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Topic: New here, left side IDC, right side biopsy scheduled

Forum: Diagnosed and Waiting for Test Results —

Share with and support others all waiting for test results from CAT scan, PET scan, Oncotype tests, Mammaprint, FISH, IHC, and other diagnostic tests.

Posted on: Jan 9, 2021 04:10PM

GreenOutdoors wrote:

Hello,

First time posting, I can't thank everyone enough for posting questions and answers. This forum has been so helpful already. I'll try to make this short and please moderators let me know if I'm posting in the wrong place.

I'm 45, small dense breasts, NBN gene positive, strong family history. Diagnosed (ultrasound biopsy) 12/24/20 with IDC with focal DCIS, left side, 0.7cm.

PreOp MRI shows a 0.5cm satellite tumor near biopsied tumor as well as a 2cm non mass enhancement on the right breast.
Diagnostic mammogram of the right side shows lobulated density and architectural distortion. Right side diagnostic ultrasound shows 10mm irregular shaped hypoechoic area with posterior acoustic shadowing birads 4.

Two biopsies scheduled for this Monday, one ultrasound guided and one mammogram guided because they're not sure if the two things are the same or two separate spots (only one area showed on MRI)

My plan is bilateral mastectomy with reconstruction, BS and PS agree that it makes sense for my situation. MO says he needs results of upcoming biopsies and pathology from surgery before we can have plan. Recommends at minimum Tamoxifen. He will contact me with biopsies results.

My questions are: How common is multi focal breast cancer along with synchronous bilateral breast cancer? Please someone tell me that the upcoming biopsies can still be benign. Everything looks very small, so would I still be stage 1 after surgery if no lymph nodes are involved? (None showed on MRI). I've been mostly composed and patient so far, but these added biopsies and waiting are getting to me. Well... that wasn't short! Sorry, but if you've read this much, thank you so much 😊

Dx 12/24/2020, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Dx 1/14/2021, IDC, Right, Grade 1, ER+/PR+, HER2- Surgery 1/25/2021 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jan 9, 2021 04:46PM Beesie wrote:

GreenOutdoors, welcome! But sorry you've had to join us.

To your questions, "How common is multi focal breast cancer along with synchronous bilateral breast cancer?" From what I've read, about 2% of patients are found to have synchronous bilateral breast cancer. Multi-focal along with synchronous bilateral breast cancer? That would obviously be less than the 2%. How much less, I don't know - I don't know if having tumors in both breasts makes it more likely to have more than one tumor in each or either breast.

"Everything looks very small, so would I still be stage 1 after surgery if no lymph nodes are involved?" Yes, if each tumor is small, you could still be Stage I. Staging is based on the largest sized tumor, not on the cumulative total size.

And yes, your biopsy could be benign. Many of us have biopsies done on the contralateral breast after our initial diagnosis but prior to surgery. I am one of those who did. I don't think the odds of finding cancer are any higher than they would be for any other biopsy - mine was benign. On average BI-RADs 4 biopsies have about a 75% chance of being benign, although of course the range within BI-RADs 4 is very wide, from >2% to 95%.

Good luck with the biopsies. Hopefully you do get benign results.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Jan 9, 2021 05:29PM Trishyla wrote:

Not that common to have bilateral breast cancer, but as you can see by my stats, it is possible.

I had bilateral breast cancer. Triple negative cancer on one side and er/pr positive cancer in the other. I had bilateral mastectomy with immediate DIEP flap reconstruction. I would highly recommend it.

The biggest effect it had on my treatment was not that it was bilateral, but that it was two very different forms of BC. The triple negative made the most difference, ensuring I would need chemo.

And it is also possible for the new areas to be completely benign. I sure hope that turns out to be the case for you.

Best wishes for a good outcome.

Trish

Dx 8/30/2016, IDC, Left, 1cm, Stage IIA, Grade 2, 1/2 nodes, ER+/PR+, HER2- Dx 8/30/2016, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER-/PR-, HER2- Dx 9/6/2016, IDC, Left, 1cm, Stage IIA, Grade 2, 1/2 nodes, ER+/PR+, HER2- Chemotherapy 9/28/2016 AC + T (Taxol) Surgery 4/4/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Chemotherapy 8/5/2017 Xeloda (capecitabine)
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Jan 9, 2021 08:03PM GreenOutdoors wrote:

Thank you for the reply Beesie, I didn’t know that it was not cumulative total size, that is so comforting to read! And you are right that the odds seem very low and most biopsies are negative, I’ll focus on that to make it through the work week!

