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Topic: Biopsy scheduled - questions

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: Nov 30, 2019 09:33PM

Nvrachel19 wrote:

Hi everyone. I went to the breast specialist like I mentioned in my last post. She said since the ultrasound and mammogram show nothing, the only way to tell what my lump is would be vacuum assisted biopsy. It’s scheduled for next week. I’m very hesitant and worried about it.

I’m very slow to heal due to other health issues, how long would it be until I am back to normal (exercising, skiing, etc)? Is there lasting pain?

Also, if my ultrasound didn’t show anything two different times, how can they use an ultrasound to guide the needle?

I guess I’m just struggling with cutting into my body when there isn’t a “ton” of evidence to warrant it. I know it will give me a 100% answer, which is nice since I do have a lump. I just feel like maybe there’s another way? Maybe not.

Lastly, has anyone told them to not put a clip in? I really don’t want metal in my body if it is somewhat optional.

Hope this doesn’t sound too clueless! Thanks.


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Nov 30, 2019 09:56PM MinusTwo wrote:

Rachael - it's best if you start one thread and stick with that thread so people can get to know you. But I'll answer on this one.

There are lots of of threads about the different types of biopsies. You can search by that name. Are they really cutting? Or is it a punch biopsy or needle biopsy? If you're unsure, take your copy of your mammo & ULS films and go find another doc for a 2nd opinion

But yes, you do want a clip so they can keep track of what has already been ruled out.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Nov 30, 2019 10:14PM Beesie wrote:

Rachel, I'll second what MinusTwo said about sticking to one thread... I don't know what information you provided previously so it makes it difficult to reply.

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.

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? I've had lots of biopsies, some ultrasound guided, some mammogram guided (stereotactic biopsy), and for my multitude of large palpable cysts, my surgeon would just insert a fine needle with no guide required

Do you have a copy of your imaging reports? What do they say, and what is the BIRADs rating? That's very relevant to determining if this biopsy is necessary or not.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Nov 30, 2019 10:26PM AliceBastable wrote:

I requested no clip because it's possible I have a metal allergy (not tested but various doctors have been cautious and assumed I have one). The biopsy area still showed enough for the MRI and surgery. Plus, the radiologist, nurse, and ultrasound tech were delighted to have an unused clip to examine and dissect.

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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Nov 30, 2019 10:50PM Nvrachel19 wrote:

sorry I didn’t know about multiple threads. I didn’t think anyone would see the old post if I replied to that. Little history: I’m 34, 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. The lump is fairly big, maybe like a chapstick tube? I haven’t noticed it or symptoms changing though through the years.

The doctor specifically said ultrasound guided and vacuum biopsy. That’s a bigger needle right? That’s why I have no clue how that will work if the ultrasound shows nothing. You can feel the lump in there but it’s not close to the surface where you could pinch it or anything. Just if you kind of move your hands around can feel it deep in there. They haven’t given me imaging reports, just papers showing that results were normal but dense tissue.

Should I see a second doctor? 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, so I just want this over but not with unnecessary tests. Thanks

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Nov 30, 2019 11:23PM Beesie wrote:

When you add a new post, it bumps that discussion thread up to the top of the active list. People who've responded previously will notice it, and those who didn't reply earlier will havethe benefit of getting all the information and seeing the previous responses.

Do you feel that this lump has increased in size since you first noticed it two years ago? If not, I wouldn't think that a biopsy is necessary. And I don't know how an ultrasound guided biopsy can be done if the mass isn't showing up on an ultrasound.

Do you have copies of the mammogram and ultrasound imaging reports? If not, get them. You need to know what they say to decide if a biopsy is warranted. Since the referral was optional, my guess is that your imaging has a BIRADS 3 rating, which usually means a 6 month follow-up rather than a biopsy. But without knowing what the report says, it's all speculation.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Nov 30, 2019 11:47PM Nvrachel19 wrote:

I'll call in Monday to see if I can get the image reports. I haven't noticed the size change in the last six months or so but I couldn't really feel it before that. I never knew what to look for until my doctor pointed out the exact spot.

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Dec 2, 2019 12:08PM Nvrachel19 wrote:

I got my image reports. The ultrasound and mammogram both say BIRADS 1: negative.

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Dec 2, 2019 07:01PM MinusTwo wrote:

Good news !!!

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Dec 2, 2019 07:06PM Nvrachel19 wrote:

Thanks! But even with the BIRADS 1, they still want the biopsy because of being able to feel a lump. Is it overkill? Does anyone know how often both mammogram and ultrasound would miss a tumor? I asked about doing MRI or thermography and she said it wouldn’t help.

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Dec 2, 2019 08:32PM Beesie wrote:

Is the surgeon doing the biopsy herself or is she sending you to a Radiologist for the biopsy? Normally a Radiologist would do a vacuum assist biopsy.

Personally I would want to know how the biopsy can be done if the imaging doesn't show the mass and the mass is not easily palpable.

And I do think that an MRI would be helpful. It might not show the mass or provide help in identifying what the mass is, but if nothing shows up that looks like it could be cancer, that would be an important data point. And if the mass does show up and looks suspicious, then an MRI guided biopsy could be done.

