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Category:

Breast Biopsy

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Question:  #1 11/15/2009		Q:	What information is there regarding outcomes for those who have decided not to have surgical excision for radial scar found on biopsy only (not mammography)? What type and frequency of monitoring is advised? I had multiple breast biopsies for microcalcifications and the findings were benign except for radial scar. My doctors have recommended excisional biopsy. From what I have read and been told by my doctors, there is a very small chance of finding cancer and I am questioning the need for the surgery. I understand that having more tissue will allow a more accurate diagnosis of this lesion but it will not change the fact that I am at increased risk for cancer in the future because I had this abnormality in the first place. I asked about non surgical options and my doctors told me there were "none", but I have heard of people choosing watchful waiting. I would appreciate your thoughts on this. Thank you very much.
		A:	the standard of care is to have it surgically excised. there aren't any studies that show what to do if it isn't removed. and there are situations in which cancer is found. reconsider your decision. better safe then sorry.
Question:  #2 11/15/2009		Q:	I had low grade dcis almost 5 yrs ago then 3 yrs ago a sclerosing papilloma and since that time have been getting digital mammos yrly and us on left breast to keep eye on it well this time they spotted a 1.2x.7x.9 cm which appeared more prominent and complex w/ mostly solid but now has a cystic component. I had it biopsied which came back as begin part fibroadenoma and something else cant remember but no atypia. Does this sound right to you I questioned it. This whole area at the 11:00 spot is starting to have alot of thing going on 3 masses oh and in the biospy report it did state about microcal in the tissue. Still wish I cld get genetic testing done but the cost of a couple grand is way more then i can afford would i have tried everyway to get a low cost or free test but now luck.
		A:	this is worth a second opinion. you might want to have the pathology re-read with us. if so, call sheila at 443-287-2778 and she will instruct you how to get this done. genetic testing is expensive. true. i'm not aware of a discounted method to get it done though since it is done only by one company.
Question:  #3 11/8/2009		Q:	Thank you for your quick reply regarding my question on biopsy in the periaerloa area and wire localization procedure. It seems to me that they do not offer this procedure - I am scheduled Nov 12th - will it be able to be done without it? (I do not think that this procedure is offered at my regional hospital.) The surgeon explained the the nipple will look odd after surgery - she discussed what she was going to do and there was no mention of any other procedure being done - just that it was going to be tricky and to be prepared for the nipple to look different as the blood supply in that area can compromise the healing process. I want to find out what the lump is, but it concerns me that she has not offered this procedure - I do want to know what it may be.
		A:	hhmm. so first, make sure you are in the hands of a breast surgical oncologist and at a comprehensive cancer center so that the surgeon taking care of you is specialized in breast, only does breast... make sense?? find out his/her experience in doing this type of procedure in the past on others. how suspicious does this area look?? what was the bi-rad score by breast imaging radiologist??? you might want to at least consider a second opinion elsewhere before embarking on this too. if you want to come our way call 443-287-2778 and request sheila to book you with one of our breast surgical oncologists. simply tell her that you had email with Lillie on sunday.
Question:  #4 11/7/2009		Q:	Hi again Lillie, : Just a question regarding my ealier post - I am scheduled for an excisional biopsy -( because it is too small to do a FNA) of a small, 3mm palpable breast lump that was not visible on any imaging.It is located in the periaerola area.This lump is tricky to locate by palpation - My surgeon did not mention that I will have a wire localization procedure done prior to surgery - my understanding is that she is just going to go in and take out a wedge of tissue in that area - in the hope that they get the lump.That is the reason that this procedure is being done with a general anaesthetic - as she did not want to create any swelling in that area by injecting it with a local. Should I ask for the wire localization procedure to be done?
		A:	given the tiny size, and the strategic location, you want to have tissue removed but only what is absolutely necessary otherwise the nipple may flatten out. (removing tissue under the nipple can cause it to kind of collapse or at least flatten. that may not be a concern to you but for most women it is.) so inquire about the wire so it serves as a bulleyes.
Question:  #5 11/1/2009		Q:	im sorry for so many questions. recently john hopkins recieved my slides from my biopsy. they confirmed from the slides that it was indeed dcis. but they also wanted my lab to send them the paraffin block. but my local lab refused.could you tell me of what possible reasons they wont send that to john hopkins to have them look at that with my slides that they sent. just to let you know. my lumpectomy did not find that i had dcis. all calcifications were only fat necrosis. thank you for your imput.
