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Awaiting Biopsy- Birads 4A

Hello everyone! I'm glad I've found this group. I am in Ontario, Canada and in the high risk category for breast cancer and so get an annual MRI/Mammogram. I am 37. My mother was diagnosed at 59 with stage IIIb E+ PR+ HER2- and is two years in remission. She is in the US and being treated by the Cleveland Clinic. My mother does not have BRCA gene, but that is the only gene they screened her for due to her cancer type and age. I have some other risk factors that put me in the high risk category. Anyway, while I was warned biopsies would be in my future with younger screenings, I wasn't prepared yet (are we ever?).

Unfortunately I haven't been provided the direct reports (I will be getting them from the hospital), but I do have the imaging.

Verbally I've been told they believe the area to be an intramammary lymph node or fibroadenoma. It is 0.6cm×0.4cm, so pretty small. The reason I've been told they want the biopsy is that it appeared on my mammogram, MRI and was confirmed on the followup ultrasound. But, I don't quite understand because I also have very cystic breasts that appear on my imaging and they've never required biopsy of those!

The ultrasound tech said in her opinion it was a lymph node that was not suspicious, but that she wasn't sure what follow-up would be because sometimes with high-risk, they just biopsy everything. My family doctor and the booking nurse at Breast Health both indicated very low suspicion because I was in tears from the anxiety. They kept repeating Birads 4A statistics to me.

As so many of you know, these possibilities are life changing. I own a thriving small business and don't want to lose it. I've seen everything my mom has went through. We almost lost her twice due to acquiring c-diff during treatment. We lost my father-in-law a week after his first chemo treatment to bronchitis. I have developed bad health anxiety from all of this.

I'm just sort of lost. If it's likely a benign thing... why the biopsy? I feel like I'm not being told something. On the other hand, the alternative is follow-up MRIs at an earlier interval, which maybe more expensive to the system here than just biopsying it. And I don't know that I'd want to wait for anything suspicious. I just wish it weren't happening.

My biopsy is on the 30th and I was told to expect to wait two weeks for pathology. A note to that, I've known women using the same Breast Health centre who were rushed in next day for their biopsy. Hopefully it's a good sign that I'm not being rushed, but there's always that part of your brain nagging- what if it's spreading? And if it's a lymph node, that can't be good?! Oddly, I have nothing else suspicious in that breast.

Anyway, thank you for listening. I appreciate everything so many of you have been through, and know this probably sounds a bit over-reactive.

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Comments

  • maggie15
    maggie15 Member Posts: 843

    Hi @bluerose04 , I'm sorry that you have to go through the stress of a biopsy and waiting for results. Things move slowly in the breast cancer world because it takes a while for tumors to grow. While imaging is an initial step the only way to tell the status of an abnormality is having the biopsy. About 80% of biopsies turn out to be benign but it is normal to be concerned. I hope you get good news. Hang in there and let us know how it turns out.

  • kaynotrealname
    kaynotrealname Member Posts: 365

    Yeah this part sucks loads. I'm so sorry you're going through it and that you have to wait two weeks for your results. However, it reads that they are pretty confident you've got nothing to be concerned about and are just taking precautions due to your high risk status. I would hang onto that. A bi-rads 4A is much more likely to be benign than cancerous. If your doctors aren't concerned try to make it a rule not to be because chances are this will happen again. It's the way the game works. Maybe therapy will help you come to terms with it since we all know the waiting part is torturous.

  • bluerose04
    bluerose04 Member Posts: 4

    Hi everyone, thank you for your comments and reassurance. I am just leaving an update as I had my biopsy today. It was core needle ultrasound guided and they had to go in three times. My mass is the size of a pea, and I had an old school radiologist that didn't say much, but did note that it changed after the first pull and when I asked if that was good said "yes". I had a clip inserted and mammogram after to get my new baseline. The biopsy didn't hurt much for me thankfully. I think the numbing was the worst part. My arm does hurt a bit now and I'm starting to feel it, so icing it. I'm still very anxious, but happy this is over with. I did cry a little at the start from nerves. Here's to hoping! 🤞A two week wait now! 🙄 I will update once I get results either way.

