Topic: Benign Biopsy / Discordant Result - Anyone choose not to excise?

Forum: Benign Breast Conditions — A safe place to discuss benign (non-cancerous) breast conditions.

Posted on: Oct 4, 2021 02:25PM

Posted on: Oct 4, 2021 02:25PM

mlhs27 wrote:

Hello all,

Thank you to all of the posters here, this forum has been so helpful for me as I've been navigating all my testing. I had my first screening mammogram ever in September (I'm 48, no family history of BC, and just left it too long, I know), and was referred for a follow up diagnostic mammogram and ultrasound because of architectural distortion in one breast. Diagnostic mammogram / ultrasound confirmed the architectural distortion, with possibility of associated lesion. I had a biopsy on Friday, 10/1, and the pathology report was uploaded to the patient portal on 10/2 showing a benign result, with what appear to me to be some pretty typical findings for a perimenopausal woman (everything relevant is copied below) - my PCP added a note that based upon the results, all looked well to her and I didn't have anything to worry about. However, this morning the radiologist added an addendum with her conclusion that the results were discordant, and I should proceed with a surgical excision.

I'm meeting to discuss my results with a breast surgeon in two weeks, but I can't for the life of me understand why I wouldn't just monitor based on the findings. The nurse I spoke with acted like I was nuts for considering this. I'm wondering if anyone has had a similar result and elected not to proceed with a surgical excision? In the interests of full disclosure, I got a really bad vibe from the radiologist (her affect can probably best be described as funereal, and to top it off she offered to pray for me, which really put me off), and I have a borderline phobia regarding medical treatment, so it is entirely possible I'm being irrational. I'd appreciate a gut check?

Here are the results:

Conclusion from diagnostic mammogram (written up by different radiologist than the one who did the biopsy):

Persistent area of architectural distortion in the outer anterior right breast. While there is a vague 4 mm hypoechoic area in the right breast at 11 o'clock, 3 cm from the nipple, it is uncertain if this represents a true lesion or a pseudolesion
interposed between the patient's dense hyperechoic breast tissue. This architectural distortion remains indeterminate. Tomosynthesis guided right breast biopsy is recommended to exclude malignancy. If there is no evidence of malignancy upon biopsy,
the sonographic following could then be reassessed in 6 months with a limited right breast ultrasound.

Additional probably benign ovoid masses are noted in the right breast at 9 o'clock, 4 cm from the and 9 o'clock, 2 cm from the nipple. These masses can be reassessed in 6 months on the limited right breast ultrasound recommended above.

These findings and recommendations were discussed with the patient in person at the time of the examination.

Pathology report:

Final Diagnosis:

Right breast, lateral; core biopsy:

  • Fibrocystic changes consisting of usual ductal hyperplasia, sclerosing adenosis, apocrine metaplasia, and microcyst formation.
  • Microcalcifications present.
  • No glandular atypia or malignancy identified.

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Oct 4, 2021 07:05PM norcals wrote:

Hi Mlhs27.

I cannot provide you with any guidance on how to read your report - hopefully Beesie or others will chime in - but I wanted to give you some support. Also, my NP initially did not recommend a mammogram when I thought I felt a lump. I insisted on a mammogram and ultrasound, and a few weeks later I was diagnosed with stage 3c/4 IDC. Hopefully, others will be able to give you more guidance on the test results, but I just don’t want you to dismiss the radiologist’s recommendations without really weighing the pros and cons of a biopsy

Dx 6/17/2019, IDC, Left, 6cm+, Stage IIIC, Grade 3, ER-/PR-, HER2- Chemotherapy 6/23/2019 AC + T (Taxol) Chemotherapy 4/5/2020 Xeloda (capecitabine) Radiation Therapy Whole breast: Breast, Lymph nodes, Chest wall
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Oct 4, 2021 07:47PM gamzu710 wrote:

I can only share my experience. I had an excision-turned-lumpectomy following a core needle biopsy that had showed atypical ductal hyperplasia, benign but high-risk. Upon surgical excision, the pathology came back as triple-positive IDC and it was determined that there had been a sampling error with the CNB and the radiologist had missed the lump by a millimeter or two. I start chemo in 2 weeks. If the radiologist continues to be concerned I would not dismiss that.