		A:	hhmm. i don't know why another pathology dept at another facility is refusing to cooperate. this is very unusual. i'm sure we were requesting it to look at more tissue samples which is what you clearly need to have done.
Question:  #6 11/1/2009		Q:	how common would it be to remove 4 dcis calcifications. with a sterotactic biospy. and 40 more calcifications. were nothing more than fat necrosis.when a lumpectomy was performed.recent mammogram did reveal that there is no more calcifications now.
		A:	most calcs are benign actually. if clustered tightly together and have an irregular edges when magnified then we consider them more suspicious for being an early stage breast cancer. it would not be that "4 calcs were dcis". a single calc is now how we determine if something is cancer or not. if a small area of the calcs were dcis and a large area of calcs in the exact same anatomic spot of the breast were benign that would be a bit unusual.
Question:  #7 11/1/2009		Q:	Hi Lillie, I am scheduled for an excisional biopsy -( because it is too small to do a FNA) of a small,palpable breast lump that was not visible on any imaging.It is located in the periaerola area, . My question is - is the nipple area more risky to biopsy and is there more chance of a mastectomy being performed if cancer is found in this area? My surgeon commented on the difficulty of operating in this area, and wants to do the biopsy uner a general anaesthetic to minimalise the swelling that may occur if a local is used.She said that it was tricky to locate it by palpating and she wants to take out a wedge of tissue to ensure that they get the lump -( it is about 3mm) - and I have had it for 9 months. I am post menopausal. Sounds a bit scary, as she said that the blood supply in that area can create issues with the healing process and that the nipple will look very odd afterwards. Is there any other way of finding out what the lump may be?
		A:	it is tricky for the radiologist to be about to perform a wire localization procedure to bullseye the spot. that needs to be done shortly before they walk you into the operating room and is done in breast imaging facility there. the other tricky part is removing only what needs to be removed and not taking more tissue than needed since the location is underneath the nipple and that tissue helps to provide the nipple projection that women are accustomed to having and enjoying. (otherwise it can flatten out the nipple.) If this were to be found to be cancer it is clearly very very very tiny. a central lumpectomy would be done which would result then in having to remove the nipple and areola but both can be rebuilt by a plastic surgeon. don't assume that this is what it is though. way too early to be guessing that far ahead.
Question:  #8 8/30/2009		Q:	When I was 16 weeks pregnant I found a lump in my breast, obgyn sent me for a breast ultrasound which revealed abnormal lymph node (it was round shaped and lost some of the fatty helum), radiologist was very concerned, I believe it was rated BIRAD-4. I was sent for mammogram (nothing was seen besides lymph node, but I have dense breast tissue), and then had a core needle biopsy, which thankfully came back as "reactive hyperplasia", no cancer found. It''s been two month and lymph node is still there, same size, surgeon wants me to wait till I deviler and then have it removed. I had also had a chest X-ray to rule out other enlarged lymph nodes (for lymphoma), and blood work. Do you think this lymph node should be removed? Is it OK to wait for 3 more month until I deliver? Do you think there is a still chance that it could be malignant? Thanks!
		A:	lymph nodes can be enlarged for reasons other than cancer. if you are really worried about it the radiologist in breast imaging should be able to do an ultrasound of the node and perform an FNA- fine needle aspiration- to give you peace of mind that this isn't anything of concern.
Question:  #9 8/29/2009		Q:	For those who are reading all of your wonderful questions and helpful answers, but who feel fearful, I would just like to say,I am 57 years old and have never ever been called back for a second mammo, but this time I had a screening mammo in early July, was recalled for a magnification because of calcification clusters that were not there last year, was then scheduled for a stereotactic biopsy..and what to me sounded like an awful procedure. The needle to numb my breast was less painful than a bee sting, the biopsy was painless, I had no bruising, no hematoma and best of all NO CANCER.... sometimes it can be scary to read all the posts about bruising and pain and swelling but I think it is comforting to also read from those who did not experience all of those effects and ended up with good news. Thank you for your site.......
