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Category:

Breast Biopsy

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Question:  #571 5/17/2006		Q:	Thank you for your response to my e-mail(44yr. no family history. 1.9 cm solid mass was found on diagnostic mammogram and U/s , 1 o'clock on the left breast, closer to the skin than to the chest. No mention of calcification. Radiologist recommended U/S guided needle core biopsy without any further information. I am wondering if you consider other types of biopsies such as stereotactic biopsy and also the one with vacuum assisted device. What are the chances of false negative result on different types of biopsies? ) However, when I read it again, I realized that you mentioned false positive result, not false negative. I am wondering about false negative result. I appreciate your response. Thank you.
		A:	you need to go with what the radiologist recommends as far as the method of doing the biopsy. its what he is comfortable with and feels if the best method of doing it that will be the right way for you. i suspect it will be a ultrasound guided core biopsy. ask him what type of instrument he will be using and request he explain it further.
Question:  #572 5/17/2006		Q:	My gyn ordered a diagnostic mammogram and an US after a screening mammogram revealed a cluster of microcalcifications last month. The diagnostic mammogram report revealed very little new information other than the area was suspicious and recommended biopsy (birads 4). The US also appeared suspicicious with a small "hypoechoic area". I have seen a general surgeon and am being scheduled for a biopsy. A radiologist will assist. I am currently in Bradenton Florida but most of my summer will be spent in the Grand Rapids Michigan area. Would I be better off to seek a breast care/breast cancer center in Grand Rapids or should I get the biopsy done in Florida since my gyn, my recent mammograms, and my appointment with the general surgeon were all in Bradenton? Or should I start over in Grand Rapids BEFORE the biopsy with physicians that have more specific specialty? If so, is there a breast cancer/breast care center in Grand Rapids that you would recommend?
		A:	choosing the facility for biopsy should be based on their experience. if the radiologist specializes in breast imaging (not a general radiologist) and the breast surgeon specializes in breast disease/breast cancer then feel confident you are okay where you are.
Question:  #573 5/17/2006		Q:	I have a friend who ways diagnosed with BC back in 2001. She underwent a lumpectomy without chemo but with radiation. She was advised to take Tamox, but she did not. Now five years later, upon her most recent mamo, a cluster of calcifications and necrotic tissue was seen, in the same breast where she had BC. On Firday she will have a mamotone to further study this. What are the chances that she will have a recurrence? Thank you.
		A:	its possible. the radiologist would have made a comment as to how suspicious he is about it. if it is then sounds like it was identified early. the downside is that the breast cancer be radiated a second time so the standard of care would be mastectomy. if she wants to come our way we are happy to help her.
Question:  #574 5/17/2006		Q:	Thank you for your response to my question(5/15). (44yr. no family history. 1.9 cm solid mass was found on diagnostic mammogram and U/s , 1 o'clock on the left breast, closer to the skin than to the chest. No mention of calcification.) Would you recommend U/S guided biopsy or stereotactic biopsy for my case? Thank you
		A:	the radiologist really needs to make that call but good chance he will say ultrasound core biopsy.
Question:  #575 5/16/2006		Q:	I was diagnosed with R lobular and L and R ductile breast cancer. I had a bilateral mastecotomy.I am Her2 negative and FISH positive. Is this rare?
		A:	not as rare as you might think... this emphasizes the importance of doing the FISH test.
Question:  #576 5/16/2006		Q:	44yr. no family history. 1.9 cm solid mass was found on diagnostic mammogram and U/s , 1 o'clock on the left breast, closer to the skin than to the chest. No mention of calcification. Radiologist recommended U/S guided needle core biopsy without any further information. He spent 2-3 min with me , I was in shock and did not know what questions to ask. After calming down, definitely not happy of the level of care I received. I did some homework and your site is of tremendous help. I am wondering if you consider other types of biopsies such as stereotactic biopsy and also the one with vacuum assisted device. What are the chances of false negative result on different types of biopsies?
