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Question:
#2251
01/01/2003
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After 18 months of testing for enlarged lymph nodes, including two biopsies of right inguinal and right axilla lymph nodes, I had a stereo tactic biopsy after a mammogram and ultrasound revealed scattered and clustered micro calcifications the report reads: adenosis, rare ductal microcalcification
hyaline fibrosis and focal ductal hyperplasia What does all this mean? |
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well, it means that you have some abnormal cells growing in the breast but doesn't necessarily mean cancer. A needle localization biopsy by a surgeon will probably be the next step to remove a larger area of breast tissue for a definitive diagnosis. |
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Question:
#2252
01/01/2003
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Are mammotone biopsies usually/always performed by radiologists? Is there any reason to be concerned that it is not a surgeon who will be performing my procedure?? |
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The majority of the time it is a radiologist who specializes in breast imaging who does a mammotome biopsy. There are a few surgeons doing them but they are in the minority.Remember, surgeons are trained to cut-- mammotome doesn't require an incision! |
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Question:
#2253
01/01/2003
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I had a wire loc, excisional biopsy done in late Sept.for microcalcs. Findings were focal ductal hyperplasia. Not much bruising or pain, some thick scar tissue which has since diminished. However, for the past two-three weeks I've been having pain, similar to the post-op pain. All over my breast. Is it normal for the pain to last this long? I can't get in to see the dr until late Jan.
Thanks for your help! |
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it is not unusual for women to complain of breast pain for several months after biopsy is done. there are lots of nerve endings in the breast, one of the reasons it is a sex organ, and some of those nerves were disrupted when the biopsy was done. give it time... glad you got good results too. |
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Question:
#2254
12/30/2002
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I am a 42year old woman who is post-menopausal, have gained 25lbs in one year, no children, no HRT, both parents died when I was 17 so no family hx available, prev L breast biopsy 1995 (benign)who is undergoing changes in my breasts. My breast are now less dense and through lots of testing (mammogram, ultrasound, cyst aspiration and upcoming mammotone) two masses have been found. They were not visible on earlier mamms as a mass due to breast density. One is irregular in shape therefore the mammotone. The other smaller mass will be followed with another mamm in 6 months. I wasn't too worried but now wonder if an excisional biopsy rather than a mammotone would be better so that it would all be taken out. Please advise. |
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mammotome is fine as long as done by an experienced doctor familiar with this technology. This will provide you a definitive diagnosis without a surgical excision that merely creates more scar tissue. So the plan sounds reasonable. |
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Question:
#2255
12/27/2002
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my questions is simple. I am one year post treatment for breast cancer. My recent ultrasound report states a heterogeneous hypoechoic lobular focus. I am going for a fine needle aspiration but have to wait 2 weeks for an appointment. What does the ultrasound term heterogeneous hypoechoic lobular focus mean? |
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it has to do with its appearance and location--- difficult to see light passing through it, implying that it is probably a solid object. Keep in mind that most masses are benign so don't sweat over it yet if you can help it. Keep yourself busy so that the 2 weeks pass fast for you and then take it from there.. |
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Question:
#2256
12/23/2002
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Now I am really confused. After the first of the year I'm having a biopsy on some microcalifications found in my right breast. The surgeon will remove the tissue and told me this will prevent them from showing up in future mamograms. Now I read scar tissue may form making future readings unclear.
So, would the stereotactic biopsy be the best route? I've read these are usually malignant and a first marker for cancer so I thought a biopsy that would remove all the tissue would be best.
Like I said - Now I'm really confused! |
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stereotactic biopsies using MIBB or mammatrome devices result in virtually no or little scarring inside the breast. open excisional biopsies do cause a lot of scarring and can make suture mammograms a little trickier to read. so if you can, go for the less invasive method. |
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Question:
#2257
12/23/2002
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I'm scheduled for a needle localization biopsy in Jan due to calcifications found on a routine mammogram. The surgeon told me that the area is only 2 mm, and that there is an 80% chance that it is benign. She said if it is maligant it would be "The smallest one I've ever seen." Also, the radiologist said this to me "Worst case? - It's out. It's gone, and you don't have to worry about it." Does this sound right? Is it possible to just have the cancer removed and not have any treatment?