		A:	thank you! and congrats on good news.. L
Question:  #10 8/29/2009		Q:	I''m sorry, I don''t understand. I''m only DCIS, not invasive. Are you saying that those tests are only relevant when the cancer is invasive? (Referring to HER2 and recepter) Sorry to be such a ninny. I do realize that my cancer does not appear to be serious. And I really do appreciate you taking the time to educate me. Just trying to make sure that I don''t take it too lightly and not have the right tests done so that we choose the best treatment. Thank you very much
		A:	i don't have a way of connecting one posting with another so thought you had a mixture of both invasive and noninvasive. Her2neu is NOT done on DCIS. no need to. only applicable at this point in time for invasive disease. hormone receptors ARE to be done on DCIS (or if there is also invasive disease then the results of the invasive trumps the dcis). it is common to not do it on the biopsy and instead to do it on a bigger sample of tissue obtained at time of surgery.
Question:  #11 8/29/2009		Q:	Sorry, One quick follow up question. Is it normal for the pathology to not submitt the DCIS sample lesion of (0.5 cm) for receptors and/or HER2 neu analysis? Should I have the additional biopsies done by same surgeon and analyzed by same pathologist? I''m thinking it''s kind of important to know about the receptors and HER2
		A:	correct. only invasive disease gets tests when both dcis and invasive are present. invasive trumps any receptors for dcis.
Question:  #12 8/29/2009		Q:	Ultrasound showed 7x6x8mm lesion in right breast. Sent for ultrasound guided biopsy and results: IDC,G2, DCIS component: minimal, approx. 1%, low grade No calcifications, no necrosis Tumor volume approx. 50% of total core Estrogen receptor 13% positive Progesterone receptor 21% positive Her-2 1+ negative Ki-67 3% Low Going for consultation with breast surgeon at MSK in NYC on 9/16. What can I expect to hear? Scared to death. Thanks so much for educating me through this site. It has helped me tremendously to cope and plan my future.
		A:	first, sounds like this is a very very early stage breast cancer. small and should be pretty each to treat. the discussion will probably be on lumpectomy with radiation. this is a very very slow growing tumor too. good for you. it is only mildly hormone receptor positive based on biopsy so be sure they repeat the hormone receptor tests on the lumpectomy specimen as well. the numbers might go higher making hormonal therapy an option for prevention of recurrence. be well. don't sweat over this.
Question:  #13 8/29/2009		Q:	I had a mamogram on 7/6 which showed 3 foci of increasing calcifications in my right breast. Milk of calcium. However 2 additional foci are increasing. One directly retroareolar. (recommend biopsy) This appears to be compared of at least 2 foci of calcifications. One focus is more coarse, and present previously. However, anterior to this, are finer calcifications. These are not definitively layering. Anterior to this, in the direct ductal line is another focus of calcifications that are not definitively layering. These are relatively fine. On the left breat, there are calcifiations to the left upper, far lateral breast. Present previously and appear to be ralatively stable. Although a couple of these may be layering, not all demonstrate this benign characteristic. Recommended six month follow up mammogram with magnification. On 8/6 I had a stereotactic biopsy of the one calcification in the right breast. The pathology came back as Ductal Carcinoma In Situ, non-comedo type, focal (0.5 cm) with coarse calcifications seen. No evidence of an invasive component is found. Due to the focality of the lesion the tissue block was not submitted for receptors and/or HER2 neu analysis. Clinical correlation is suggested. A moderate focal chronic inflammatory host response was found. Granulomas were absent. The background shows diffuse fibrocystic changes with additional scattered microcalcifications found within sclerosing adenosis. The surgeon recommended removal of a golf ball size piece of tissue followed by ballon seed radiation. When I pointed out the calcification in the left breast. He said yes it would be prudent to biopsy that one and perhaps the other 2 in the right breast before making any definite decisions on treatment. My question is based on this information, should I get a second opinion before doing additional biopsies or should I do the additional 3 biopsies before getting a second opinion? Thank you for your time and knowledge. God Bless
		A:	biopsy makes sense to rule out multicentric disease. calcifications become guilty by association once one area of calcs are biopsied and determined to be early stage breast cancer.
Question:  #14 8/16/2009		Q:	Hello- I wrote last week (40 years old, first mammo with microcalc cluster and nodules in other side). You told me a few questions I needed to ask. Here are answers: Birad 4 on microcalcifications. Most are round but a few (I think there are a total of about 6) are pleomorphic. The nodules (4 of them, round- right behind nipple)not much of a concern. I saw a general surgeon (came highly recommended) on Thursday- he seems to think it will be benign- I have stereotactic tomorrow morning and needle core on nodules also. My question- the microcalcs are in more a round shape (the cluster I mean). I am reading that linear and branched is more of a concern. I read that the nodules being smoothe and round is good- but 4? What are your thoughts on both issues? I''ve been nervous (of course). Have two little ones, and so am more than nervous. The surgeon does about 3 of these a week (stereotactic)- I hope I made the right choice with him. THANK YOU! (have been waiting all weekend to get my question in).
