Biopsy not concordant with breast images
I an 37 years old, went to m GYN due to pain on the left breast. She sent me for a mammogram and u/s. Mammogram repeated for more images. Results BIRAD4 And radiologist said Highly suspicious for malignancy. Stereotactic biopsy was done results Benign fribosis and benign fibroadipose tissues. My GYN wasn’t comfortable and sent me for an MRI with and without contrast. Results of the MRI
LEFT BREAST: Area of non masslike enhancement in the upper-outer quadrant of the posterior
depth of the left breast measuring 1.9 x 1.7 x 1.8 cm (image 122/240) with washout kinetics
corresponding to recently biopsied area that yielded to benign results. Additionally, area non
masslike enhancement with linear distribution of 3 o'clock position in the left breast measuring
approximately 7 cm in anterior-posterior dimension. No evidence of adenopathy.
Went to see a breast surgeon and she explained that the Biopsy did not have any breast tissues only fatty tissue and it does not correlate with the images. She is having her radiology team review all images and will contact me within 2 weeks to see what the next step is. She stated that 7cm is too large of an area to remove when the biopsy is not telling her anything. Has anyone had something similar? How can someone mess up a biopsy?
Comments
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Hi @suzy2618, I’m sorry the biopsy got none of the targeted tissue. This sometimes happens for a variety of reasons. The area of concern might not have been lined up exactly with the mammogram coordinates or by chance the needle got fibrosis and fat but no tissue. There are other types of biopsies that can be done. A core needle biopsy done with ultrasound can remove how ever many cores the radiologist thinks is sufficient. Mine made sure there were calcifications (which appeared on my mammogram) in some cores. The other method is to use a savi scout where a tiny reflector is placed in the correct area of the breast. This allows the surgeon to find the right spot using both sight and sound.
It looks like the breast surgeon is considering options on how to perform another biopsy. Hopefully it will happen soon and you will get a benign result. Like everything else in life there can be hiccups along the way to getting a diagnosis. All the best.
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Hi @suzy2618 I’m so sorry you’re going thru this. It is extremely stressful.
There are so many factors that come into play with biopsies. @maggie15 already mentioned some, and another big one is your breast density. For me, my own very dense tissue made it difficult for my biopsies. It took 3 procedures and a second opinion to finally get the correct area and diagnosis for me.I’m glad your team is taking another look. Don’t be afraid to seek help with a second opinion also. Sending good thoughts your way.
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Thank you ladies for the replies. So waiting on the 2nd opinion doctor.. she wants her radiologist team to look over the images before deciding what step to take next. She stated that 7cm is way too large and having a partial massectomy without biopsy results makes no sense. The first doctor I saw she wanted a partial massectomy without repeating biopsy. I freaked out and that’s why I went for a 2nd opinion. I hate that the 2nd doctor is making me wait 2 weeks she said to give her 2 weeks so her radiology team reviews all images etc. Why couldn’t she just sent me to repeat the biopsy? 😭
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7cm is way too big for a lumpectomy (partial mastectomy) without definitive biopsy results. Surgery, period, without those results is premature at best and recklessly rash at worst. Scarring or fibrosis (benign) is a distinct possibility, especially with fatty breasts (much easier to detect a solid mass than with dense breasts). I had a lumpectomy 10 yrs ago; the last few semiannual diagnostic mammos flagged the tumor bed seroma surrounded by scar tissue, and it took a radiologist familiar with my history to verify it's benign—four mammos in a row. One more diagnostic mammogram on the R (already back to just annual screening on the L—BIRADS 0, no anomaly), and if it's unchanged it will go from BIRADS 3 ("Probably benign") to BIRADS 2 ("benign") and routine annual screening mammo on the R going forward.
Why no repeat biopsy? Probably because it wouldn't reveal anything different. And 2 weeks isn't going to make a difference in the growth (if any) of the area in question. 2nd opinion doc is on the right track having a team review all images—"looking before leaping."
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My 3rd opinion breast surgeon sent me for two MRI guided biopsy which my appointment is tomorrow. They are doing the biopsy on both the 2.1 cm architectural distortion and the 7cm linear nme. She did tell me I will need surgical removal no matter what the biopsy says of the architectural distortion. Thank you for replying 🙏
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