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Topic: Biopsy performed by Radiologist or Breast Surgeon?

Forum: Waiting for Test Results —

For members not diagnosed with breast cancer, but waiting for test results:  Biopsy, mammogram, ultrasound, or other screening tests. Waiting is VERY difficult but remember...

"Worry does not empty tomorrow of its sorrow. It empties today of its strength." -- Corrie Ten Boom

Posted on: Aug 8, 2019 06:27AM

Mimi820 wrote:

Hi, I have been lurking like crazy after my mammogram and ultrasound yesterday. Went in for left breast pain (nipple area for last few months). Gyn ordered diagnostic mammogram and ultrasound. Left was “ok”, however, they saw two spots on my right breast!? Ultrasound tech was very quiet-Radiologist was nice but gave me NO inkling what she thought it could be. I asked about a cyst or Fibroadenoma (had one of those 10 years ago in left breast). She replied, “not cysts. One could be a fibroadenoma, and I’m not sure what the other mass is”. She requested I have a biopsy. Is it normal that they do not say anything-even if they think it’s one way or the other? Their silence was awkward and unnerving.

My question is, do I have the Radiologist do the biopsy or see my breast surgeon first? (I had already had an appt with the breast surgeon to ask about my left nipple pain-appt is next week) is there any difference, pro/cons? I just want the biopsy done already. Thank you for your advice. I’m a worried mess

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Aug 8, 2019 07:36AM DiagnosisDisruption wrote:

I went from mammogram to ultrasound (same day) to biopsy (two days later). The radiologist performed my needle ultrasound biopsy. I didn't see my surgeon until I had all my scans and reports.

I had my 6 month mammogram in February, and she put my "cancer's there" mammogram from last year side by side. I have no idea how that tech kept a straight face without crying last year. You could see that spiculated mass clear as day.

Dx 12/8/2017, IDC, Left, 2cm, Stage IIA, Grade 2, 0/2 nodes, ER+/PR+, HER2+ Targeted Therapy 1/23/2018 Herceptin (trastuzumab) Targeted Therapy 1/23/2018 Perjeta (pertuzumab) Chemotherapy 1/23/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 5/23/2018 Lumpectomy: Left Surgery 6/12/2018 Lumpectomy: Left Radiation Therapy 7/18/2018 Whole-breast: Breast Hormonal Therapy 10/10/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 8, 2019 07:44AM Beesie wrote:

Yes, it is perfectly normal for a Radiologist to not speculate. She is recommending the biopsy precisely because she can't be sure what the mass is, so unless she has a really clear idea in advance (a BIRADs 4A biopsy or a BIRADs 5 biopsy), it makes sense to say nothing. Do you know the BIRADs rating of your imaging? That will provide a guide as to what the possibility of malignancy is. A BIRADs 4A biopsy has a less than 10% chance of being cancer. A BIRADs 5 biopsy has a 95% chance of being cancer. BIRADs 4B and 4C fall in-between. A BIRADs 4 (with no A,B,C,) has about a 20% - 25% chance.

A core needle biopsy is best performed by a Radiologist - they are the experts on that procedure.

A surgical biopsy, on the other hand, would be performed by a Surgeon.

Good luck with the biopsy. Hoping for a benign result.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 8, 2019 08:34AM Mimi820 wrote:

Thanks for the replies! I am going to try to pick up my report today-if it’s ready. Looks like nothing will happen this week. Can’t get script for biopsy until Monday:/ Practitioner away until then. Mind as well wait to see Breast Dr Thursday at that point

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Aug 8, 2019 08:53AM GiddyupGirl wrote:

Mimi: my BS referred me to radiologist for the needle biopsy (ultrasound guided).

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Aug 8, 2019 09:16AM AliceBastable wrote:

I had an ultrasound about a week after the mammogram. The appointment was set up for "ultrasound and possible biopsy." The u/s tech had the radiologist come in to look at her findings, and they did the biopsy right there in the u/s room (after some prep, of course). It was all very smooth and considerate.

Endometrial cancer 2010, basal cell multiples, breast cancer 2018, kidney cancer 2018. Cancer's a bitch, but I'm a bigger one with more practice. Dx 5/2018, ILC/IDC, Left, 2cm, Stage IA, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 7/10/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 8/7/2018 Radiation Therapy 10/28/2018 Whole-breast: Breast, Lymph nodes
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Aug 8, 2019 09:23AM edj3 wrote:

My biopsy was also done by my radiologist.

In my case, the sequence of events was regular 3D mammogram, diagnostic mammogram + ultrasound shortly after that (not the same day), biopsy Friday of that same week at the same location as all the mammograms, call on Tuesday to say welcome to the BC club.