		A:	don't sweat over this. the possibility the nodules are benign is very highly likely. the calcs are about 25% risk of cancer, meaning 75% probability that are nothing but calcium.
Question:  #15 8/9/2009		Q:	My wife had her right breast bioppsied on Thursday 8/6/09. Doc said preliminary results seem just to be a bruise. Is this common or uncommon, I would say from first mamo to first ultrasound was maybe a week, then from there to biopsy was two weeks when they did second mamo and ultrasound. We should know defenitivly on Monday what pathology says, just driving me crazy till then.
		A:	actually kind of odd to have a biopsy done with the outcome being a bruise. a bruise, hematoma in essence, should have been visible as being such on ultrasound.
Question:  #16 8/8/2009		Q:	I am scheduled this Thurs for 3 biopsies. Two are on the right breast- ultrasound showed normal, but MRI showed two lumps with rapid enhancement and some kinetics with slight washout? (My mom died of premenapausal breast cancer at 36-I believe she had a sarcoma and invasive carcinoma) On the left breast the mammogram showed a change in califications and I have a new cluster of microcalcifications. I already went once a couple weeks ago for a stereotatic biopsy (I have Implants) and the radioligist would not do it stating band of tissue to close to implant). That is why they sent me for MRI. I went to a surgeon who is now sending me back to same hospital (Memorial Regional, Hollywood, FL) for another attempt plus the two ultrasound guided on right breast. My question is this... how great is the risk of implant rupture? My surgeon called and made the appt himself- he seemed annoyed that they had not completed it on first visit and does not want to do an unnecessary more invasive surgical procedure if he does not need to. I have been going through this crap since my mammogram 7/3 and am worried the radiologist will just pull out again for fair of liability and then another month of Drs will go by. Opinions please. Thanks
		A:	you have what we call "busy breasts"-- lots going on as is reflected in your mammogram. your family history is very significant as you no doubt know. the risk of implan rupture is directly dependent on how talented and experienced the radiologist is in doing this type of biopsy on a woman with implants. we do these all the time but most facilities don't. so your risk is in the hands of the doctor doing the procedure. i realize you live in Fl but you might want to consider coming north. you can send your mammograms to us for review and then have biopsies performed. we get results back from biopsies in 24 hours. might be worth the trip for you. if you want to embark on this, we do this type of biopsy on women with implants every single week, call Sharon at 410-955-7288 and tell her that you had email with me (Lillie) over the weekend. she will assist you from there. L
Question:  #17 8/3/2009		Q:	What about the combination of multiple foci of atypical ductal hyperplasia and LCIS? I am 51 years old(premenopausal) with a family history of breast cancer (mother, maternal aunt and maternal grandma-all postmenopausal. I have very dense breasts. I am contemplating a prophylactic mastectomy. I know this wouldn''t be something I would do with just LCIS but does the combination of ADH and LCIS, along with my family hx, make it more likely for me to develop invasive cancer? Do you think this is appropriate? Lastly, about ten years ago I had one treatment of bovine collagen around my lips and nose. They appear to have seen microscopic deposits of this in my excisional biopsy of my breast. Can this happen? I was never informed that this could travel to my breasts. I can''t tell you how important this is to me to have a trusted institution like JHU answer these questions. This is a tough decision and I value your opinion. Many thanks.
		A:	You are at considerable risk given your family history and with a history of ADH and LCIS (both count really), it would be reasonable to consider prophylactic surgery. Have any of your relatives been tested for BRCA1 or 2? You could also take Tamoxifen (or Raloxifene if you were postmenopausal) to reduce your risk of breast cancer, but these are all conversations to have with your oncologist. (or get a 2nd opinion). Can't tell you about the collagen injections. Have never heard about this, but it doesn't mean it couldn't be possible. Best wishes.