Thank you |
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well, no. not really. Clear margins need to be ensured whenever cancer is removed. this can only be achieved with a lumpectomy--- it would be a tiny lumpectomy but nontheless a margin of healthy tissue must be removed around the cancer to ensure there is none remaining. There is a clinical trial enabling women with tiny cancers of 2mms to forgo radiation therapy, but this should only be done as part of a clinical trial. hope that helps. (and hope your results are benign and you don't have to worry about it.) |
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Question:
#2258
12/23/2002
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I have DCIS,comedo, grade 3 in one spot and DCIS without deion in another spot of the same breast- I have additional calcification in other spots of the same breast. The surgeon recommend mastectomy
Did I understand that after the stereotactic biopsy that all the cancer may be gone and the only way to know this to to remove my breast? That seems a little extreme!
My Breast surgeon and Plastic surgeron prefer the TRAM over any other reconstruct. HOw do I get more info on the DIEP
Can taking large amounts of micronutrients reverse DCIS
Also I took a test called AMAS which measures the antbodies in a person blood. It is suppose to be 95% reliable in detecting cancer even before the test for antigens. My levels have dropped from 127 pt to 43 pt over 5 weeks after two biopsies and addded immune nutrients to my system. Any comments? |
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It is virtually impossible to remove all cancer cells with stereotactic biopsy. and since your breast is growing DCIS in multiple spots it would not be uncommon to find it in other areas too once the entire breast is removed. TRAM takes your muscle and is considered to be the "old flap method" these days. More common and preferred is at least the "free flap" that takes only a post stamp size of muscle. DIEP flap is the most sophisicated method and takes no muscle at all, which is ideal. There are only a handful of places in the country doing DIEP flap, Hopkins being one of the leaders for it. If interested in exploring this option with us call 410-955-8964 and ask for an appointment with Dr. Nahabedian (plastic surgeon who specializes in this) and one of our surgical oncologists who specializes in breast cancer. You have time to make these informed decisions since you are dealing with noninvasive disease so take advantage of it. If you want to talk with someone who has had DIEP flap recon done send me an email at: shockli@jhmi.edu |
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Question:
#2259
12/19/2002
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I had a mammogram that showed a suspicious lesion. I had a "gun" 14 gage biopsy done that showed "fibrocycstic change" They have now repeated the same area biopsy with a mammatone. Why would that be? |
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not sure... they may have been concerned that they weren't dead center in the area of the lesion in question and therefore wanted to use a device with a bit more accuracy. that would be my guess. |
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Question:
#2260
12/18/2002
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my mother was diagnosed with breast cancer at 61 yrs of age. she had a mastectomy performed not followed by radiation or chemo...3.5 years later (just few days back) she is diagnosed with a local recurrence on the same side where she had the mastectmoy performed 3.5 yrs back. the margins are not clear. Should she need to get extensive surgery done before we can think about local radiation & chemo. or can radiation can eliminate the need for further surgery. Plz reply asap...we are extremely worried & in need of advice.Also how soon should radiotherapy & chemo start after the biopsy/surgery. |
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it is impossible to say without a formal consultation of your mom, which involves review of all of her records and a clinical examination as well. Sometimes radiation is first; sometimes surgery is; it is dependent on many factors... If surgery is done first, then, depending on scans, she may need chemo if the disease has spread. this would begin 4 weeks postop. If she doesn't need chemo, then radiation may start also about a month later. We hope that her degree of local recurrence is minimal so that she will only need minimal treatment to be well again. |
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Question:
#2261
12/18/2002
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Magnification has revealed that I've got two clusters of calcification located in the inner quadrant, near the chest wall. I'm scheduled for an open surgical biopsy and need guidance on which kind of anesthesia to choose: local with sedation or general. |
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local with sedation would be the more common type to use. sometimes referred to as "conscious sedation" or "green mask". |
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Question:
#2262
12/04/2002