Trish, thank you for replying, your stats are interesting (the left one so similar to mine) and they help me understand why the MO would want the second biopsy results before deciding on any treatment. So I need to look at it as two separate cases, and next week is just another biopsy. It is so nice to read that you are happy with your reconstruction! My plan is to have tissue expanders, then implants. The PS surgeon I saw seemed more experienced in that technique, and I do know someone who recommended him, soI hope I’ll be happy with the results. Thank you for the good outcome wishes!

Dx 12/24/2020, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Dx 1/14/2021, IDC, Right, Grade 1, ER+/PR+, HER2- Surgery 1/25/2021 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jan 9, 2021 11:31PM - edited Jan 9, 2021 11:33PM by Krose53

Hi, I had bilateral breast cancer and a total of four tumors. The largest 1.6 and the smallest 4mm. I also had IDC and ILC but both ER positive and HER 2 negative. I had 4 biopsies. 2 were positive and 2 benign. Then 2 new positive tumors found by pathology after my BMX. Both missed by the breast MRI. It looked as though I did not have lymph node involvement even after surgery according to my BS but unfortunately it was found I did by pathology. I was shocked by having so many tumors. I had dense breasts but had regular yearly mammograms. Hang in there. Once you have your complete diagnosis and plan, it gets much easier.

Dx 11/16/2017, ILC/IDC, Both breasts, 1cm, Stage IIA, Grade 2, 2/5 nodes, ER+/PR+, HER2- (FISH) Surgery 12/27/2017 Mastectomy: Left, Right Chemotherapy 1/22/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 4/1/2018
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Jan 10, 2021 08:33AM ctmbsikia wrote:

Hi. Sorry you’re here and sending best wishes for benign biopsy and a successful surgery.

I had a mixed type tumor on the left side and 3 biopsy’s on the right. When I showed up for the 1st one the doc reading my mri saw another area which she thought was lcis so I had 2 biopsy’s that day. One was a fibroadenoma, the 2nd was lcis. My bs also did a surgerical exicision of this area (it’s like a brick in there!) which also was lcis. I have had nothing remarkable since on that side.

So, yes it can happen but think the odds are low. Good luck

Dx 12/14/2017, DCIS/IDC, Left, 4cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2- Dx 1/16/2018, LCIS, Right Surgery 1/30/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/10/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Jan 10, 2021 09:11AM GreenOutdoors wrote:

Hello Krose53, thank you for explaining how your situation went. How scary that two tumors were missed by all the imaging! The pathology report must have really comforted your decision for BMX. I haven’t miss a mammogram or ultrasound, about 6 months ago I had an all clear left side ultrasound in the area that now shows the IDC. I’m always told that my breasts are busy and “wow, you have dense tissue”. I’ve had to go for 6 month follow ups almost every time the past 5 years, one benign biopsy (fibroadenoma) 5 years ago. I hope I don’t sound too naive, but I thought that with all the preventive care I was doing, worse case, I’d end up with stage 0. Obviously I know better now. 😃

Ctmbsikia, thank you so much for answering! I’m realizing now that all this extra imaging is really common and necessary. Which makes me feel better, I’m glad I posted. The BS wanted me to have biopsies the same day but the center was just too busy and so I’m getting that done tomorrow afternoon and I hope to have the results Friday, then surgery date, then covid tested. Thank you again

Dx 12/24/2020, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Dx 1/14/2021, IDC, Right, Grade 1, ER+/PR+, HER2- Surgery 1/25/2021 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jan 14, 2021 06:30AM GreenOutdoors wrote:

Hello, I wanted to update to say that I had the mammography core biopsy on Monday. The ultrasound biopsy was canceled because they were unable to reproduce the ultrasound finding.

I haven’t spoken with my surgeon or MO yet but my patient portal updated with the following “pathology revealed grade 1 invasive ductal carcinoma with foci suspicious for lymphovascular invasion. Pathology conforms with imaging findings, I was biopsing the area of distortion seen mammographically. The MR finding is actually more medially situated (...) it might be best to perform MR biopsy of the right breast as well prior to planning surgery therapy.”

My plan is BMX, and we now know that I’ll need sentinel node biopsy on both sides. What would be the advantage of having an MR biopsy before surgery? I don’t understand why it would be recommended. Can someone please explain what I’m missing?

Both left and right biopsy reports state foci suspicious for lymphovascular invasion. Am I correct in thinking that can increase the odd/risk of finding positive nodes? What else does it mean?

Thank you for reading and answering.