		A:	false positives for a diagnosis of cancer would be highly unusual and frankly would be a pathologist's error and not a sampling error by the doctor doing the biopsy. stereotactic biopsy is also a vacuum assisted procedure. sometimes these biopsies can be done in ultrasound as a core biopsy. don't know the specifics of this mass to know how concerning or not it appears to be but the radiologist can tell you. in doing the ultrasound biopsy he may use a hand held device that looks something like a gun and sounds like a loud click when the specimen is harvested.
Question:  #577 5/14/2006		Q:	I recently had a biopsy due to a finding on mammography/ultrasound. Results: Left breast tissue with extensive cystic change, macrocyts, apocrine metaplasia; duct ectasia;focal florid ductal epithelialy hyperplasia; focal atypical lobular hyperplasia (LN 2); no malignancy is seen. The ALH was seen in one duct, so no need to re-excise. Other pertinent history: 45 year old, white. Total abdominal hysterectomy at 34 yrs old (chocolate cyst). Premarin 0.625 mg daily since then (12 years on premarin). No breast cancer on maternal side. The surgeon recommends stopping the premarin and seeing an oncologist. Possibly starting tamoxifen. Otherwise, I am in good health, eat properly, exercise regulary and am at a healthy weight. Is stopping premarin advised? If so, what is the best way-gradual decrease in dosage, or "cold turkey". If premarin is stopped, is tamoxifen needed? I wonder if the premarin is the culprit of the breast lesion? Studies aren't conclusive, and 34 was too young to go through menopause! Thanks!
		A:	the medical oncologist you see should be someone who specializes in high risk women so that a proper assessment of your true risk for breast cancer can be calculated for you. having a single foci of ALH usually isn't enough to warrant taking hormonal therapy for prevention. discontinuing HRT though will be discussed with you and when a woman is advised to stop taking it a weaning process is usually fine to do rather than cold turkey. so meet with a med onc doctor first.
Question:  #578 5/11/2006		Q:	My twin sister was diagnosed with malignant phyllodes tumor. What is the normal treatment. We have two differing opinons. One states chemo and radiation since you need to treat it like cystosarcoma while the other disagrees and doesnt agree with chemo. I need clarification
		A:	not too often chemo but there are exceptions. sounds like it would be wise to request the case be presented to their weekly tumor board for team discussion.
Question:  #579 5/13/2006		Q:	Diagnosed atypical ductal hyperplasia right breast. Procedure: Right Breast Needle Localized Excisional Biopsy on 4/7/06. On 4/28/06 underwent right axillary sentinel node biopsy and wide excision right breat lumpectomy site. I will be sent to a medical onocologist for radiation and possible chemo. This is new to me - no family history of breast cancer. The Pathology summary reads: Specimen size: 72/50/24mm. Number of invasive foci: No residual invasive carcinoma. Number of insitu foci: Two. Size or extent mm: 3mm and <1mm diameter. Histologic type: uct carcinoma in-situ, solid and cribriform types. Neclear gread: Intermediate. Necrosis: None. Lymphnodes, total/positive: One right axillary sentinel lymph examined/0 positive nodes (specimenA). Receptor studies: obtqaine on prior sterotactic core biopsies (NS06-1468, 4/7/06). ER: Negative. PR: Negative. Her-2-neu: IHC: 5% tumor cells positive, intensity 1+. Margins, mm: Invasive: N/A. In situ: Clear by 1 mm. pTNM: pT2, NO, MX. What does it all mean. I would like to have an understanding before I go for my appointment with the onocologist. Does the report, in your opinion necessitate radiation and possibly chemo? Thank you so much for any help that you can give me with this. I have a family history of colon cancer attributed to familial polyposis. No family breast cancer as far as I know. Thank you again, Linda Breeding
		A:	its a little tricky to read... sounds like the margins may be close though- 1mm. which would imply if that is correct that more tissue may need to come out before radiation. radiation is always a necessity for invasive breast cancer when a lumpectomy is done. the surgeon should have explained that prior to operating on you. radiation is tolerated well and easy to do... since it is a tumor that is a stage 2, chemo will be discussed with you. ask them to show you a chart that demonstrates the survival impact chemo has in percentages to help you decide.