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I had a mammogram and sonogram of my left breast. The mammo reveals calcifications. A second mammo was done - my calcifications did not form into layers and they did not form the classic teacup shape. A stereotactic biopsy was suggested, which I will have done next week. My sono showed some cysts in the area targeted. Do you think that my calcificons will prove to be malignant because they don't form the classic shape.I have calcifications in both breasts, but slightly more in the left breaast. I don't have a copy of my current report, but a report from 1999 reads, "There are clustered and nonclustered microcalcifications scattered throughout the left breast which are benign in appearance on magnification views and grossly unchanged and mostly benign fibrocystic in orgin. SOme benign appearing coarse calcifications are also in the right breast. I have gone for yearly mammograms, I just don't have copies of the reports in front of me. I was told that the doctor has a low level of concern, but as I begin to educate mysef I am beginning to have a high level of concern. Any clarification will be appreciated. Thank you |
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the odds are probably in your favor but there are cases of psherical calcs coming back malignant, so pursuing biopsy sounds like a smart move. we will hope for benign findings for you... |
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Question:
#2263
12/03/2002
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I just had an incisional breast biopsy done. The doctor said they found some kind of a fibrocystic (not sure, nodule or spot something like that) and calcifications, but no pre cancer or cancer. One other thing that was said I did not understand. She said that I had enlarged cells. When I asked her for further information she said I had typical hyperplasia as opposed to atypical hyperplasia. She said that although the cells were enlarged they were all shaped the same or something like that. I have not been able to find anything about this. Did I hear the doctor right and if so is does this increase my risk of breast cancer?
Thank you
Millie |
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either a patient has atypical ductal hyperplasia or ductal hyperplasia... it is never reported as "typical hyperplasia" but sounds like she is implying that it was NOT the atypical kind which is good news... so rest easy. This doesn't increase risk of BC-- the atypical kind can however in some circumstances. |
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Question:
#2264
12/01/2002
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I had a stereotactic biopsy on both breasts due to calcifications. My left breast healed up nicely but my right breast was very bruised and bled a lot after the biospy. It feels hard in the bruised area and around the place they went in with the wire. Is that normal or should I go back for a recheck? The biospies were benign. Please answer soon I'm getting concerned about this. |
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rest easy. It is not uncommong to have bruising and thickness where such a biopsy was done and can take several weeks, even more than a month, before it resolves. glad to hear there were benign... something to celebrate during this holiday season. |
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Question:
#2265
11/30/2002
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I had a stereotactic breast biopsy done november 25th 2002 on my right breast and two micro chips have been left in. I had this done due to microcalcifications, thank God no malignancy was found. Now I am terrified of having the clips since I found out they are made of titanium and are radiopaque, I feel I will get the cancer from this radiation source even if minute. Why are women not told what these clips are made of and that they
also contain alluminide alloys that have been linked to Alzheimers disease. Thank you.
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these clips are considered perfectly safe so don't fret. They are used to mark the spot where the abnormality was seen because on future mammograms, without such a marking, it may be impossible to see where the biopsy was done, thus missing important information about your breast anatomy and its structures when reading future films. These clips will not give you cancer. don't worry... |
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Question:
#2266
11/28/2002
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I am 44-years-old and have had 2 surgical excisions of lumps in my right breast. One had a fibroadenoma and one had a papilloma. I had a recent mammogram that showed new microcalcifications of the same breast close to the chest wall. I underwent a stereotactic bx and the results were atypical ductal hyperplasia. The nurse from the facility called me and said the results were benign, and to follow up in one year. I am really worried as the biopsy took 4 hours as it was extremely difficult for them to get the "cluster" in position on the machine. I do not have a clue what to do and any input appreciated. |
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if ADH was found on a stereotactic biopsy then the next step is an open surgical biopsy performed as a needle localization procedure to ensure that you only have ADH and nothing else in that area of the breast. So if this is the case, see a surgical oncologist who specializes in breast cancer to pursue a more definitive biopsy of the area. you are probably fine but need to be sure... |
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Question:
#2267
11/28/2002
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I am a 45 year old female with no history of breast cancer in the family, I noticed a lump in my left breast about the size of quarter but elongated. I went to the dr, he said he didn't feel much and said it was fibrocystic breast disease, but referred me to a surgeon as a precaution. I had the mammogram and ultrasound, both showing nothing. Now the surgeon wants to do an open surgical biopsy on December 13. I was wondering why this biopsy was his first choice, his comment was so we could remove the mass and not worry about it. Wouldn't a core biopsy or vacume biopsy be just as effective in checking for breast cancer with out having invasive surgery? Why does the lump have to be removed if it is not bothing me, and if it is nothing but a breast mass? |