Dx 4/9/2019, DCIS/IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Dx 5/6/2019, LCIS, Left, <1cm, 0/1 nodes Surgery 5/6/2019 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 6/1/2019 Whole-breast: Breast
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Aug 8, 2019 09:23AM Lukesmom17 wrote:

I was escorted from my mammo to ultrasound and spoke with the radiologist. They then took me to do the biopsy just an hour later or so. Maybe that's unusual.

Dx 7/12/19 ADH
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Aug 8, 2019 09:54AM Trishyla wrote:

Same for me, Lukesmom. All three of my biopsies were done by the radiologist within an hour of an ultrasound. Great guy. Tried very hard not to hurt me, even though one was right behind the nipple. (Very painful area for a biopsy)

Here's hoping for benign results, Mimi820.

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 8/4/2017 Xeloda (capecitabine)
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Aug 8, 2019 12:11PM - edited Aug 8, 2019 12:21PM by Mimi820

I was able to pick up my report. It states my BiRads is 4b. Two right breasts masses about 1cm. One described as Lobulated margins 1.0 x 0.6 x 0.8 cm Hypoechoic mass and no internal flow. The other is slightly smaller described as oval circumscribed Hypoechoic mass with no internal flow.

Radiologist wants to biopsy the first mass listed.

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Aug 8, 2019 01:01PM Beesie wrote:

BIRADs 4B indicates that the Radiologist assesses the cancer risk to be >10% but <50%.

Hypoechoic means the mass is solid, not fluid, i.e. it's not a fluid-filled cyst.

https://breast-cancer.ca/ultrahypo-echosolid/

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 11, 2019 09:07AM Lala-44 wrote:

My breast surgeon preformed my ultrasound guided core biopsy. It went perfectly and I also have breast implants

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Aug 11, 2019 08:21PM SUPer52 wrote:

Mimi, when I was informed by the radiologist reading my mammogram that I was being referred for a biopsy, she told me another radiologist would perform the procedure since it was to be a stereotactic biopsy and not an excisional biopsy. She also told me that they refer for biopsy anytime the chance of malignancy is greater than 2%.

I knew I wanted to go somewhere else for the biopsy and any necessary follow up treatments, so I had my images and records sent to a breast surgeon at a dedicated breast care facility about an hour and a half away. He called me to say that they (he and the radiologist there) agreed the area should be biopsied and scheduled an appointment for me to consult with him. At that consultation, he explained the findings on my mammogram more thoroughly, pointing out that there were actually two areas of concern. He then scheduled me for the biopsy which was performed by a radiologist, but he also said that one of the areas to be biopsied would be difficult to get to and if the radiologist wasn't able to get to it, then he would perform a surgical biopsy. The first radiologist never said anything about two different areas of concern, so I was glad that I had my report and images reviewed by the surgeon. It only added a few days to the entire process even though I went out of town for that second opinion. (although of course at the time it felt eternal).

I'm sorry that you had to wait over a weekend before you could start to move forward with your plan. I can empathize about just wanting the biopsy done already.

Best of luck to you and hoping for benign results!!!

"My mission in life is not merely to survive, but to thrive; and to do so with some passion, compassion, some humor, and some style." -Maya Angelou Dx 1/15/2019, DCIS/IDC, Right, 0/4 nodes, ER+/PR+, HER2- (FISH) Surgery 1/23/2019 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 2/25/2019 Lumpectomy: Right Radiation Therapy 4/8/2019 Whole-breast: Breast, Chest wall Hormonal Therapy 5/11/2019 Arimidex (anastrozole)
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Aug 12, 2019 05:06AM Mimi820 wrote:

thank you SUPer52 for your information. I’ve been thinking a lot about this. I’m going to try and see if my biopsy prescription was written by my primaryso I can make an appt. praying I can schedule it this week. Thank you and I will keep you posted!

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Aug 19, 2019 10:43AM Mimi820 wrote:

Hi, I wanted to wait to post after this ordeal was over with! What a horrible two weeks of agony and emotions! I had my biopsy last Wednesday. Dr decided to biopsy both masses in my right breast. Said one looked like Fibroadenoma and the other was questionable. Said it would take 3-5 business days for results. Got the call this morning to go in for results. Thankfully they were both benign Fibroadenomas! I’m 46 and a little surprised I have them -not picked up in previous imaging, but I guess any age can get them. I had gone in for LEFT breast pain when the two spots came up on my right side. I had one Fibroadenoma removed over 10 years ago in my left breast that I found while breastfeeding my daughter. It popped out near the nipple area.