Question:  #580 5/11/2006		Q:	I had a core needle biopy of my right breast on April 6. Everything is fine. But half my breast turned black. The bruising has faded but now that part of my breast now seems to have undergone a pigment change. It is beige rather than white. Will my breast return to its normal color?
		A:	not sure but it eventually should.
Question:  #581 5/11/2006		Q:	Thanks for your quick response to the question on finding dcis during an excisional biopsy. You mention a re-excision, and say "it isn't hard to do." Does that apply to the doctor or the patient? And, does that mean a second excisional biopsy at a later time?
		A:	both-- it means going back in throug the same incision and trimming up the margin that has residual cancer on it. usually a 15 minute procedure.
Question:  #582 5/10/2006		Q:	If an excisional biopsy is done and dcis is found, can it all be removed at the time of the biopsy?
		A:	the doctor can't see DCIS with the naked eye, so the pathologist determines if it all was removed or not. if not, then re-excision is done which isn't hard to do.
Question:  #583 5/10/2006		Q:	I am 29-years-old. I found a large lump in my breast and had a mammogram and ultrasound. A biopsy was then recommended. I had the biopsy. The first read of my biopsy said "DCIS." The second read said "atypical cell clusters" and also indicated "hyperplasia." What is a logical action plan? Thank you.
		A:	if biopsy was a core biopsy (and not open excisional) then time to see a breast surgeon and obtain more tissue. if you want to come here call 443-287-2778. you are young to have to deal with this. either way you are now in a high risk group.
Question:  #584 5/11/2006		Q:	On Feb 9, 2006, I had a breast biopsy that turned into a partial masectomy. I was very fortunate that he said everyting was benign, but I have had a recurring problem of fluid build up in my RB. He had drained it twice in his office (2 weeks apart) and it is filling again. His explanation to me was "that the body doesn't like and empty cavity so it is filling it with fluid". The first time was grape juice colored and a spit tray full, two weeks later was 3/4 full and bloodier looking. I then acquired a fever in my RB. He put me on antibioctic and said was probably due to inflamation from needles. It is filling again. Do you have a "satisfying" explanation-suggestion. I maybe a country girl, but I am not taking what he says to the farm. There was no driain tube put in at time of surgery. Please help unconfuse me. Thank You.
		A:	if it is getting bloodier then it raises the question about a blood vessel weeping inside.... consider a second opinion.
Question:  #585 5/9/2006		Q:	Hello, I am a 50 YR OLD FEMALE, IN 1997 I had invasive infilitrating ductal carcinoma, stage 3, in 2003 I had Non Hodgkins Lymphoma, stage 2, I was just diagnosised with with High Grade- invasive infilitrating ductal carcinoma in three different tumor sites 9 ranging from 2.5 cm to 1.5 cm) all in the right breast and scheduled for a mastectomy then Chemo- my oncologist stated this is something that is unusual and they need to be aggressive- I am just not sure what to do- what is your suggestions
		A:	you didn't mention if the cancer is in the same breast or the opposite breast as before. when multicentric disease is found, as it this case, mastectomy is the recommended surgery since it isn't realistic to do multiple lumpectomies and get good cosmetic results. additionally, if the breast has been radiated before it can't be radiated again resulting in mastectomy. co0nsider getting a formal second opinion since your cancer history is unusual.
Question:  #586 5/9/2006		Q:	I had a stereotactic biopsy Feb 3 - three month later I was finally able to be seen by my Gyne after enduring pain. He felt a new lump (cyst or blood mass) and sent me to a Breast Surgeon. He felt the same thing and said he had heard of patients having nerve pain after cancer surgery. He sent me to Radiology for a sonogram. The Radiology disputed both doctors' findings regarding the lump and regarding the pain said "in all my years I have never heard of such a thing". I now wait until my six-month follow-up mammogram (to which the Breast Surgeon added a sonogram for the lump). I no longer get the "zingers" that may have been attributed to nerve damage. When the area around my nipple is pressed, the pain is severe. The whole breast still seems tender. I had a biopsy approx. the same time last year with no complications. The one this year, I felt a tug like someone clamped a pair of pliers on my nipple and yanked. (Both were benign.) I have been getting conflicting messages. How do I know if this is the proper channel to follow?