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you are right that it would be smart to get a core sample of it and know what you are dealing with rather than rooting around in there surgically- so see another breast specialist to get a second opinion. A breast MRI might be helpful too since it can be felt but not seen on traditional breast imaging tests. |
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Question:
#2268
11/26/2002
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My sister recently had a biopsy because her mammogram showed numerous microcalcifications throughout her right breast. The biopsy showed cancer and now she is being scheduled for a mastectomy. Are there any other treatment options besides surgery? |
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if the disease is extensive for DCIS, then mastectomy is usually recommended, otherwise it is very hard to get clear margins and still have a good cosmetic outcome. Reconstruction though is usually done at the same time and should be discussed. Skin sparing mastectomy with flap reconstruction is the most popular and provides a nice cosmetic outcome if done by experienced surgeons. |
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Question:
#2269
11/24/2002
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What is the failure rate -- false negatives -- associated with fine needle aspiration? Thanks. |
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it directly depends on the skill and experience of the doctor doing the procedure. It is always wisest to be having this done by a radiologist who specializes in breast imaging or a surgeon who specializes in breast cancer. If the spot in question is very tiny, stereotactic biopsy is a better bet then blindly doing an FNA. |
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Question:
#2270
11/24/2002
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My mother is 67 years old and in good health. Just found out her grandmother died late in life of breast cancer. Mom had a mammogram,went in 10 days later for additional views and was told she had a cluster of microcalcifications within the mid to posterior third of the breast at approximately 12 o'clock. She was told by the radiologist at that time that there was an 80% chance this was cancer after which she doesn't remember hearing much of anything else except recommending a stereotactically done biopsy. Her regular doctor then called her on the phone and said he understood she probably had cancer and had to have a biopsy right away. Other people told her and from books she read, that if ts cancer it is a very slow growing cancer and she should wait 6 months and have another mammogram to see if it has changed and if so then consider having the biopsy. Also read that biopsy sometimes spreads cancer to rest of breasts etc... We are all very concerned about her and don't feel she has been given the proper amount of information to make a decision on. Please comment on this for us. We've all been trying to do research and learn more but having a hard time understanding and don't feel she should wait. Also don't understand on radiologist report "On true lateral view, findings suggesting a small associated mass are noted, although this is less conspicuous on the cranlocaudal view." No one explained anything except recommending a biopsy -- class 4, suspision for malignancy. Please help us understand these findings, we are all very afraid and worried. Isn't it vital to get something going right away? P.S. Your web site is fabulous. Thank you so much for it. |
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What you have described is pretty classic for a probable diagnosis of early stage breast cancer-- but that doesn't mean we know its growth rate. She should pursue stereotactic biopsy now and based on the results, proceed with treatment. Biopsies do not cause the disease to spread so take that off your worry list. Her mammogram has served her well in identifying a probable cancer even before it would be felt as a mass. Once her biopsy results are known you might want to visit our website's pathology section to learn more about the type of breast cancer it is. remember tha more than 80% of women are good candidates for breast conservation today which is good news and hopefully she will fall into the 80%. She is surely the poster child for mammography-- early detection is the key to longevity. |
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Question:
#2271
11/20/2002
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I read that women who go to breast specialists for surgery obtain better results. What type of surgeon would be qualified to perform a needle localized biopsy for residual microcalcifications for LCIS? My pathologist recommends a good breast surgeon. I am on a very restrictive health insurance plan and there are only three surgeons in our town who perform breast surgery. All three of them are board certified but only in general surgery. However the one I am seeing does most of the breast surgeries here. Is there such a thing as a breast cancer surgeon and what would their credentials be? I read in an article from cancerlifecenter.com/rethinking.htm that there is a new minimalist approach to lumpectomies which involves where the cut is placed as well as removing less fatty tissue and rearranging the remaining breast