My recommendation would be a second opinion, or at least getting better answers from the surgeon before going ahead with the biopsy.

Hopefully djmammo sees this thread and offers his input.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Dec 2, 2019 09:06PM - edited Dec 2, 2019 09:08PM by Nvrachel19

it's in the surgeons office where I'm having it done but I'm not sure if it's her or a radiologist doing it. That's one reason why I am questionable, is she just out to make money or actually is concerned about it. My appointment is this Saturday and if it's necessary I don't want to delay it, but also maybe asking someone else is a good idea. She just said an MRI wouldn't help because if the MRI doesn't show anything, I need the biopsy. And if it does show something bad, I will need the biopsy. I guess she said MRI itself can't rule cancer out? She said she didn't think it felt like cancer (feels soft not hard), but no way to know for sure. Ugh this stress is going to kill me

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Dec 2, 2019 09:31PM - edited Dec 2, 2019 09:31PM by Nvrachel19

I just checked my paperwork and there's a consent form saying the doctor will do it. And the paperwork says ultrasound guided vacuum biopsy. Now I am even more confused. I agree that it's usually a radiologist doing it, is this concerning?

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Dec 2, 2019 09:37PM Beesie wrote:

Okay, I didn't want to say it, but your comment "is she just out to make money" is what I was wondering too.

Maybe she does want to get to the bottom of what this lump is that you've had for several years, but why not an MRI before the biopsy? If the MRI shows the mass, it will be easier to do the biopsy.

Given that you've had the mass for years, given that if feels soft (which might suggest it's just breast tissue - I always had what felt like a lump that was just a natural part of my breast tissue) and which would explain why nothing is showing up on your imaging, if you are uncertain about having the biopsy, I don't think a delay would be a problem at all, if you need to delay in order to get a second opinion.


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Dec 2, 2019 10:02PM MinusTwo wrote:

The surgeon doing an ultrasound biopsy? Doesn't make sense. If they can't see the lump with ULS, how is that going to guide them to the biopsy spot?

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. Or dentists either for that matter. It may be ligit, but like Beesie, I'd delay and get a 2nd opinion.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Dec 2, 2019 10:10PM Nvrachel19 wrote:

I guess I’ll call tomorrow and ask how they intend to use ultrasound. Sucks I didn’t think to ask that at the appointment. How would you suggest I find a second option doctor? Could I call my referring gyno and ask her? Thanks everyone

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Dec 3, 2019 01:18AM AliceBastable wrote:

Chiming in to agree that there are lots of red flags on this biopsy plan. Just tell your gyno you have no confidence in that surgeon and you need a referral to a new one. Or can you get the referral from your primary care doctor? Good luck.

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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Dec 3, 2019 07:35AM djmammo wrote:

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 helping members understand their health care provider's reports and recommendations.
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Dec 3, 2019 11:54AM flashlight wrote:

Nvrachel19, Where are you from? Maybe someone on this site is in your area and can give you some recommendations. I hope you follow djmammo's advise. Good luck to you.


Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 11/26/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 1/27/2019 Whole-breast: Breast, Lymph nodes Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 3, 2019 12:03PM Nvrachel19 wrote:

I’m in Las Vegas. The doctor is a general surgeon, the site says she does a lot of breast work but also other things. The procedure is at her office that she shares with other surgeons. It’s a really small place, I was surprised they have the tools there. Only a few rooms. It’s at the same place I had my consultation.

I just called to ask how they will use ultrasound if nothing shows, and she said even if the ultrasound doesn’t show anything she can feel the lump and can do it that way. I’m obviously no expert so maybe they can, but when I feel it, seems too deep to just poke into and hope it’s the right place. I had to point out exactly where it sometimes hurts to her. Ugh!!! They just said they will discuss it more when I go. Devil

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Dec 3, 2019 12:21PM ctmbsikia wrote:

Your original post says you went to a breast specialist, now you're saying the Dr. is a general surgeon? Or is the general surgeon just doing the biopsy?

I'm thinking the no MRI maybe an insurance issue with a birads of 1? I don't know. But if they're paying a biopsy then truly that is the only way you will know 100% what it is.

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 1/31/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/11/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Dec 3, 2019 12:24PM Nvrachel19 wrote:

the original referral from my gyno after the mammogram and ultrasound said breast specialist, but I guess the lady is a general surgeon/specialist

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Dec 3, 2019 12:26PM Nvrachel19 wrote:

also, if it’s useful I’ll pay out of pocket for an MRI. I’m no stranger to high medical bills lol

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Dec 3, 2019 12:28PM ctmbsikia wrote:

I would high tail out of there if it was me. You need another opinion. Take your reports to one of the larger cancer centers. surely there is one in Vegas. Good luck to you.