Question:  #18 7/27/2009		Q:	Let me start by saying " Hello" my name is Mary and I am a bit confused, worried, and on edge, if you could answer my questions I would greatly appreciate it. I went to the doctors cause i found a lump, while being examined the doctor also thought he felt another lump. went for mammogram, was sent for biopsy''s. The biopsy report on two suspicious areas reads like this: RIGHT BREAST MASS, 8 oclock, ultra sound guided biopsy Fragmenys of frbroepithelial esion with focally stromal cellularity Note: although the apperance is compatible with a fibrodenoma, the possibilty of a phyllode tumor can not be entirely excluded in this core biopsy material. re-excision is prudent Gross deion: the specimen is received in formalin in a container labled with patients name and right breast mass, It consist of a 2 cm aggergate of multiple cores of soft rubbery yellow - white fibroadipose tissue. 2nd biopsy right breast 12:00 4 cm out fna: sinificant findings presnt. concistent with peoliferative fibrocystic changes with cytologic atypia: Mirco Diion: the cytoconcentrates show a few clusters of ductal cells, a few foam cells and plaques of apocrine cells. Most of the ductal cells cluster are crowded with overlapping uniform nuclei. Rare ductal clusters are atypical showing disordered polarity, variation in nuclear size and sublty irregular nuclear contours, Cyst debris and rare stromal fragments are also noted. the cell block section are non-contributory. Could you please explain this better to me? All i get from the surgeon is everything is ok. And I thank You and appreciate you help in this matter
		A:	So far there are benign findings. an excisional biopsy will make sure that it is all benign. There is low chance of anything more, but you need to be certain. I would be hopeful but get the recommended biopsy. ds
Question:  #19 7/26/2009		Q:	Are breast core biopsys painful. Will be having one in a weeks time and have a fear of hospitals etc. Will they localize the area and can I have a ''twilight'' anaesthetic? Georgia, Melbourne, Australia.
		A:	I have had a biopsy and felt it was not a bad experience. First the area is identified with ultrasound or stereo images(stereocore biopsy). Then the skin is cleaned and numbing medicine is placed into the skin and deeper into the tissue. The numbing medicine feels like a pinch and a burn for less than counting to 10 slowly. Think of it that way as it happens--pinch, burn, count to 10. You will feel pressure but should not feel pain. if you do, ask for more numbing medicine. I drove myself home after the procedure. If you are anxious, maybe asking some one to go with you would be a good idea. Also ask the dr to explain everything as it happens. Seems to help some women. Good luck. Hope it all goes well. ds
Question:  #20 7/26/2009		Q:	Hello Lillie, First I want to say that I am so grateful for the service you offer. You are truly an angel. I was diagnosed last month with Breast Cancer. It''s so hard for me to even say those words. My head is still spinning and it''s been a real roller coaster of emotion. I feel like my friends all look at me differently. Somehow I never thought it would happen to me, but I guess we all feel that way. I am 56 years old. I walk 3 miles every day and strength train twice a week...and eat very healthy. Somehow this still happened to me...and I guess there is some lesson to be learned. My surgery for lumpectomy is scheduled for July 31st... Below is my pathology report. I was just wondering if you have any advice or comments. My biggest fear is they will find something unexpected when they perform the surgery...and it will be more serious than I realize. I guess we all live with that worry. Thank you again for your support. I''ve decided that somehow after I get through this, I would also like to help other women to fight this battle. PATHOLOGY REPORT - FINAL DIAGNOSIS: LEFT BREAST AT 5 O''CLOCK, CORE BIOPSY - INVASIVE DUCTAL CARACINOMA, GRADE 1, FOCAL INTERMEDIATE GRADE DUCTAL CARCINOMA IN SUTU, CRIBRIFORM PATTERN WITH MICROCALCIFICATIONS. COMMENT: HISTOLOGIC SECTIONS DEMONSTRATE INVASIVE DUCTAL CARCINOMA THAT MEASURES 0.5 CM IN THE LARGEST BIOPSY. TUMOR IS CHARACTERIZED BY A LOW MITOTIC RATE, INTERMEDIATE GRADE NUCLEI, AND MODERATE TUBULE FORMATION FOR A TOTAL NOTTINGHAM SCORE OF 5. LYMPHOVASCULAR INVASION IS NOT IDENTIFIED. ER - 90% PR - 80%
		A:	You are in the shock and disbelief stage of this experience with a breast cancer diagnosis. And a rollercoaster is the best way to describe what you are going through. There are many kinds of breast cancer and your path describes a cancer that is small with favorable characteristics and very treatable. When you know more, share this kind of positive information with your friends. Your friends are as worried as you are. It's great that you take such good care of yourself for all kinds of reasons--walking is a great way to deal with the stress and exercise now helps with recovery--it did for me. There are always lessons to be learned with our struggles--gives meaning to our wounds. I suspect you will pass what you learn forward. I wish you the very best. ds
Question:  #21 7/12/2009		Q:	My test results were negative for breast cancer after my wire localization biopsy and lumpectomy. My problems began when the surgeon punctured my lung with the wire/needle localization. I was in the hospital for 5 days and had to get a chest tube to reinflate my right lung. How often does this happen? Did he not follow proper procedure technigues? I am also concerned about returning to this surgeon for follow up care. I want to be proactive, but this has put a very bad experience on my breast health.
