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Category:

Breast Biopsy

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Question:  #2281 11/01/2002		Q:	If a mass is found in the breast, what are the possiblities of what it is?
		A:	it depends on many factors-- what exactly it feels like, location, size, texture, other breast abnormality symptoms, etc. Statistics report though that 80% of the time a lump in the breast will be benign.
Question:  #2282 11/01/2002		Q:	My wife had one of her breasts aspirated to check on a mass and the doctor scheduled her for surgery to remove the mass because they asperated dark blood from the mass. He told her he was concerned because it was dark blood, What are we talking about here.
		A:	it could be one of many things but the concern is that it might be breast cancer. the pathologist will review the fluid under a microscope and determine if cancer cells or precancer cells are present. if so, the a more formal biopsy with removal of actual tissue would be the next step.
Question:  #2283 11/01/2002		Q:	After a breast biopsy, my mother was cleared of cancer and then 2 months later they came back and said she has lCIS and want her to have the breast removed. The right breast was removed 4 years ago and we need to know what she should do. She is 67 years old and weighs about 195 lbs. Her physician located in Vero Beach is not aware of any medicine she could try instead of the surgery. Please let us know what you think. Thank You
		A:	LCIS is a marker for predicting breast cancer risk but infact is not cancer in and of itself. It is unusual to do mastectomy surgery based on just LCIS alone. she should be seen by a medical oncologist who specializes in women who are high risk for breast cancer. this individual can help determine what degree of risk she has of this breast developing cancer in the future as well as recommend some ways to help reduce her risk. Tamoxifen (hormonal therapy for breast cancer prevention) might be a possibility depending on her hormone receptor status from her previous mastectomy surgery and some other medical factors.
Question:  #2284 10/29/2002		Q:	My breast biopsy has actually turned into a lumpectomy since the tumor has been found to be malignant, and I am pondering the next treatment step while I wait for the final pathology report and consultation with my doctors. At the time of the biopsy my surgeon did not remove any lymph nodes. We are considering radiation after a sentinel node biopsy and I am wondering how often this procedure results in false negative reports. I had all of my lymph nodes removed on the left side with my mastectomy last year, and none were positive for cancer. Also, I am wondering if the aggressive nature of my tumors last year would have any effect on the recurrence in the remaining breast if I don't opt for a mastecomy this time.
		A:	This is a new primary on the other breast which occurs to 15% of women diagnosed with breast cancer at some point in their lifetime. If the cancer had recurred in your chest wall of the mastectomy side then folks would say it is related to the aggressiveness of your cancer you had-- this is a new primary though. so your next step is to ensure clear margins, get back full pathology results and do sentinel node biopsy which is accurate the majority of the time even after the tumor has been removed.
Question:  #2285 10/29/2002		Q:	hello, i just received my pathology report for a core biopsy of a tumor in my breast. i am 36 with a high risk for breast cancer. can you tell me in detail what "all" of this means: "sclerosing adenosis with focal infarction, papillary duct hyperplasia and inflammation". this biopsy was seen by three pathologists ending up with dr. rosen at cornell. the findings above are his. he also states a excisional biopsy should be performed to assess the lesional area and that the presence of infarction in unusual in this setting. is infarction necrosis? why is it unusual here? does it mean it could be cancer? how do i get another opinion? everyone has said they have not seen this before. can a core biopsy tell you if cancer cells are present? can this be benign? i am very anxious. i will be getting surgery in two weeks. is it risky to wait this long to get a diagnosis? thank you
		A:	hhhmm. feedback regarding this level of detail really warrants a formal consultation vs an email response as far as translating your report.Don't assume cancer is the outcome.it should be fine to wait 2 weeks though even if the final outcome where to be a diagnosis of cancer. try not to lose sleep over it between now and then
Question:  #2286 10/27/2002		Q:	Recent mammogram..."Within asymmetric density in the upper outer juxtacutaneous region, there are multiple microcalifications of variable form. No acoustically dominate findings. No cystic or solid lesions. No focal shielding. Recommend excisional biopsy. 4-Suspicious" What does this really mean? What are the % rates it's benign or malignant?
		A:	Category of 4 is fairly suspicious for cancer--- microcalifications of the type you've described are oftentimes an early stage breast cancer-- DCIS-- ductal carcinoma insitu-- noninvasive breast cancer. I biopsy would be a good thing to do. Category 4 would imply probably a 70% level of suspicion.