tissue to fill in the void. When I asked my doctor about this, I was told that he just removes the tissue and the void fills in automatically. Is this true? Are there wide differences in the way a needle localization is performed? I also read in Susan Love's book that some doctors take out a wedge shaped core tissue and others go down to the problem area and remove only the tissue around the calcifications so as to conserve tissue. How do I find a good doctor? Am I making too much out of this. I have heard stories that scared me of women being deformed after a lumpectomy. Is there anyway of knowing what to get an idea of what the end results should look like. I was thinking of asking to see pictures of past surgeries. But didn't know if that was an okay thing to ask. My pathologist is saying not to have wide excision and the surgeon says that is the only way he treats even LCIS, because he does not want to go back in again. Should I find someone else? |
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You want to be in the hands of doctors who are part of a comprehensive breast center that is part of a hospital that carries NCI designation as a cancer center. You want a surgical oncologist who specializes in breast cancer and a radiologist who specializes in breast imaging. The procedure for the needle insertion would be done by the radiologist and the surgical oncologist who be performing the actual operation immediately after the wire is placed to mark the calcifications. Yes, the breast does fill in where tissue is removed, assuming that not a marge area of tissue is taken out. It does so rather quickly too-- just a few months. this is why they place a clip where they removed the calc since it won't be visible on future mammos once the breast fills it in with more breast fat. There is a document on our website call :Breast Cancer-- making the right choices for you. Check it out as well. |
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Question:
#2272
11/18/2002
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I have been given an uncertain diagnosis of possible breast cancer. However, I want a second opinion from the best. Could you please give me the name of your top radiologist? Also, will this radiologist do a actual exam? The last person I went to was not very informative, and I need help and answers before something goes undetected. Thanks for your help |
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Give Lillie Shockney a call tomorrow morning at 410-614-2853 and she will assist you. Sounds like you work here and she can probably help arrange things for you while here at work |
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Question:
#2273
11/18/2002
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I am having a biopsy for calcifications in the right breast. What will the recovery from the biospy be like? |
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if it is done as a stereotactic biopsy then the recovery is an afternoon. If it is done as a needle localization open excisional biopsy then usually 2 days. |
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Question:
#2274
11/17/2002
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I live in Israel and in my first mammogram at age 40, irregularly shaped microcalcifications were found in my left breast, along with spherically shaped microcalcifications. The doctor recommends stereotactic biopsy of the irregularly shaped microcalcifications. She claims that mammatone stereotactic biopsy is more accurate than "plain" sterotactic biospy. Only the latter is covered by my health insurance plan. In the literature I've read thus far on this site, I have not seen a differentation between "mammatone" and "plain" steretactic biospies. What information can you give me regarding the differences? Also, in the U.S. today, does "plain" no longer exist because mammatone is just so much more accurate and prevalent? Thank you. |
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hhhmmm. I'm not sure what your doctor means by "plain"?? the instruments most commonly used for stereotactic biopsy are mammotome (by Johnson & Johnson) or MIBB (by Us Surgical). Maybe he is referring to a core biopsy that is done without any guidance from technology. Using technology that help pin point the exact spot where the calcs are is to your advantage. |
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Question:
#2275
11/18/2002
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Are there published recommendations for the management of atypical lobular hyperplasia found on mammotome core biopsy? Should ALH be routinely re-excised or is this an area of unresolved controversy? What is standard of practice at your institution in these cases? Thanks. |
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The standard of care as followed by surgical oncologists who specialize in breast cancer is to perform an open excisional biopsy for ADH,or LCIS , usually done with needle localization. ALH is a bit harder--- some will re-excise and others will leave it be. |
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Question:
#2276
11/17/2002
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I am 34 years old and was recently diagnosed with atypical ductal hyperplasia by way of excisional biopsy. The mass was near my axilla so some lymph nodes were noted in the path specimen and noted to be mildly reactive. (no malignancy is identified)
What are your recommendations for further treatment options? I have no family history of cancer of any kind.
Age of menarche 13
Age at delivery of first child 33
Would I be putting myself at greater risk by considering another pregnancy?