		A:	this is very very unusual for the outcome to be a pneumothorax. perhaps more signficant, wire placement is usually to be done by a breast radiologist. they are trained in this procedure. perfectly natural to be hesitant about continuing with this surgeon. you are welcome to come to us for further treatment.
Question:  #22 7/13/2009		Q:	After my last wide excisional biopsy, the pathology report states: radial scar with florid adenosis, columnar cell atypia and apocrine atypia. Biopsy related changes including linear scars with old hemorrage, one involving radial scar. Can you explain the different types of atypia indicated in my report? Is one type of atypia worse than another? Thanks!
		A:	The different atypia simply reflects the different cell types seen. Columnar cells are different than apocrine, and both types are showing some atypia. Generally speaking, atypia is not that concerning by itself, but when associated with hyperplasia, can sometimes be associated with the earliest changes of breast cancer. I would talk to your doctor about your pathology reading, but it doesn't seem too concerning.
Question:  #23 7/4/2009		Q:	Hi, I am 30 years old and not married. My GP felt a lump at my left breast during an annual breast checkup. I went for a consultation with a specialist as well as a scanning in May. The results were that I had multiple cysts in both breasts. There was a particular 0.6cm solid lump on left breast nodule at 6 o''clock. I had a mammotome breast biopsy beginning of June. The diagnosis was apocrine papilloma but there was no evidence of malignancy (benign?). Deion: Specimen consists of 7 pieces of whitish fibrofatty tissue measuring from 0.5cm to 1.4cm in length. Microscopic deion: Mammotome cores show stromal fibrosis and an papilloma with apocrine changes that has been transected. A separate core also shows part of a papillary lesion. No malignancy is seen. My questions are: 1. Is it normal to have multiple cysts in breasts and why? 2. I had sought 2 different opinions. One doctor advised going through a surgery to remove it as there would be a 15-20% chance it may develop into cancer. Another doctor said it was fine to let it remain and monitored it. What do I do? 3. If i choose to allow the papilloma to remain, will it affect breastfeeding when i have my own babies next time? Will it affect breastfeeding if i choose to have surgery to remove it? I am afraid to go through any surgery as it may have complications later. For your info, I am also suffering from endometriosis and had remove a cyst in Aug 2007. I was on contraceptive pills for half a year till early 2008. I really do not wish to go through another surgery. It seems like I have so many cysts in my body!
		A:	1. very normal. causes are unknown but all women have cysts. 2. the first doctor was correct. so have it removed. 3. probably not but don't leave it there. standard of care is to remove it.
Question:  #24 6/21/2009		Q:	Hello, I have a question regarding the excision biopsy results of my wife (31 yrs old, live in Boston, no family history for BC). Around 2 mths ago, she found a lump in her breast and FNA biopsy results indicated that it was a fibroadenoma with hyperplasia. While we were debating whether we needed to remove the lump, her breast surgeon found another small lump in the same breast (deep and in a different quadrant). Rather than characterizing that lump w/ultrasound and FNA, we decided to remove both lumps via excision biopsy. The pathology results for the second (prev. un-characterized) lump are as follows: 1) Ruptured Cyst with thick fibrous wall. 2) Columnar cell hyperplasia with focal flat epithelial atypia. 3) Apocrine metaplasia and florid ductal hyperplasia. For the first lump (fibroadenoma), the pathology results are as follows: 1) 1.7 cm Fibroadenoma with a cyst in the center. 2) Calcifications consistent with prior cysts. 2) Usual ductal hyperplasia, sclerosing adenosis. The surgeon, after looking at the results, said that both lumps are benign and there is nothing to worry about (since this is common in young women). However, I am worried due to the following reasons: 1) Doesn''t the atypia found in the cyst put her in a high-risk category? Would her young age cause this to be an even higher risk? 2) Both lumps were found by just breast examination. Do we need to do mammography/MRI to be sure that we haven''t missed anything. 3) She has developed a huge hematoma/bruise because of the biopsy. It''s been 16 days and the swelling still hasn''t come down yet. Do we need to be particularly concerned abt. it? Is there anyway the accumulated blood/inflammation can play a role in further activating or transporting the atypical cells? 4) We are planning to have kids soon. Would a pregnancy in the very near term cause any complications (increase her risk?). We''ve tried asking some of these questions to the surgeon but she completely brushes them away. Any insight you can provide here would be much appreciated. Thanks a lot for providing this valuable service to the general public.