Question:  #2287 10/27/2002		Q:	I was told that because my LCIS was discovered through the finding of microcalcifications on a routine mammogram and because some of these microcalifications were not removed with the core biopsy but left as a marker for the surgeon, that I needed a re-excision to remove them and to check for invasion. Should the microcalcifications all been removed and a clip inserted rather than leaving behind a small area of microcalcification as a marker? Was this an error on the part of radiology? Also there seems to be some discrepancy as to how much tissue needs to be removed in the re-excision. The surgeon is saying "wide margins" and the pathologist (one of the best there is) is recommending that I do need wide excision---he stressed this repeatedly---but said only remove the remaining microcalcification which is very small. I don't want any more tissue removed than necessary.
		A:	What has been done is standard of care-- and the next step would be to do a needle localization biopsy to remove more tissue and ensure that all the abnormal cells are gone. this can't be done in radiology as it just isn't the calcs but the tissue around them too that probably contains LCIS. and yes, they need to check to make sure it is only LCIS and nothing more. Wide excision can be merely a few millimeters so don't worry about a great deal of tissue being removed but do ask the surgeon what cosmetic outcome to expect so that you know what you will look like post op.
Question:  #2288 10/27/2002		Q:	What is the best way to treat the swelling after the biopsy and for how long?
		A:	ice, rest for 24 hours, and anti-inflammatory over the counter drugs.
Question:  #2289 10/27/2002		Q:	I had an excisional biopsy done yesterday and the surgeon said that his gut feeling was that it will be benign (as was the core biopsy done 6 months ago for non palpable lump) My core biopsy stated almost all of the samples were fibrofatty tissue and that "a rare ductal structure was noted" What does that mean? at my 6 month follow of the core biopsy the surgeon and myself felt a lump and he suggested the excisional as a precaution. Could the core have missed anything?
		A:	that term simply means that part of the biopsy sample included the wall of one of your milk ducts. The doctors will do a follow up mammogram in a couple of months to see what shows then and to ensure that what was felt and seen before is now gone. good for you that it was benign-- something to celebrate!
Question:  #2290 10/26/2002		Q:	Two weeks ago, I had a core needle biopsy of 6 mm nodule that appeared on a sonogram. The results showed a fibroadenoma and a small sclerosing papilloma, at the same site. The doctor who performed the biopsy (at the radiology center) called and told me everything was benign and just continue with the six month follow-ups. However, my breast specialist said he wants to do an excisional biopsy because of the papilloma. The first doc said that sclerosing papillomas don't become malignant and does not think that this procedure is necessary. What should I do?
		A:	the standard of care would be to have it removed.
Question:  #2291 10/26/2002		Q:	I had a stereotactic breast biopsy done a little over a year ago. It was benign. Microclips were left in to mark the area. I now have an asbcess form in the area of the biopsy. I have been on anitbiotics for almost a week and am still painful, but it is getting better. Can the markers cause this type of reaction? If so, how can they be removed? Thanks
		A:	it would be highly unusual for this infection to be related to the clips since they were placed a year ago-- if they had been placed 2 weeks go then the wound might have become contaminated in some way. That doesn't sound like your situation though
Question:  #2292 10/26/2002		Q:	i just read a posting/answer that stated that small clusters of microcalcifications are rarely benign. i thought that only about 20% were malignant. curious b/c i had a stereotactic core biopsy earlier this week and am still waiting for the results. i've been comforting myself by thinking that the large majority of these type of lesions were benign. is this a false sense of security? also, why does it take so long to get results? i had my biopsy tuesday morning and it's now friday morning; still no results. VERY STRESSFULL AND FRUSTRATING! thank you.
		A:	20% of biopsies of the breast, in general, unrelated to their deion on a mammogram, are malignant; 80% benign. Clustered calcifications though are oftentimes a sign of an early stage breast cancer. If the individual calcifications when enlarged are irregular in shape rather than spherical then this points more so to possibly being an early stage breast cancer. remember that if it is cancer, it has been caught early.
Question:  #2293 10/26/2002		Q:	I had a core needle biopsy for a solid tumor which had grown over a 2 year period per comparative mammograms. Three of the four specimens obtained showed fibroadenoma and the fourth showed atypical ductal hyperplasia on deeper levels of the fibroadenoma (actin stain was used). I have seen two surgeons at different hospitals and was told by one of them that I was at high risk for the development of breast cancer and the tumor should be removed. The second told be that she would not suggest the removal of the lesion since many times they go away on their own and I should not be labeled as high risk. What are your thoughts? I'm 42 years old with multiple cystic changes in my breasts but no personal or family histoy of breast cancer?