Dx 12/24/2020, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Dx 1/14/2021, IDC, Right, Grade 1, ER+/PR+, HER2- Surgery 1/25/2021 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jan 14, 2021 06:38AM MelissaDallas wrote:

Because whether or not you have a mastectomy, the findings on your biopsy might change your treatment plan, possibly requiring chemotherapy prior to surgery

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.
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Jan 14, 2021 07:00AM GreenOutdoors wrote:

Hi MelissaDallas,

Thanks for answering! I was really hoping they would have all the information they needed from Monday’s biopsy. I don’t have the ER/PR/HER2 results yet but should soon. I think I’m trying not to feel overwhelmed and I’m not sure how to do that if I have two different types of cancer on the right side in addition to the one on the left. You’re correct though, can’t have a good plan without the whole picture

Dx 12/24/2020, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Dx 1/14/2021, IDC, Right, Grade 1, ER+/PR+, HER2- Surgery 1/25/2021 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jan 14, 2021 07:59AM MelissaDallas wrote:

It IS overwhelming, and of course it is possible that you could have a tumor with different statistics in the other breast, but it is not PROBABLE. Still you need to know. Most of the “lets do one more biopsy based on the MRI” cases I see here turn out benign. MRIs are notoriously sensitive, but nonspecific, leasing to lots of benign biopsies.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.
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Jan 14, 2021 08:56AM SummerAngel wrote:

I agree that I'm sure they would like to do the additional biopsy in case they would like to treat you with chemo before surgery, but that isn't a treatment that's absolutely necessary and probably unlikely for a small tumor. You can skip it and go straight to the BMX if you like, it's your choice. Everything about your treatment is your choice. I had "many areas of concern" before my BMX but only two biopsies, one on each breast. I was told that I needed to have a BMX and that if I refused a BMX I'd need at least 4 more biopsies to rule out other tumors, so it was an easy decision. I also had relatively small (B cup), very dense breasts and had implant reconstruction with TEs and am very happy with the results.

Reading here it will seem like bilateral BC is much more common than it actually is. I think those of us with this more unusual diagnosis tend to be more interested in the subject.

Age at dx: 45. Oncotype, left-side tumor: 9. Right side had multifocal IDC and "extensive" LCIS. Isolated tumor cells in 1 right-side node. Dx 3/27/2015, IDC, Left, 2cm, Stage IIA, Grade 1, 0/3 nodes, ER+/PR+, HER2- (FISH) Dx 4/27/2015, IDC, Right, 1cm, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 6/1/2015 Lymph node removal: Sentinel; Mastectomy: Left, Right Surgery 6/1/2015 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/27/2015 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/3/2015 Reconstruction (left): Fat grafting, Nipple reconstruction; Reconstruction (right): Fat grafting, Nipple reconstruction
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Jan 14, 2021 11:47AM GreenOutdoors wrote:

SummerAngel, thank you for your reply. It’s so nice to read from others who have gone through this, are happy with reconstruction and doing well post treatment. You are an angel (summer or winter!) for taking the time!

The BS called and doesn’t think the additional biopsy is required because the biopsied area is contiguous to the area seen on the MRI and MR biopsy won’t change the surgery plan because we know that it’s bilateral. The BS and MO spoke, then MO called and said that he wants to wait for the additional testing (ER/PR/HER2) results to come back in case I need chemo prior to surgery (if HER2 + or triple negative). He should get those back in a couple of days.

So if I understood everything, the plan is to schedule me for surgery knowing it could (but hopefully won’t) be postponed based on additional results. So I’m back to somewhat patiently waiting

Dx 12/24/2020, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Dx 1/14/2021, IDC, Right, Grade 1, ER+/PR+, HER2- Surgery 1/25/2021 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jan 14, 2021 05:12PM Beesie wrote:

Well, it's good at least that you don't need the other biopsy. And yes, you've got it exactly right. If you are HER2+ or triple negative, then chemo is often done prior to surgery (although not always for smaller tumors). But if you are ER+ and HER-, then surgery will come first. Then you will likely have to wait for the Oncotype test result to find out if you can pass on chemo or if it's recommended. So more somewhat patient waiting!


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Jan 17, 2021 07:45PM - edited Jan 23, 2021 03:19AM by GreenOutdoors

Hello Beesie,

You're right, I was very happy to not need another biopsy! Thank you for pointing out the little victory.
I was given a tentative surgery date of 01/25 and I've been in OCD mode cleaning everything in my house since! I don't have the ER/PR/HER2 status yet but I'll update the thread when I do, and I'm going to head over to the January 21 surgery thread.

Edited to say that I received the ER/PR/HER2 results 11days after my biopsy. I was getting worried the longer wait meant “worse" results. The lab simply had a long backlog to work through. My surgery can proceed as scheduled.

Dx 12/24/2020, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Dx 1/14/2021, IDC, Right, Grade 1, ER+/PR+, HER2- Surgery 1/25/2021 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement

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