Architecture distortion with benign biopsy but sent to MRI and surgeon
Hi everyone,
I am new here and just went through a roller coaster with my breast exams over the past week. Hoping to get some help and support from this group.
I am 38 and just finished breastfeeding my 1 yr old. I did my first mammogram last Friday and got callback for diagnostic mammogram followed by ultrasound. I was told I have architecture distortion on my mammogram and my ultrasound showed some correlation like hypervascularity in the same area. The radiologist marked it as BIRADS 4 and recommended a biopsy. She told me she does not think this is breast cancer but to err on the safer side she suggests biopsy it to rule it out. She also said she expect the result to come back as negative.
so I schedule the biopsy and another radiologist did it this week. I just got the result today and it is benign! The report says it’s fibrosis something. However, I don’t feel like I can celebrate because the radiologist who did the biopsy recommended MRI as next step following by surgeon consultation.
I was fairly confused and asked her to call me directly. She first told me she expects the result to be either DCIS or radial scar. And since the result is neither of these two she suspected there might something we missed hence we need to do a MRI then send me to a breast surgeon for consultation. I asked why we did not do MRI first then biopsy, she then told me it’s a standard process to send all patients with AD on mammo to surgeon consultation, irrespective of the biopsy results. And since she thinks it’s either DCIS or radial scar, either one would require a surgery. I was fairly shocked and also pissed at the same time. Because none of this information was communicated with me during my mammogram results explanation or before my biopsy. So I completely did not know what to expect after my biopsy results.
At this point I felt the benign biopsy result does not mean much (which makes me feel sad as I was using all my energies to keep myself sane while waiting for the result) and there are many more tests need to be done. Also feels like the radiologist is fairly anchored on I have something there and they just need to keep running tests to get it.
I am wondering if anyone here has similar experiences and can/want to share your perspectives? I’d also love to understand if this standard process of sending all patients with AD to surgeon consultation and potentially (follow up most cases) surgery removal of the area is actually the case in your experiences/areas?
Thank you all! Sending lots of love, support and positive thoughts to everyone here. Tough process, and I am glad we have each other to lean on.
Comments
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Hi @gdlktt86, I’m sorry you are dealing with AD. It is often caused by radial scars which are benign but grow in a tissue environment favorable to cancer cells. The radial scars hide the nearby breast cancer from imaging. A surgical biopsy (small lumpectomy) is usually done so that a pathologist can examine enough tissue to make sure no breast cancer cells are present.
My AD was treated under an older protocol of observation by mammography. After two and a half years of clear mammograms I developed osteomyelitis of the mandible. The oral surgeon told me that this jawbone infection meant there was cancer somewhere. Sure enough I had a 3.2 cm IDC tumor with multiple radial scars in the margins and a positive lymph node. Originally it probably was DCIS, noninvasive and stage 0, but it grew into a stage 2 invasive tumor over that time.
It’s disappointing when you are told you need more procedures after a benign biopsy but my experience explains why this newer protocol is followed. It may still come back as benign but it is better to be safe than sorry. Let us know how it turns out. All the best.
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thanks for sharing your story @maggie15 sorry to hear you had to get your diagnosis that way but I am glad you were able to get under control.
Appreciate the encouraging words, I guess I’ll do more tests and see there those take me.
Really thought the benign biopsy would be the final step in my journey but looks like this would a longer game so I am trying to prepare myself better.
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Hi @gdlktt86
I am sorry you are on this roller coaster at this time of year and at this age you do not expect to have such issues.
I have gone through the same as you this year (age 32), I went for a concern on my right (which was clear on imaging), but they found AD on my left. Similar to you with the works of testing that followed, only difference I had the Mri before the biopsy.
AD can be caused by benign or malignant changes and if it is a radial scar the issue is they mimic malignancy on imaging so the radiologist cannot tell which it is, plus radial scars can also have atypia or cancer.
My Mri result showed abnormal enhancement further adding to the concern for cancer. This upgraded to Birads 5. However, both surgery and biopsy did not show any malignancy, despite ticking all the boxes.
My surgeon said with the radial scar on biopsy result that it could be observed and re-imaged in 6 months, or surgery (wide excision biopsy) straight away, I did not want to go through the imaging process again and due to the younger age my surgeon recommended surgery.
Also with core biopsy they only take such a small amount, hence a larger biopsy in open surgery can give more accurate results & ensure nothing is missed.So go and get your MRI done and make an appt with a surgeon who can explain everything to you, better to be on the safe side and make sure nothing is missed.
I wish you all the best for positive results, make sure you look after yourself, it is such an emotionally draining process to go through and reach out for support if you need it.0 -
Hi
I will advise you to see the surgeon . It made a difference on my case . I spent a year doing different diagnostics tests and all of them , including an MRI were negative . I ended up having IBC and it was caught by the Surgeon. Hope it is not your case , though.
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@emmay92 thank you so much for sharing your story and I am so glad your results came back benign.
How did your surgeon identify the AD is radial scar? Did you do a core needle biopsy after MRI?
Sound like not all surgeon insists on taking out radial scar as a standard procedure.My case is a bit more tricky, my biopsy result does not show radial scar. And recently I did my MRI the results came back ok (no enhancement). So nothing can really explain the AD on my mammo. I have an appointment to talk to the surgeon team and will see how they’d advise.
Thank you again for your encouraging words! It is very emotional draining to be in this waiting stage, hopefully I can get clear and settling explanation soon and can start with whatever next steps the surgeon team recommends.Take care!
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Hi , hope you are doing well
I had a negative MRI . My 3rd US showed a suspicious area , and I underwent a biopsy that came back positive
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Hi @gdlktt86
What was the result of your core biopsy?
That is great your MRI showed no abnormal enhancement. Although if it was a radial scar do not always enhance.
Have you had your appointment with the surgeon?
I hope you get some clarity after meeting the surgeon.
I had my MRI first then core biopsy and followed by surgeon & Wide local excision. Mine showed the radial scar on the core biopsy at 1/3 but at 1/5 (more distortion) was benign changes.. at surgery they found 2 separate radial scars along with a long list of benign changes (florid usual ductal hyperplasia, PASH, sclerosing adenosis, apocrine adenosis, columnar cell change, columnar cell hyperplasia, fibrocystic change, duct ectasia, benign calcifications)
My concern is my MRI did enhance abnormally and the distortion was seen on both Mammo and US. Then final pathology showed the radial scars extended to the margins, which leaves me hoping nothing was missed as cancer can be at the periphery of radial scars apparently..Oh such worrying and anxious times, I hope you are taking care of yourself and have good support around you :)
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