Thank you for your input |
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ADH is a risk factor for possibly developing breast cancer in the future but not a big risk factor that warrants a great deal of attention or concern. you should talk with your doctor about additional pregnancies but based on literature to my knowledge there is nothing to contradict having more children as there is no evidence it increases your risk. Be followed by a breast specialist annually so that you can feel confident you are getting a good clinical breast exam and proper mammography annually. Since excisional biopsy has already been done there is no other treatment per se that is warranted for ADH, just merely to rule out by doing an excisional biopsy that there is nothing else there. good luck to you. |
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Question:
#2277
11/17/2002
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The frozen section performed during my lumpectomy produced a false positive so the surgeon performed a partial mastectomy, including removal of the nipple and two lymph nodes unnecessarily. How often does this happen and how could it be avoided? Who is culpable, the pathologist or the surgeon? |
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It is not considered advisable to do a frozen section on breast tissue since it is primarily made up of fat and fat freezes poorly resulting in false positives and false negatives. Actually, for the most part, frozen sections for breast haven't been done since the 1970s at most institutions due to this problem. Sorry to hear you have experienced this unfortunate situation. no doubt the doctor was hoping to give you a rapid answer the day of biopsy but there are pitfalls with this method. Talk with your surgeon about your distress about this outcome. You will know after talking with him what you want to do from there. (lymph node frozen sections by the way are being done and work fairly well today. Just breast tissue frozen sections is the issue.) |
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Question:
#2278
11/10/2002
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I recently had an excisional biopsy because of a cluster of microcalcifications seen on my mammogram. I was resistant to having this because the radiologist told me that only one out of every ten biopsies was malignant. However, the surgeon pointed out that my microcalcifications were near the chest wall, and "they don't like to see that." I just received a copy of my mammogram results, and one of them mentions "a few microcalcifications... deep along the chest wall." This referred to the breast that was NOT biopsied, and nobody seemed concerned with this one. My question is, based on my surgeon's comments about microcalcifications near the chest wall not being a good thing, I'm wondering why nobody even mentioned that I had some there in my other breast. Is it because they were not clusters of microcalcifications that they did not cause concern? Also, you mentioned in a previous answer that a mammogram should be done after an excisional biopsy to make sure the microcalcifications were removed, but this was not recommended to me. Is this normal procedure? Thank you! |
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keep in mind there are 2 types of micrcocalcifications-- those that are worrisome and those that aren't. The ones in the other side you should ask about but it sounds like they didn't look suspicious for being a potential problem. they still should have mentioned to you that they exist though so you wouldn't worry when you got the report. Yes, it is standard to re-mammogram the breast post biopsy for calcifications. they also xray the tissue removed to ensure that the calcifications they are targeting are the ones they took out. |
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Question:
#2279
11/10/2002
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I am 27 and mother of 3, no family history of breast cancer. During pregnancy I noticed a lump on my breast. After ultrasound and the delivery of my baby, my surgeon has recommended an excisional biopsy. I am breastfeeding and would like to know if I am at risk of complications or infections. Also, what are the chances that this is breast cancer? |
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having an open excisional biopsy during breast feeding can produce a series of unpleasant outcomes because the ducts are still actively producing milk. a common problem is the development of a fistula that takes a long time to heal. talk with the doctor about how likely the mass is to be cancer and whether you should stop breast feeding in preparation for this procedure to be done to reduce the risk of infection and fistula. Your age is clearly not in a zone that we usually see breast cancer, but there certainly are women in their 20's nonetheless diagnosed. Explore this more. |
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Question:
#2280
11/06/2002
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i recently had a breast cyst aspiration and the path report read: poorly preserved papillary group of ductal cells, ductal atypia, i am unsure what this means, please advise. i have fibrocystic breast also and have for years. |
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there was presence of some abnormal cells but nothing terribly alarming. ductal atypia should be followed up on by a breast specialist to help you determine if you are at increased risk of breast cancer or not for the future. cyst fluid is usually greenish brown in color and commonly not sent for pathology review unless the doctor suspects something so ask the radiologist who did the procedure if he/she found the fluid to be a different color or not as well so that information can be provided when you are evaluated. rest easy. glad you just had a cyst! |
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