		A:	tumors,(fibroadenomas) don't go away. You are at higher risk of developing breast cancer but shouldn't be labled as very high risk-- just slightly higher than the general population. most doctors would recommend removal.
Question:  #2294 10/26/2002		Q:	I had a core biopsy which came back as a fibroadenoma. I am 40. This was my first mammogram/ultrasound etc. Should it be removed notwithstanding that it is benign? The surgeon said it was a matter of preference as to whether to remove it, but that it was more thorough (since only 4 cores were taken). The procedure would be by mammatone or excisional biopsy. Is there a protocol for this stuff???? My ob/gyn said wait for a while (6 months). I don't know.
		A:	usually fibroadenomas are removed and need to be done so as an open surgical exicsion.
Question:  #2295 10/26/2002		Q:	What is the difference in the procedure and information yielded of stereotactic biopsy and a core biopsy for determing a possible fribroadenoma? (No personal/family history of bc.) Thanks
		A:	pretty much the same-- they both obtain a piece of the mass for analysis. One is not necessarily in this case better than the other
Question:  #2296 10/26/2002		Q:	In my annual mammogram the physician sent me to a radiologist for an ultrasound because of a small lump just below the nipple of the right breast. ( I have had two previous surgical procedures for the removal of benign lumps in that breast) Both of my breasts are lumpy with fatty deposits. Following these two mammograms and 2 ultrasounds, I was sent to a hospital for a needle biopsy. This procedure returned with a finding of a benign lump. The surgeon has now recommended a removal of the benign lump. Is this prudent or is it okay to have a follow up ultrasound in six months to note any changes??
		A:	it is standard practice to remove them. It is hard to visualize things behind them on a mammogram
Question:  #2297 10/20/2002		Q:	I had a stereotactic biopsy which revealed focal aytpical duct hyperplasia and dense stromal fibrosis. They're suggesting surgical excision of the area. I'm seeing a breast oncologist on Monday. Please tell me what to expect. Thank you
		A:	usually a more extensive biopsy is recommended to ensure that there isn't any DCIS or invasive disease around the tissue already removed.Probably a needle localization biopsy will be recommended. This will provide the additional information needed to ensure you are okay.
Question:  #2298 10/20/2002		Q:	I am being referred to additional, magnified views due to finding of a cluster of linear like tiny calcifications on center area of right breast. I've only read how the clustering is always suspicious and have seen responses to questions about their being malignant. Has anyone had a cluster of tiny calcifications that proved to be benign? I am 42 and have a mammogram every year. Thank you very much.
		A:	there are rare occasions of clusters being benign. Tracking of calcifications along a ductal track also oftentimes point to early stage cancer suspicions too. this is the value of mammography-- seeing and finding these things before they grow to be actual tumors.
Question:  #2299 10/20/2002		Q:	I had my first mammogram last year at age 46. Microcalcifications were found, and a sterotactic biopsy was done. It came back benign, however out of 5 taken out ,one calcification had a-typical hyperplasia. No further treatment. This year my mammogram, says the following :"there is a metallic tissue marker outer quadrand right breast. There is a questionable cluster of microcalcifications in the retroareolar portion right breast. Some additional scattered microcalcifications are seen in both breasts. There are no dominant masses or areas of architectural distoration. " Were the calcifications removed? I felt the triggers in my breast. Did they come back? Or are these new ones. Do I have to have another biopsy?
		A:	A mammogram after your previous biopsy would have been done to ensure that the calcifications perviously seen were removed when the biopsy was done. S inquire about that. If they were, as should have happened, then this would imply that these new calc are just that- new, and yes, they would warrant biopsy again. Hopefully a stereotactic biopsy can be arranged. If not, then a needle localization biopsy would probably be recommended. this is the value of mammography-- finding these abnormalities when they are still very tiny.
Question:  #2300 10/20/2002		Q:	Below is the ultrasound report done in September 2001. The doctor didn't tell me in detail what the report meant. She just said it's a small nodule. She did not mention whether it is cancerous or non-cancerous. She told me it is up to me whether I want to do an operation or not. She advised me to wait for a few months. The report for the ultrasound is as follows: ”There is a small nodule in the right breast. It is located at 8 to 9 o’clock position and measures 6.9 X 7.8 X 4.5mm. It is hypoechoic, well defined and shows some posterior enhancement. No other focal breast lesions seen. The rest of the breast show normal stromal and glandular components. Impression: Small right breast nodule, most likely a fibroadenoma.” May I know in detail about the report?
		A:	This may be all the information available that was able to be deciphered from what they saw on the film. This combined with a mammogram and clinical breast examination should help more clearly tell the doctor if he/she feels this truly is a benign tumor or not. Many women feel it more reassuring to have it removed and definitively know than to wait and see if it grows later.