		A:	1.you are correct that the presence of atypical hyperplasia does increase risk for breast cancer. the report didn't quantify how significant this was as a finding though (ie, a few cells or a defined area. so ask.) 2. mammogram and ultrasound should have been done prior to these surgeries being done. now that there is a hematoma, it would be recommended to wait several months before imaging will be at all accurate. 3.hematomas don't cause increase in atypica or in the development of breast cancer later. it can take months for a hematoma, if relatively large, to have the body absorb it. 4.technically no. studies have shown that pregnancy doesn't increase risk. in some cases it may even decrease it. if the fibroadenoma had not been removed, it would actually make it grow though from hormone stimulation. not harmful but noticable I understand the frustration in my getting answers from your surgeon and am glad i'm able to help you today. LS
Question:  #25 6/21/2009		Q:	Hi I am a 41 year old female who was just diagnosised on 6-17 with breast cancer...the growth was discovered during a annual mamo and sono ..the size is 1.3cm the biopsy report came back " invasive mammary carcinoma poorly differentiated ..in situ carcinoma not identified..no diagnostic evidence of lymphovascular invasion is seen..immunohistochemical studies of er/pr and her 2 neu pending:a seperate report of will follow...note:possibility of a medullary carcinoma should be ruled out in the excisional specimen" first what is you opinion of the biopsy report 2nd I went to see a general surgeon on 6-17 who suggested a lumpectomy and needle biopsy of the nodes...he was willing to do the lumectomy 6-26-09..however I am holding off for an appt with a breast surgeon who specializes in oncology at a center of excellence ..the earliest appt she has is 7-7..however we go away annually at that time..so all my breast cancer survior friends are telling enjoy my vacation and the see her when I return on 7-13...whats your though on waiting till 7-13 just to see the dr not even the lumpectomy..thanks
		A:	it's best to be in the hands of a breast surgical oncologist. confirming the type of breast cancer this is, is important in planning your treatment including surgery. so pathology slides need to be re-reviewed. we can get you in sooner than the dates you've been given, if you want to come to us for a second opinion with a breast surgical oncologist and also have pathology reviewed. just call 443-287-2778. you want to be in the hands of people who are familiar with mammary (mixture of lobular and ductal, for which the measurement of 1.3cm may be under-reporting its true diameter; same applies to medullary. so think about coming our way.
Question:  #26 6/22/2009		Q:	I''m a medical student. I want to know what incision should be given for excision of a painful fibroadenoma at 6''o clock and 3cm size. One of my teacher says a trasverse incision while another says radial incision along lactiferous ducts. who is correct?
		A:	at the 6:00 position you can do either a radial or curvilinear (not transverse). I like curvilinear. LS
Question:  #27 6/20/2009		Q:	I have a 2cm lump to the right of my nipple on the right breast. Had ultrasound scan, mammogram, numerous core biopsies. Before i''d had the results back of the core biop they told me I 99.9% had cancer. The lump is irregular in shape, has nodules and a tail. They have also found calcification in the other breast for which I had tests yesterdy and hope to get the results of those next week. The calcifications were there last year but seem to have changed so I am told. They phoned me yesterday as wanted to take more core biopsy as they couldn''t find cancer cells in the results of the lump and they are stil concerned. again this morning they tell me that on the ultrasound, it still presents to them as a cancer. I now have to wait until next Thursday before I see the consultant for the final results and what the next moves are. Is it possible that once they remove the lump they will find it to be cancerous? I am adamant i want this lump removed what ever the results and hope you agree with me. My mother was diagnosed with breast cancer at the age of 48 I am 41. Unfortunately my mum died. Hence out great great concern. The doctor that has taken all the samples so far wants the lump removed too. So far I have had a week of hell and one more to go before I go back to see the main consultant. I feel sure she''ll agree to remove the lump too.