		A:	consider a formal second opinion with another breast center and having a radiologist conduct a diagnostic evaluation to determine the possible cause of this persistent pain.
Question:  #587 5/9/2006		Q:	Female Age: 21 Family History: Breast lump found in sister's breast at 13, biopsy at 24 found cancer. Also, sister has ovarian cancer also found at age 24. My biopsy was performed 5-01-06 Clinical Brief: Right Breast Mass. PATHOLOGIC DIAGNOSIS Breast tissue, right, needle core biopsy: - fibroadipose tissue identified; no breast tissue present (19-0001) GROSS Recived in formalin are two soft rods of yellow to tan tissue measuring 4 and 7 mm in lenght and averaging 0.5 mm in diameter. IT-11 XX COMMENT Sections show 2 fragments of unremarkable fibroadipose tissue. No breast tissue is identified. (AWL) ------- My surgen (a general surgen) wants to do surgury asap because of the size (2in in length and 0.25in in diameter), and schedualed a lumpectomy on the 19th. I am also pregnant, I will be almost 9 weeks along at the date of surgury. Could this be cancerous or is he just wanting "to be sure"? because I dont think that I should have surgury while pregnant if its not cancer. What do you think?
		A:	don't know without seeing you and evaluating this further. your situation is complicated. you also should consider genetic testing if your family hasn't already embarked on this. consider coming to us for evaluation. just call 443-287-2778.
Question:  #588 5/4/2006		Q:	My mother (52) had a lumpectomy done on 5/2/06. The Micro DX of the left breast - extensively necrotic poorly differentiated invasive ductal carcinoma, nottingham grade 3, 3.4 cm in greatest dimension - resection margin focally positive for carcinoma, - negative for lymphatic or vascular invasions. I am confused because the breastcancer.org does not use the term Nottingham grading and I don't know if the Nottingham Grade 3 = Breast Cancer Stage 3. Please explain or refer me to website that provides additional information for this prognosis and recommended treatments
		A:	grade and stage are 2 different things. stage is based on tumor diameter and nodal involvement. grade is a measurement of how fast the cancer cells are growing.
Question:  #589 5/4/2006		Q:	I had a breast biopsy Sept 05 followed with surgery the mass they took out was all pre-cancerous cells. It was a mixture of all kinds and shapes of cells. I had my follow up mammogram in April 06 and the mass was removed but on the report it said there have been changes since the surgery they did not specify what kind of changes. My question is this around the nipple aerola area I keep losing the color to where there is none and it looks very misshapen and I have nipple retraction and swelling. The color comes back but it is more without color then with it. I had surgery on the same breast in 94 but it was fine then but not this time. Do I need to be concerned about this? I know it is not normal
		A:	this needs to be checked out further so pursue this with your surgeon.
Question:  #590 5/4/2006		Q:	I am 29 years old and recently had an ultrasound who's results state "1.2 cm mass in the right breast at 2 o'clock in the retrareolar region. It is solid and appears to have increased vascularity but is not readily classifiable as benign or malignant" I received a needle core biopsy who's results stated "negative for malignant cells - rare benign ductal epithelial cells are present". The biopsy report also has a comment which sais "the aspirate shows scant benign ductal epithelial cells - a ductal papilloma cannot be totally excluded". I was hoping you could help explain what all of this means. It seems obvious that it is not currently cancerous but am I at risk for it to turn or is this just some abnormality? The doctor who did the biopsy said the needle penetrated the mass as if it was made of wax. I'm just confused on what is actually in my breast.
		A:	the results are benign but they are commenting that it is a small sample and may not tell all. they wonder if a benign papilloma is present. so more testing is probably needed to determine this.
Question:  #591 5/3/2006		Q:	10 months ago I had a biopsy done for Micro calc., everything went well and the results came back fine. I have a strong family history of breast cancer on both sides of my family. I have had three mammo's done since then, but just yesterday I was told that the surgeon had left a small clip in my left breast after the surgury. Is this normal procedure?