While I am beyond grateful for this diagnosis, I just wish there could be better ways to go through this process. I realize everything comes down to insurance and money, staff, equipment, etc but Istrongly feel if a woman needs a biopsy they should know the results the same day. Just as they do in the hospital with ‘frozen sections’, having a pathologist read the biopsy then and there would save many women anxiety and worry-that is awful! Hopefully in the future we will have a better streamlined process as well as better detection on imaging also decreasing the need for biopsies (although I realize they are necessary to be certain).

Thank you all your Support!

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Aug 19, 2019 12:53PM AliceBastable wrote:

Think how many more pathologists each facility would need, plus the lab space to hold them, and all the costs involved!

Endometrial cancer 2010, basal cell multiples, breast cancer 2018, kidney cancer 2018. Cancer's a bitch, but I'm a bigger one with more practice. Dx 5/2018, ILC/IDC, Left, 2cm, Stage IA, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 7/10/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 8/7/2018 Radiation Therapy 10/28/2018 Whole-breast: Breast, Lymph nodes
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Aug 19, 2019 01:23PM Mimi820 wrote:

I agree and understand it would be costly. Maybe then have them done solely at a hospital-then it would become an insurance issue and probably higher costs. it’s a shame everything is controlled by insurance

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Aug 19, 2019 02:39PM MelissaDallas wrote:

I'm pretty sure anyone having a biopsy for anything (not just breasts) feels the same way women do about breast biopsies. Probably a lot of things with a much higher percentage chance of coming back positive than breast biopsies too.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.
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Aug 19, 2019 02:42PM SUPer52 wrote:

Great news that everything is benign!!! Thanks for letting us know your results. And be sure to celebrate your good news! Smile

"My mission in life is not merely to survive, but to thrive; and to do so with some passion, compassion, some humor, and some style." -Maya Angelou Dx 1/15/2019, DCIS/IDC, Right, 0/4 nodes, ER+/PR+, HER2- (FISH) Surgery 1/23/2019 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 2/25/2019 Lumpectomy: Right Radiation Therapy 4/8/2019 Whole-breast: Breast, Chest wall Hormonal Therapy 5/11/2019 Arimidex (anastrozole)
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Aug 19, 2019 02:44PM AliceBastable wrote:

MelissaDallas, yes. When we're first diagnosed, a lot of us think we're the only person going through a medical rough patch.

Endometrial cancer 2010, basal cell multiples, breast cancer 2018, kidney cancer 2018. Cancer's a bitch, but I'm a bigger one with more practice. Dx 5/2018, ILC/IDC, Left, 2cm, Stage IA, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 7/10/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 8/7/2018 Radiation Therapy 10/28/2018 Whole-breast: Breast, Lymph nodes
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Aug 19, 2019 03:27PM Beesie wrote:

Mimi, glad your results were benign.

Are you aware that in most cases frozen sections that are analyzed by Pathologists during surgery provide preliminary results only? I've been hanging around here a long time, and I can't tell you how often I've seen women come out of surgery thinking that they are node negative because nothing was seen in the quick analysis of the frozen section, but once the more thorough post-surgical pathology results are available several days later, they find out that they are in fact node positive. It's devastating.

For this reason, my hospital (a leading cancer-only hospital) won't do frozen sections/intraoperative pathology unless there is a strong expectation that cancer will be found and this finding will impact/change the surgery in process. In most breast cancer cases where it's not apparent from previous imaging that the nodes are likely to be positive, a frozen section is not done.

We all wish that the process was more patient-friendly, not just for biopsies, but for surgical pathology and for imaging reports. Progress is being made, but sometimes if you want something done properly and thoroughly, it takes time. And in the case of pathology and radiation assessments, it usually takes 2 sets of eyes before a report is released.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 19, 2019 03:59PM Mimi820 wrote:

Bessie, you make many good points. I was unaware of the frozen section information.

Thank you for informing me on such a topic that has so many different areas of thought and all the processes involved. I have learned worry is like a thief and how it robs one of their normalcy and creates anxiety. I just wish I could take away these situations (testing, biopsies, etc) or at least help make them less stressful for others.

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Aug 20, 2019 04:19PM april1964 wrote:

do they need the frozen sections to send to Oncotype places ?


oncotype 18 Dx LCIS/DCIS/IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Aug 20, 2019 05:25PM Beesie wrote:

April, no. The Pathology Lab prepares a tissue sample from the cancer removed during surgery.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 20, 2019 07:13PM april1964 wrote:

thanks Beesie!!

oncotype 18 Dx LCIS/DCIS/IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2-

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