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Topic: Lumpectomy to get a diagnosis?

Forum: Not Diagnosed But Worried —

Meet others worried about developing breast cancer for the first time. PLEASE DO NOT POST PICTURES OF YOUR SYMPTOMS. Comparing notes, symptoms, or characteristics is not helpful here, as only medical professionals can accurately evaluate and assess your individual situation.

Posted on: Mar 14, 2019 07:20PM

Mamaofthree wrote:

Has anyone ever been told they needed a lumpectomy to get a diagnosis? My Bi-rads was 4 and now they have it at 0 incomplete. I have a surgery consultation on Tuesday and I’m not sure what to think of this.

It seems weird that they would need to do the lumpectomy to know what’s happening but then again I’m not a dr so maybe it’s more common than I think. Any stories or advice is much appreciated!

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Mar 14, 2019 08:28PM Beesie wrote:

Yes, it happens a lot. It's actually called an excisional biopsy or surgical biopsy, although it's pretty much the same procedure as a lumpectomy so some doctors call it that or code it as a lumpectomy for insurance purposes.

Usually when an excisional biopsy is necessary, it's after a needle biopsy, if the needle biopsy found a high risk condition such as ADH or ALH. Because those conditions are sometimes are found mixed together with cancer, the entire area of suspicion is surgically removed just to ensure that there is no cancer lurking with the high risk condition.

Or an excisional biopsy can be required in situations where the area of suspicion is in a location that is hard to reach with a needle, either because it is close to the chest wall or close to the skin.

Good luck with the consult and with the biopsy. Hopefully the results are benign

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Mar 14, 2019 11:44PM Mamaofthree wrote:

Beesi

Thanks for responding! I feel better knowing it’s common and I’m not a weird case. I’ll just go with the flow and hopefully it all works out!

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Mar 15, 2019 09:16AM - edited Mar 15, 2019 09:17AM by KBeee

My most recent case was diagnosed that way. Do make sure that they send it to pathology right then and there for immediate answers. My surgeon was supposed to last time, but they were so "sure" it was benign, they decided not to, and then when it came back as cancer, I had to have a reexcision so they got clear margins. Hoping all comes back benign.

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/26/2013 Mastectomy: Left, Right Chemotherapy 9/20/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/12/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/23/2014 Reconstruction (left); Reconstruction (right) Surgery 1/29/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Surgery 2/25/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Chemotherapy 3/31/2015 AC + T (Taxol) Radiation Therapy 8/25/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Mar 15, 2019 10:44AM Mamaofthree wrote:

KBeee,

Thanks so much for the advice, I’ll make sure they do. I’m glad they sent yours in finally. I’m hoping so too! It’s hard waiting for answers. I’m glad they got me in so fast with the surgeon. Hopefully the rest of their stuff isjust as fast.

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Mar 19, 2019 08:29PM Sabrushi wrote:

Hi mamaofthree,

I'm having a lumpectomy as well, just to get a diagnosis, on Mar 25th. So far, all the docs believe my complex cyst (BI-RADS 4) to be an intraductal papilloma (sp?), but I have some doubts since there's no palpable lump nor nipple discharge at all, so I'm kinda relieved that whatever I have would be completely removed! Do you have a surgery date yet? I'm sure everything will be fine for both of us.. :)

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Mar 19, 2019 09:39PM - edited Mar 19, 2019 09:39PM by 239Happy

Hello Did you have a biopsy? Or was that not offered before lumpectomy. I'm new on here, so all of this is new to me.

Praying!

Dx 3/11/2019, IDC, Right, <1cm, Stage 0, ER-/PR-
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Mar 20, 2019 01:34AM - edited Mar 20, 2019 01:34AM by Mamaofthree

I had a biopsy but it came back incomplete. I have surgery scheduled for the first of April and will hopefully know what it is by the 5th.

I'm pretty relieved whatever it is will be removed. My surgeon seems knowledgeable and super personable so that also helps. Hopefully I can just keep busy until then so it doesn't drag on forever. From what he said the recovery isn't bad at all so I'm hoping he is right! I just can't lift my youngest for a couple days.

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Mar 31, 2019 08:16PM Chloe2 wrote:

I am in the boat right now. Had DCIS right breast in 2013, DCIS left breast 2017, and now FEA and ALH in the right. I am waiting for a date for an excisional biopsy. If DCIS again, or worse, I will have a mastectomy, but I am now wondering even if not upstaged, if a mastectomy would be the best choice due to the risk.

Dx 2/2013, DCIS, Right, 1cm, Stage 0, Grade 2, ER+/PR+ Surgery 3/14/2013 Lumpectomy: Right Radiation Therapy 5/13/2013 Whole-breast: Breast Dx 3/2017, DCIS, Left, 2cm, Stage 0, Grade 3, ER+/PR+ Surgery 4/18/2017 Radiation Therapy 5/24/2017 Whole-breast: Breast
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Apr 2, 2019 06:34PM - edited Apr 2, 2019 07:01PM by Mamaofthree

I had my excisional biopsy yesterday and so far it's been uncomfortable not unbearable. He ended up taking a little more than a golf ball size. He said he got clear margins in case it ended up being something so I wouldn't have to have another surgery hopefully. Didn't know that was something they could do without knowing what it was. Still hoping for good results from pathology though. Anyone else have a similar story?