  • maggie15
    maggie15 Member Posts: 843

    Hi bluerose04, It's good that the biopsy is over. Keep up with the icing for a while. Waiting is hard but something you have to deal with in the bc world. Thanks for keeping in touch. All the best.

  • brendamejia89
    brendamejia89 Member Posts: 16

    I’ve learned that the stress and waiting will kill us more easily than a diagnosis. Try to stay calm! I know is easier say than done but our mind is so powerful so we need to be in charge.

  • bluerose04
    bluerose04 Member Posts: 4

    Hi everyone! I just wanted to update this, as I know I often look for follow ups to what happened and people don't come back! So after a harrowing journey (my report was ready two weeks ago, but was sent to the wrong doctor evidently by pathology!). I nearly lost it! It's been 8 weeks since my MRI and I couldn't take this taking any longer- but, I was able to get an answer this afternoon- it was a benign fibroadenoma! No malignancy! Thank goodness! I'm high risk, so I'm sure I'll be back to the forums from time to time, but just wanted to update!

  • maggie15
    maggie15 Member Posts: 843

    Wonderful news @bluerose04. Thanks for letting us know. It's good to have something to celebrate.

  • salamandra
    salamandra Member Posts: 735

    That's great! I'm sorry you had to go on this ride, and glad you got to get off it now.

  • bluesky1969
    bluesky1969 Member Posts: 80

    Not sure where to post about my latest from a PET scan report: "however, the right internal mammary lymphadenopathy is far more concerning, particularly given the patient's history, is highly suggestive of malignancy."

    I live on Vancouver BC. Biopsy on Tues am. Have been taking small doses of lorazepam all week.

    I looked up Internal Mammary Lymph Node on the boards but didn't see much. Maybe I'm too stoned haha

    I had a R Mx 2018, no nodes, no chemo, no rads, Tamox for 3 yrs (couldn't tolerate), and 2 reconstruction surgeries.

    Pet Scan was Sept 7th.

    If positive, would that be considered mets? Please let me know which threads might be of assistance.

    Thank you ❤️

  • maggie15
    maggie15 Member Posts: 843

    Hi @bluesky1969 , I'm sorry your PET scan indicated the need for a biopsy. If IMLNs were positive it would put you at stage IIIA. More scans would probably be done to check there was nothing distant involved. Hopefully the results will be good and you won't have to look at the stage III or relevant chemo/rads/targeted therapy threads. Keep as calm as you can (with the help of lorazepam) until you know what you are dealing with. Let us know how it turns out. Fingers crossed it is nothing serious.

  • bluesky1969
    bluesky1969 Member Posts: 80

    Thank you Maggie15, it is comforting to hear back.

    I have a phone appt tomorrow am w a MO, then a biopsy Tues am. I just want to get the whole thing over with - the diagnosis, the plan - and get going. I have autoimmune issues, and not sure where that will fit into the equation. Everyone responds differently to difficult situations - for me, I want facts - all of them. Been reading papers online, trying to research what little I know about the PET results. I know I'm probably getting ahead of myself but the twisting-in-the-wind part - this time - is too much.

    I really hope my MO respects me enough to tell me real info, unlike the other I saw. I brought a paper into her w questions about poor prognosis for BC in LIQ. She totally blew me off.

    Thank you Maggie15, your reply made me feel less alone (I can't tell my boys until I have a plan in place. And Have only told my dad and ex hub so they can wrap their heads around a possible new diagnosis)

  • laughinggull
    laughinggull Member Posts: 511

    I love your approach, Bluesky. I also want facts, good and bad. You will get the story straight soon. Good luck with the biopsy tomorrow. As others said, even if positive, it would not be considered distant metastasis, you would be stage 3-ish and still curative treatment. I had several nodes (axillary) involved from the get go, but no detectable distant metastases. I hope your results are benign. If you have cancer in those nodes, hope they are, similarly to mine, playing goalie and preventing the cancer from spreading somewhere else.

    Will be thinking of you tomorrow and hoping for the best results for you. One step at a time. I know it's hard to stop the torrent of thoughts and what ifs about the treatment, your concurrent health issues etc. But you will get clarity and make decisions, one day at a time. You will not be able to face and decide about everything today, but you will in due time -if it comes to that. Stay strong. You are not alone and you can face this.