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 1/31/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/11/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Dec 3, 2019 02:51PM Nvrachel19 wrote:

well I’ve called three of the big hospitals that have cancer centers and none of them have doctors that work with them full time for breast stuff. It’s mostly just testing they do. One of the doctors they recommend is the one I’m seeing! So now I’m really super confused. Of the few they listed none of them are a straight “breast surgeons” they are all general surgeons who focus on breast stuff. Does Vegas just have crappy care or what is this? Now I’m thinking I should just do it and have all this over with. Or start looking for doctors in California? Ugh

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Dec 3, 2019 05:11PM - edited Dec 3, 2019 05:13PM by Beesie

Here's the thing. Officially there is no such thing as a "Breast Surgeon". Breast surgeons are General Surgeons who specialize in breast surgery and ideally exclusively perform breast surgery and nothing else. Some doctors use the title "Breast Surgeon" but it means little, since there are no specific qualifications that designate a surgeon as being a "Breast Surgeon". I'd guess (or hope) that most surgeons who use the title "Breast Surgeon" are honest and have in fact trained in breast surgery and focus much of their practice on breast surgery. But a surgeon who does only 5% of his surgeries on breasts could still call himself a "Breast Surgeon". On the other hand, my surgeon, who exclusively does breast cancer surgery and is head of the Breast Surgery department at a leading cancer hospital, uses the title "General Surgeon".

What you want to look for is training, not title. Through his/her medical education, did this surgeon specialize in breast surgery, perhaps having a fellowship in breast surgery? You want to look at focus. What areas does the surgeon list that he/she works on? Just breast surgery or only two or three areas, or a long list of areas? And you want to look at reviews. Are they all for breast surgery or are most for other types of surgery?

I'm sure you can find true breast specialists in Vegas, but it might take a bit of digging to figure out who's who. I'd say it's worth looking, and worth cancelling/delaying your Saturday appointment for the biopsy. You can always reschedule later if it becomes apparent that a biopsy is advisable, and that this doctor is a good choice. At this point there is nothing that sounds urgent about your situation, nothing that says you should go ahead with the current biopsy plan despite your questions and concerns.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Dec 3, 2019 05:47PM Beesie wrote:

Is this one of the places you've checked out? Some of the breast specialists appear to be well trained and focused on breast surgery:

https://cccnevada.com/

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Dec 3, 2019 06:31PM AliceBastable wrote:

My surgeon is listed as a general surgeon, but she and another general surgeon have their offices in the breast health clinic at the hospital complex I use. They only do breast surgery. Most hospitals have breast health areas and that would be a good place to start with inquiries about finding a breast specialist. At the mid-size hospital I used, it was all seamlessly connected: mammogram, then notification of follow-up needed with ultrasound and possible biopsy. The u/s findings showed I did need a biopsy, and that was done on the spot by a dedicated breast care interventional radiologist. From there, I got an appointment with the surgeon, in the same location. I guess I could have gone outside that clinic if I'd asked for a different doctor, but I liked and trusted everyone in that breast center. The MRI, surgery, and radiation were in the main hospital building.

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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Dec 3, 2019 07:10PM - edited Dec 3, 2019 07:11PM by Nvrachel19

is biopsy a fairly “easy" thing to get right? Since it will be months before another doctor can see me should I have the biopsy done now and then just have them help if there is bad results? The thought of doing a biopsy by feel sounds scary, but is that something common they do? Maybe it’s not a big deal like I imagine.

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Dec 3, 2019 07:13PM Betrayal wrote:

AliceBastable: I would say you were lucky that your breast center care was so seamless. Although I went to a designated breast care center for a follow-up mammogram and an ultrasound, the radiologist who performed the ultrasound scared me half to death and he physically barred the door so I could not leave the room. He insisted I was not able to leave the department until I had made an appointment with a breast surgeon. I found this to be an utterly useless waste of my time since they knew they needed to biopsy what they had found on ultrasound. However, they did get to charge for a surgeon visit pre and post biopsy. If I had been able to think clearly or had better direction from the nurse navigator, I might have had a more positive experience. It left me wondering what the nurse navigator's role was since I had little if any direction here.

Dx 1/7/2016, DCIS/ILC/IDC, Left, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 1/31/2016 Lymph node removal: Sentinel Surgery 1/31/2016 Lumpectomy: Left Surgery 3/3/2016 Lumpectomy: Left Radiation Therapy 3/30/2016 Whole-breast: Breast Hormonal Therapy 6/24/2016 Arimidex (anastrozole) Hormonal Therapy 5/18/2017 Femara (letrozole)
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Dec 3, 2019 09:32PM Beesie wrote:

Rachel,

djmammo is a Radiologist who specializes in breast imaging. I think his comment about the value of an MRI in your situation is very important.

*****

"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...

...If you could get your ins company to cover an MRI that would put this question to rest.

*****

The fact that your mass is not showing up on imaging and yet the surgeon wants to do a biopsy rather than a MRI is concerning.

And to your question, just based on reading posts here for many years, I don't think it's common at all for a vacuum-assist or core needle biopsy to done based on feel. Much more common is a doctor saying that a biopsy can't be done because nothing is showing up on imaging.

If you have the biopsy done by feel and the results show normal breast tissue, will you have any confidence that the needle hit the right area?

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke

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