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Dec 3, 2019 07:35AM
Nvrachel19 et al
There is a lot to "unpack" here. I'll try to reply to all the key comments
"I've had a lump that is sometimes painful for a few years now. Had an ultrasound two years ago, showed nothing. Had my first mammogram and ultrasound two months ago, showed nothing. I haven't noticed it or symptoms changing though through the years." "The ultrasound and mammogram both say BIRADS 1: negative."
If we see something on a mammogram or US that we think is benign, we follow it up. If there is no change in 2 years we leave it alone. In your case nothing was seen.
"I really don't want metal in my body if it is somewhat optional."
It is not optional. It is an important part of the diagnostic process. If the lump needs to come out, the marker comes out with it anyway. If benign, it acts as a do not disturb sign for future exams. It can be removed after a benign diagnosis if you want but you will need to tell every imaging center from now on about its removal.
"What I can tell you is that a vacuum assisted biopsy is a needle biopsy, not a surgical biopsy, so there will be no cutting into your body."
In essence the vacuum assisted device is like a hand held stereo biopsy unit. They are automated/motor driven and much smaller now than in the past and battery operated. The hospital bought us one as they can bill more for a biopsy done with it than with the usual spring loaded gadget. They are good at what they do but for me they take longer and are not ergonomic enough, my wrist aches after using them.
"Did the surgeon specifically say that the plan is to do an ultrasound guided biopsy, or is the lump palpable in which case no guide is necessary?"
Is the surgeon a 100% full time breast surgeon or a general surgeon who also does breast? How many image guided biopsies do they do a year? None of the full time Breast Surgeons I have worked with did their own biopsies, they were too busy in the OR.
"The doctor specifically said ultrasound guided and vacuum biopsy."
Unless specializing in breast I can't imagine a surgeon's office having the proper US equipment for breast imaging and if it's not for guiding the biopsy I can only think it would be for the required documentation, that is images taken of the needle in the breast to prove it was done.
"Originally the radiologists said not to worry and check again next year. Then I got a letter in the mail with an optional referral to see a specialist"
The comment about the specialist may have been part of a form letter and not a specific recommendation.
"But even with the BIRADS 1, they still want the biopsy because of being able to feel a lump."
I assume this is the surgeon's office talking.
"Does anyone know how often both mammogram and ultrasound would miss a tumor?"
For a palpable lump the size you are describing it would be very odd for it not to be seen on 2 exams done 2 years apart.
"I asked about doing MRI or thermography and she said it wouldn't help."
This statement regarding the MRI is false. Thermography is a scam.
"Neither does it make sense that a surgeon is doing this procedure on a Saturday - in her office. I don't know any "established" docs who work on Saturdays."
It does seem odd. Is the location of the biopsy the same as the location of the office you visited or somewhere off-site?
"She just said an MRI wouldn't help because if the MRI doesn't show anything, I need the biopsy."
This is a completely false statement. Although false positives are common, the negative predictive value of a normal breast MRI is somewhere around 98% especially in light of both a neg mammogram and neg ultrasound.
You can Google any physician and find out their training and qualifications as well as their area of specialization fairly easily if you have any doubts (and yes I actually recommended Googling something). You want to see that a doctor was educated at a reputable institution, trained in the specialty that applies to your specific health problem, are licensed in your state and accepts your insurance. Some sites will also tell you if the doc has been sued for malpractice which is a valuable piece of information if it relates to the service they intent to provide to you.
If the images really show nothing, a review of them by a different radiologist would not help, you would have to have another set of images done somewhere and ins may or may not cover that. If you could get your ins company to cover an MRI that would put this question to rest. The wording of the request coming from your PCP or Gyno would be critical and have to say something like "pre-op mri for suspicious lump not defined on Mammo or US" or something to that effect to convey to the ins company that it is medically necessary. Good luck. Keep us in the loop.
Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com