		A:	yes, normal and standard of care. this is used to mark where biopsy done so they can follow it on future mammograms.
Question:  #592 5/3/2006		Q:	You answered my 1st question as #9 on 4/27, asking what the result was. Thank you for your response. Unfortunately, I have invasive ductal cancer, less than 1 cm. I am scheduled for a total mastectomy on right side with sentinal node biopsy on 5/22. Lumpectomy was not recommmended for me because I have antiphospolipid antibody syndrome, a connective tissue (autoimmune) disease. My surgeon told me that radiation is contraindicated for my condition, and partial radical would leave little left anyway. I am not having reconstruction. If nodes are clear, he plans to send results to California for DNA testing. If risk of recurrence is unlikely, he said it's possible I won't need anything else besides hormone therapy. (No chemo) Does this sound reasonable? I am looking for a second opinion in my area, but the only doctor whom I was referred to is out of town until after my surgery date. (I will keep looking.) I am also getting BRCA testing done right before surgery, to decide about the left and the ovaries, but that will take a month to get back. I have 2 small children, and I want to be treating this very aggressively. If it's small and no nodes are involved, is it safe to do nothing else than a drug like tamoxifen?
		A:	this makes sense. seek a formal second opinion then before confiming post surgery therapy.
Question:  #593 5/4/2006		Q:	Yesterday I had a stereotactic vacuum assisted biopsy as I had micro calcifications noted on my recent mammogram of my left breast. A small cluster showed up on a 2004 mammogram, but the report read negative. I moved to a different state in 2006 and the mammogram showed the cluster. The radiologist obtained my 2004 films which showed the original cluster with change as of the 2006. Recommendations wait 6 months, which I was not comfortable with so found a radiologist who agreed that the change in the mammo. warrant a biopsy. The radiologist after starting the procedure and taking sonogram films said there was another cluster near the first one. He took a sampling of the first cluster, but not the second one. He said if the results are benign he would watch the second cluster. Due to the extreme pain I was in (the procedure is extremely painful) I just wanted to get out of there. However, I do not understand why he didn't take a sampling of the second cluster as he didn't want to wait and see for the first cluster. Now awaiting the results. Should he have taking a sampling of the other cluster or is this two different procedures?
		A:	depends on how suspicious they looked really.... wait and see what these results are.
Question:  #594 5/2/2006		Q:	My mom (71 years old), no family hx had coned compression view of left breast and bilateral breast ultrasound. The report read: The density seen in the upper outer quadrant of the left breast appears to spread apart with the application of pressure and shows no evidence of any architectural distortion or microcalcifications. There is however a rounded soft tissue density that is seen with fairly well defined borders. On ultrasound this corresponds to a well defined hypoechoic solid mass of 6x9x6mm for which there is distal shadowing. The opinion was that it does not appear to be cystic and at best appears indeterminate on ultrasound. After the surgical consult, the surgeon recommends a core bx first, and excisional bx only if needed...does this mean only needed if CA cells found? However, given the size, well-defined borders, and age of patient, wouldn't it be better to just remove the whole thing in 1 shot and therefore will have tissue for pathology? I also read that core bx have high chance of false negatives (this mass is not palpable).
		A:	open excisional only needed then if atypical cells found.
Question:  #595 5/1/2006		Q:	I have suffered severe and painful nerve damage in my breast. Now I need a sterotactic biopsy. All the women I have spoken with tell me that this procedure is very very painful. My Dr agrees and tells me the pain will "put me throught the roof". My Dr. has not answered this question - can you? Why can't I have twilight sleep or more than local anesthesia during sterotactic biopsy?
		A:	several reasons--- 1) you are positioned prone (laying on your chest) for this procedure and therefore it is difficult to monitor your airway. 2) there is no anesthesiologist available in a breast imaging setting to monitoring your continuously for such a procedure that would be required 3) the doctor doing the procedure will use local anesthetic which should effectively numb your breast to make the procedure very well tolerated. the only other option is a wire localization open surgical biopsy where you would be put to sleep in the operating room but prior to that, a wire has to be inserted to mark where the surgeon is to go and that needs to be done with you standing or sitting and compressed in mammography.