Surgery 7/1/2021 Lumpectomy (Right) Targeted Therapy 10/1/2021 Kanjinti Chemotherapy 10/20/2021 Taxol (paclitaxel) Radiation Therapy 1/30/2022 Whole breast, Radiation boost: Right breast Hormonal Therapy 3/8/2022 Aromasin (exemestane)
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Oct 5, 2021 02:37AM rah2464 wrote:

What about requesting a breast MRI to hopefully clarify imaging? Your report mentions dense breast tissue, but not how high on the scale. An MRI might be a more successful imaging option. It seems as though you have a radiologist that is being very thorough and careful, but perhaps there is somewhere you can get a second opinion if you are still not wanting to do the excisional biopsy. I am of the school to err on the side of caution but that is just me. I had an excisional biopsy when I was 30, turned out benign. The surgery was very easy and minimal recovery. Wish you all the best as you determine what steps you will take next.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 6/26/2018 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 7/26/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 5, 2021 03:36AM moderators wrote:

Hello mlhs27, and welcome to! We hope that this turns out to be nothing serious, and you can move past this. If it helps ease your mind, here is an article called What Mammograms Show: Calcifications, Cysts, Fibroadenomas where you'll learn more on different benign masses that can come from testing. Good luck, and please come back to let us all know how it goes at your next appointment.

Best wishes,

The Mods

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Oct 5, 2021 07:02AM - edited Oct 5, 2021 07:04AM by mlhs27

Thanks so much for all your responses, they've given me a lot to think about - I will certainly ask if an MRI is an option. What I didn't mention in my first post was that the radiologist who reviewed the diagnostic mammogram was a different person than the one who performed the biopsy; the first suggested to just monitor if I got a benign result, the second said excision. What has been frustrating is that the two radiologists seem to contradict each other; I guess there's no real way to find the "right" answer, hopefully the breast surgeon can help talk me through it.

Gamzu710, best wishes that the chemo treatment goes well. Thanks again to you all for taking the time to respond, this forum is really amazing.

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Oct 5, 2021 06:51PM JoniB wrote:

Hi mihs27. I don't write often but wanted to reach out to you as I also was told I had a benign biopsy and was then told my results were discordant. They wanted to do an MRI guided biopsy to be sure they found "the spot" (what they were seeing was very small). I had already had breast cancer and a lumpectomy 9 years before so I was used to yearly MRIs and mammograms. I did agree to the biopsy and the radiologist took many, many samples and the results were malignant. Had someone not questioned the original biopsy and say the results did not match up with what they were seeing on my imaging my second cancer would never have been found. I did not want to have the second biopsy either and I wanted to believe the first "benign" result but that would not have changed that there was a malignancy. Better to find out now or breathe a sigh of relief when told the results are benign. I wish you the best.

Two time breast cancer survivor. Recurrence after 8 years. First time 3 mm ER-, PR-, HER2+. Recurrence 4mm - triple positive.
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Oct 6, 2021 12:15PM BCinfoseeker wrote:

My advice: do not let it go. I had a false biopsy after a BI-RADs-5 3Dmammo and ultrasound. I had a lumpectomy - found out from that pathology that it's cancer, and it's now in at least three of my lymph nodes. I'm having a bi-lateral mastectomy in November.

Do NOT let it go!

Dx at 61. Three masses detected right breast; Bi-Rads 5. Initial biopsy false negative. Lumpectomy pathology: Multi-focal IDC. Surgery 8/27/2021 Lumpectomy: Right Dx 9/2/2021, DCIS/IDC: Cribriform, Right, 1cm, Stage IA, Grade 1, ER+/PR+, HER2-, Hormonal Therapy 10/13/2021 Arimidex (anastrozole) Dx 11/17/2021, IDC, Right, <1cm, Stage IA, Grade 1, 0/1 nodes Surgery 11/17/2021 Mastectomy: Right
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Oct 19, 2021 08:01AM mlhs27 wrote:

Hi all - just wanted to update that after meeting with the surgeon yesterday (who was lovely), I decided to go ahead and do the excision. Thanks to all who posted for your advice, it did help me reach a decision.

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Dec 21, 2021 11:39AM mlhs27 wrote:

Hi all - last update in case anyone is in a similar position. Had the excision, pathology results were benign. The abnormal mammogram findings were likely caused by a benign condition known as PASH.

Thank you to all you responded to this message, best wishes for a happy and healthy 2022!

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Dec 21, 2021 12:53PM gamzu710 wrote:

Great news! Enjoy your holidays.

Surgery 7/1/2021 Lumpectomy (Right) Targeted Therapy 10/1/2021 Kanjinti Chemotherapy 10/20/2021 Taxol (paclitaxel) Radiation Therapy 1/30/2022 Whole breast, Radiation boost: Right breast Hormonal Therapy 3/8/2022 Aromasin (exemestane)

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