound and told me that her gut feeling was IDC so she scheduled a lumpectomy with sentinel node biopsy. She was right: it was a 3 cm IDC tumor with DCIS and micromets in 1/3 nodes. The pathology report mentioned numerous radial scars in the tumor margins which are considered clean since the RS are classified as benign. The cosmetic outcome was excellent.
Six months from the discovery of the RS to the excisional biopsy is way quicker than my timeframe so I expect you'll have a good outcome. Consider whether you would want a lumpectomy or a mastectomy if you need further surgery. If the surgeon knows you might want a lumpectomy they can do the excision with that in mind so you will be happy with the end result. While two surgeries are more time consuming it is worth the trouble if necessary to get things right. I was able to go back to work three days after my lumpectomy. I hope things work out well. Try to stay busy with other things in the meantime.
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Dear maggie15,
Thank you for your response 🙏. I appreciate hearing about anyone's experience with these radial scars. Mine went from 8mm to 1.8 cm in 6 months. I don't know if that's typical growth for these. But seeing as though the surgical oncologist called me on a Saturday to give me the results of my recent MRI I had Thursday and tell me that he wanted to schedule the exisional biopsy after originally just opting to get an MRI every 6 months after our last consultation I couldn't help but fret a bit.
I'm just glad to hear from people that have some personal experience with this. I am surely hoping for b9 with all my being. Thanks again for the info. I do appreciate it.
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