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Apr 2, 2019 06:50PM djmammo wrote:

Mamaofthree

A small but important point of information: Technically, since you don't know what it is, you've had an "excisional biopsy". The term "lumpectomy" is reserved for removal of a known cancer. If this is benign, and in the future you put "lumpectomy" on a history sheet they may think you have had cancer. It will at least confuse matters.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Apr 2, 2019 06:58PM Mamaofthree wrote:

thanks for the response. I will refer to it as that from now on. It’s weird because that’s what it is referred to in my paperwork.

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Apr 2, 2019 07:11PM djmammo wrote:

Mamaofthree

That is odd for a couple of reasons. Is this a general surgeon or a surgeon whose practice is limited to breast? Maybe he feels very sure its benign?

I have not yet worked with a fellowship trained breast surgeon who would remove a solid mass without first obtaining an image guided biopsy to know how to plan the surgery. When doing it without having a tissue diagnosis first, you run the risk of needing a second surgery for wider margins and a sentinel node dissection.

I suppose you could do a frozen section in the OR and change the procedure if it comes back cancer but then you haven't had the Nuc Med injection necessary for a sentinel node dissection. I'm a little confused.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Apr 2, 2019 08:55PM Mamaofthree wrote:

I’m confused by it all also! They did a biopsy but they said it wasn’t compatible with what they originally thought and they didn’t have a big enough sample. Hence the surgery. I feel like it was quite a large section they took. I just have my papers of release that don’t have a lot of information; just the standards of what to do and not do after surgery.They said hopefully they will have answers as early as Wednesday but most likely Friday.

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Apr 2, 2019 10:41PM KBeee wrote:

I have had 2 excisional biopsies and both times in the OR when they make you say what you're there for I said "excisional biopsy" and they wrote lumpectomy and told me that is what they considered it. I always thought it was for a known cancer too, but interesting; I wonder if the terminology varies place to place.

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/26/2013 Mastectomy: Left, Right Chemotherapy 9/20/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/12/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/23/2014 Reconstruction (left); Reconstruction (right) Surgery 1/29/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Surgery 2/25/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Chemotherapy 3/31/2015 AC + T (Taxol) Radiation Therapy 8/25/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Apr 3, 2019 11:15AM Mamaofthree wrote:

KBeee

Yeah they kept calling it that in my pre op and everything. It’s weird, different terminology for different places makes sense. It would make more sense if they had the same terminology everywhere. Less confusing for sure

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Apr 3, 2019 03:13PM Beesie wrote:

Mamaofthree, now that you've explained more about your situation, it actually makes perfect sense.

You had a needle biopsy, as would normally be expected when something suspicious shows up on imaging. The results of the needle biopsy were discordant. This means that the imaging showed one thing but the biopsy results showed something else. In other words, from the imaging, it appeared most likely that the suspicious area was "ABC" but the biopsy found "XYZ". It also appears that the needle biopsy sample was small, which can happen if the area of suspicion is in a location of the breast that is hard to access with a needle, such as near the chest wall or up against the skin. With a too small sample, it's possible that the area of suspicion wasn't adequately sampled, which could explain the discordant result.

The normal next step after a discordant or incomplete needle biopsy is to follow-up with an excisional (surgical) biopsy, which is what you've had done. This is still a biopsy, but to ensure adequate sampling, the entire suspicious area is surgically removed.

As for your procedure being called a lumpectomy, as djmammo noted and as I mentioned in my earlier post, the more accurate/correct term for your surgery is an excisional biopsy, since the objective is to biopsy the suspicious tissue to determine whether or not there is any cancer present. In my years on this site, I have seen situations where insurance companies, doctors and hospitals sometimes call an excisional biopsy a lumpectomy. This can be confusing to the patient, and as djmammo points out, it can be confusing to other doctors in the future if they see the word "lumpectomy" on a medical history for a patient who has never had breast cancer. From what I've seen, the term "lumpectomy" is usually used only for administrative ease. Although the objective of each operation is different, the basic surgical procedure is the same, so by using one name for both operations, a facility only needs to prepare one procedural document and doctors, nurses, anaesthesiologists, etc. only need to be familiar with only one set of processes.

Over the years, I've had 3 excisional biopsies, although I honestly don't know what any of those 3 hospitals called the procedure. Two were benign and one found cancer.

Good luck with your results. Hope it's benign

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Apr 3, 2019 04:50PM djmammo wrote:

Mamaofthree

That makes more sense, you are having the open biopsy since you had "discordant findings" on your biopsy's path report. That is protocol everywhere. No longer confused.


Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Apr 3, 2019 04:55PM djmammo wrote:

The definition should not vary. Breast specialists in all disciplines use the definition below from the National Cancer Institute.

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/lumpectomy

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.

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