		A:	getting it out makes sense. the technique and additional things that would need to be done during surgery though (wide margins and checking sentinel node) would apply for removal of a malignant tumor. if found to be benign then sentinel node for example would not need to be checked. there are special times that what appears on mammo and looks cancerous ends up being a radial scar. pursue this. if you want to come our way just call 443-287-2778. you also might want to consider genetics counseling and testing too given your family history.
Question:  #28 6/14/2009		Q:	Hello, I had an x-ray guided stereotactic biopsy yesterday. They tried to use ultrasound, but couldn''t because there is no mass, only two clusters of micro-calcifications. They used a 9-gauge core needle for vacuum assisted biopsy in two locations of my right breast. The biopsies were performed with me laying prone on a metal table with my right breast hanging through a hole and my head facing toward a wall so I couldn''t see anything. The radiologist had a resident helper and an RN Breast Specialist to take the mammogram x-rays. The room was quite cold and after the procedure started I started shivering. I told the radiologist that I was cold. Nothing was done until the shivering began to impact the biopsy. Then the nurse got a blanket. Eventually she put a second blanket on me. The whole procedure was very painful, and just barely tolerable until they began sampling tissue that was not anesthetisized at all. At that point, the pain became excrutiating and I could not hold still. The radiologist said ''Oh, I guess I missed a nerve.'' Then he ignored me, and told the resident to lavage the area and inject some anesthetic. At this point the pain was so great that I could not prevent myself from crying. I asked if I could have a tissue. They replied that there were no tissues in the room. They quickly ended the biopsy saying they had gotten enough tissue to examine (3 samples, as opposed to 12 samples from the first area biopsied). After the procedure was over and I was dressed again, the nurse went and brought me a box of tissues. I''ve read all about stereotactic biopsies but never heard of this happening. How could this happen? Does this happen very often?
		A:	that was a very unpleasant experience. use of lidocaine to numb the breast is standard of care. you were shaking due to anxiety and probably the stress and pain of the procedure. hope your results are benign.
Question:  #29 6/14/2009		Q:	My 18 year old niece found a lump about 2 months ago. She had an ultrasound done and was told to see a surgeon. She saw the surgeon yesterday (6/12/2009)and was told that she could either have a needle aspiration or wait 6 months but come back if there are any significant changes. She and her Mother have chosen to wait the 6 months (which by the way seems like a long time to me) which concerns me. I would just like to know what you think of this decision? Thank you.
		A:	this is reasonable. and it takes 6 months to be able to see if any change has happened, believe it or not. the most common finding for this age is a benign fibroadenoma.
Question:  #30 6/14/2009		Q:	I am 33 years old, personal history of melanoma, history of cancer on maternal and paternal side (breast, colon, ovarian, cervical). During my last pregnancy, I discovered a lump in my right breast. After an ultrasound and Mammotome biopsy, the lump was determined to be a Phyllodes tumor - borderline. My surgeon and OB decided to wait until the pregnancy ended to remove the tumor due to the heightened risk of bleeding and other complications. A mammogram was done two weeks after I gave birth. Three weeks after I gave birth, the tumor was removed with WLE under general anesthesia. I was told the results were benign, and that I would need yearly mammograms to watch for recurrence. This was 20 months ago. I had one follow up mammogram at six months, nothing since (due to lack of insurance). For the last 7 months, a lymph node behind my right ear has remained enlarged and hard. GP told me that enlargement of that specific lymph node is nearly always caused by a scalp infection, and figures mine is enlarged due to scalp psoriasis. For the last couple of weeks, I have felt an odd sensation in my right breast... hard to describe, just a feeling of fullness and moderate localized discomfort in the same part of the breast where the phyllodes tumor was removed. I do not feel a lump. Last time, the lump was obvious. I have no insurance, but plan to arrange some in approx 3 months. I am not sure if these symptoms require urgent attention, or if I can wait. Questions: What is the likelihood of a benign Phyllodes returning? Could the lymph node be related? Why would my initial diagnosis be of a borderline Phyllodes, but then change to benign? Which result is more likely to be inaccurate? Thanks.
		A:	the key to this type of tumor is the need to get clear WIDE margins or it will grow back. a common problem with this type of tumor. let's discuss a bigger issue though. you have a significant history-- melanoma, breast, colon, and ovarian. all of these types of cancers are genetically linked. consider asking your family members who had breast and ovarian to get genetically tested and if positive then you should as well.