Question:  #596 5/1/2006		Q:	had ultrasound core needle biopsy, 03/15/06 dx with ilc in left breast, mri confirmed not in right breast. will have bilateral mast may 9th. before biop, did not have pain or any disconfort in either breast. for the last few weeks been having some disconfort in both breast. could this be a result of the biopsy. you have said that cutting into tumor (biop) would not cause tumor status to change and would not cause it to spread etc. why do you think then that i am having this disconfort now? thanks
		A:	breast cancer and breast pain rarely ever are related. that said, your body is still healing from the biopsies... and the nerves in the breast are aware that some trauma has happened there. not unusual to have random pain now. good luck next week with surgery.
Question:  #597 4/27/2006		Q:	How many needle localization breast biopsies are performed in this country per year? Thanks
		A:	gee, don't know.
Question:  #598 4/27/2006		Q:	I am 53, with a history of ADH, and have a question about biopsy results. Five years ago, a biopsy of my left breast found an intraductal papilloma with focal atypical epithelial hyperplasia; the tissue was removed. Now, a new biopsy of the same breast has found florid ductal hyperplasia with "microcalcifications in association with benign breast ducts." The radiologist noted "extensive amount of elastosis and fibrosis with entrapped benign ducts; the lesion may be part of radial scar." The good news is the benign finding. But I am high risk (ADH, early menses, late menopause, no children), and am concerned that the hyperplasia is in the same breast as the ADH. I can choose between an excisional biopsy and close monitoring and would welcome your perspective.
		A:	if you are a worrier then you'll do the open excisional... not unusual for the ADH to be in the same breast with these findings.
Question:  #599 4/26/2006		Q:	This is diagnosis and pathology: Age 57, lumpectomy of invasive carcinoma 1.8 cm, high grade: Grade III, comedo present, Extensive intraductal component absent. Microcalcifications: not applicable. Margins, 1 mm lateral and 1.75 mm superolateral and 2 mm superomedial. 2 sentinel Lymph nodes: negative, but 1 has one isolated trace cell (ITC)significance uncertain. Hormones: Estrogen positive, progesterone negative, Proliferative Index greater than 20%; Her2neu: 1+ with focal 2+, No evidence of HER-2 gene amplication. her2neu signals to chromosome 1.14 to 1. I have scheduled 4 rounds of ac chemo, followed by radiation, 33 treatments and 5 years of hormone treatment, I think Aromatase? Questions: Does this protocol seem reasonable? Why is it not suggested I do the docetaxel as well as ac? Why not Herceptin? What does it mean that microcalification is n/a? And although the lymph nodes are negative is it not possible it has traveled elsewhere from other fluids in the breast? Thank you so much
		A:	not a candidate for herceptin because her2neu was negative (1+ is negative). there are many regimens for chemo. not one specific one that is "the" one. ask though miore about your margins... some seem "close."
Question:  #600 4/27/2006		Q:	I am scheduled for a stereotactic biopsy on April 27th. after a digital mamography 6 months earlier revealed concern on some calcifications. They grew, from what I'm told,from 1 to 4 calcifications at about 2 cm total. They are also in a little line, what does that mean?? Is that very rapid growth significant? I had a previous biopsy and surgery in 1999 with regard to suspicious calcifications but it was not a sterotactic biopsy. I am extremely nervous about this procedure; one because you are awake and conscious of the process and 2, becuase of the chances of hematomas that I keep reading about. Also, my biggest question is if they are not removed and remain after the biopsy, are they always benign? Or can they change? If so, then why not just take them out surgically to begin with and not have to worry about two procedures. DOes this practice vary from hospital group to group? Or is the steriotactic biopsy the stardard procedure all the time first before they go in and remove them? THank you so much for your helpful advice.
		A:	stereotactic biopsy would be the standard of care for this. seeing an increase in the numbers and that they are in a linear line increases the probability that they may be an EARLY stage of breast cancer. follow through on this.