    I had never heard about poor prognosis on LIQ breast cancer. Interesting. Sorry to hear your MO blew you off. Did she blew off that particular paper, or just annoyed that you were asking too many questions? Hope you do better with the new MO.

    Lastly….I love Vancouver! Used to travel there for work a few years back.

  • bluesky1969
    bluesky1969 Member Posts: 80

    Thanks Laughinggull;

    My biopsy today was unsuccessful - the node is too deep and too close to my lung. The other nodes were checked by ultrasound and deemed fine. Got home, took 2 extra strength Tylenol and slept. A bit sore, dry cough and looking forward to a good sleep.

    Thanks for your support ♥️

  • bluerose04
    bluerose04 Member Posts: 4

    Hi Bluesky! I don't have much guidance here, just wanted to say I'm sorry that your biopsy didn't go as you had hoped. In my situation, I had an MRI and my spot lit up like a Christmas tree. The initial thought was it was a possible fibroadenoma from the radiologist. When I got the ultrasound after, the tech very clearly said it was an intrammamary lymph node and it did look like that from the ultrasound images I saw. After biopsy, it still turned out to be a fibroadenoma. I know it was a PET scan for you, but things aren't always what they appear so I will hold onto hope for you too!

  • maggie15
    maggie15 Member Posts: 843

    Hi @bluesky1969 , We have something in common. My enlarged IMLN couldn't be biopsied since my lung is in the way. Your autoimmune issues could be part of the equation. I have pulmonary fibrosis from radiation and was referred to an ILD pulmonologist who also treats autoimmune patients with pulmonary fibrosis from sarcoidosis etc. The scarring pattern looks different but has the same effect of destroying lung tissue. My pulmo told me that the enlarged node covered by the collapsed lobe in my right lung is probably due to inflammation since pulmonary fibrosis is inflammation gone wild. I have regular HRCTs done so he is watching the node to see if it stays stable. Your rheumatologist or MO could schedule regular ultrasounds to monitor your node. I get yearly ultrasounds to monitor my thyroid which was removed but is growing back and deviating my trachea.

    I've never been diagnosed with an AD but my pulmo commented that inflammation is my middle name. Thankfully I respond really well to corticosteroids. I hope you have recovered from the bronchoscopy.

  • bluesky1969
    bluesky1969 Member Posts: 80

    Thank you Bluerose & Maggie15. I'll def keep those two variations in mind. I appreciate it.

    I ended up in the ER w half a collapsed lung and a chest tube. Biopsy was Tues am. MO called on Weds, heard me coughing, ordered an X-ray, and by 5pm insisted I go to the ER. Was a rough couple days and coming home to my bed never felt so good.

    I have another PET scan in early Nov to compare/contrast the Sept one.

    I'm thinking about a second opinion somewhere in the US. Someone said Sloane Kettering is a good place. Any thoughts?

    with thanks, P

  • maggie15
    maggie15 Member Posts: 843

    Hi @bluesky1969 , I'm sorry to hear about your trip to the ER. The middle lobe of my right lung is collapsed from fibrosis; the chest tube is no fun. Have they done a CT of your lungs (in addition to an x-ray)? I don't know what your autoimmune issues are but my pulmonologist told me he was glad I had passed on the tamoxifen since it can cause drug induced pulmonary fibrosis in people with occult interstitial lung disease (more common in autoimmune conditions.) This might be going out on a limb a bit since the failed biopsy could have caused the partial lung collapse but just something to consider from my experience.

    MSK in NYC, Dana Farber in Boston and MD Anderson in Houston are all highly regarded cancer centers for second opinions. I hope you can get some answers soon.

  • bluesky1969
    bluesky1969 Member Posts: 80

    Hi Maggie15;

    Yes, had a CT scan when I was in Emerg. And several X-rays. Have another Xray on Weds and a phone followup Thurs. Looking forward to the all clear. For now 🤣

    Hmm - more info to consider *thank you*

    You are excellent support and I appreciate all your thoughts :)

    I'm not used to the new version of this site - not sure why my Hx isn't showing up in my signature? Will research now…