Question:  #2301 10/13/2002		Q:	I had a biopsy today of a small dense area close to the chest wall. I had a mammogram because of pain in that particular area. Is the risk of breast cancer higher when it is near the chest wall and when there is pain involved?
		A:	no. Actually, pain only occurs 10% of the time with breast cancer. so wait and see what the outcome is. If it is cancer, then surgical options will be reviewed with you as well as what additional treatment may be needed.
Question:  #2302 10/13/2002		Q:	Last May,after my annual mammogram I was called back to undergo re-screening. After several mammos, cone mammos and magnification mammos I was scheduled for ultra sounds and more mammos. Several areas ,cysts,various findings and clusters of microcalcifications were noted.The calcifications were the main concern. I was given a rating of a 4 and noted with SUSPICIOUS ABNORMALITIES...BIOPSY SUGGESTED..Biopsy recommended. Was then set up with a surgeon who saw many things going on??? With the number of calcifications he did not think that open biopsy was going to be a choice. So for an opinon of rather a stereotatic procedure would be the way to go he sent me to the radiologist that had this equipment and would do this procedure. He then did his own brief ultra sound and mammo and concluded that the calcifications could be "PROBABLY BENIGN" and to do a re-check for stability in six-months,besides there were too many to biopsy and which one should he get. With this report the surgeon just flip flopped and agreed. My regular physician did not get a follow up report and thought ,as last he knew that the procedure had been done. I was thoughly confused and wanted this to just end. After nearly three months and having some nagging feelings and findings I went back to my DR. with many swollen lymph glands from my ear to my arm-pit on the same side as the breast in concern. Also some prominent on the opposite side also. Other than a few other symptons such as leg cramps,night sweats and some changes of the breast which could be felt in both breasts,I had no sore throat,no ear infections,no coughs,no illnesses and my Doctor alarmed that I had not been biopsied(his comment being.."PICK THREE TO BIOPSY!) he recommended that I see another specialist. I then had a procedure..styloid vs. lymph glands vs.parotid mass and chest x-rays. The result being it was lymph glands with a clear chest xray. The next specialist reported that I did not have sarcoma or lung cancer.I did not even know that this was a possibility. Next thing ruled out was lymphoma. Still wondering about the breasts! Then I was sent somewhere else for more ultra sounds of the right breast and lymph nodes and more mammos...thinking that by now they are going to kill me from radiation or STRESS! Well while waiting for this specialist to be in clinic,read the reports and see me,which was going to be two weeks a "NETWORK OF ANGELS" literally went to work while I went out of town for a few days. This team was led by my VERY concerned Aunt who happens to be a nurse. In days they had taken to the phones,picking up films,reports,referals...blah,blah,blah and had everything about me moved to the SWEDISH BREAST CARE CENTER in Seattle,Wa. It took two radiologists several hours of going over films for two days and locating me to give me the new findings.....Stereotactic biopsies. This being all finally and finely orchestrated by my original Dr. and my team of Angels without my knowledge.Two sites were biopsied and another ultra sound of the lymph glands was done . This was done after conference calls with the original radiologist who had recommended the biopsies and later had done the first lymph gland procedure. He felt from his first finding that a lymph node should also be biopsied. This has not been done yet. Why? Unknown to me as of yet???The pathologist report was going to take two days and was called in the very next day! Now something called a Radial Scar or Stellar scar has been thrown out there.To search for potential malignancies in the near area. This biopsy will be down after a wire has been inserted,although markers were left in after the other biopsies. This will be done by a surgeon. That report will take 5-10 days to get from the specialized pathology screening. All of this done before the previous SPECIALIST had even read the report from what he had done! That appointment was still a week away! The Angel Team fired him! How ever today I received from them a suggested 1 YEAR FOLLOW UP...INDETERMINATE CALCIFICATIONS,CYSTS with echoes and debris.NOW...FINALLY....can and would you please explain as best you can;How has all of the degrees or the disagreements happened? How can so many readings be SO different? How could this go on for months? Not only thinking of my stress,but the cost of all of this. How can so many top people be so far off from one another when they all do the samething? What is a Stellate or radial scar? What does this other biopsy mean??? What are they looking for and why was it not found with the first biopsies? Can you shed any light on any of this? Please??Desperate,Confused Angery and NOW.....???At least things are happening and happening very quickly with much empathy given for what I have been through.
		A:	you've had a lot happen... there are times when doctors don't agree with the findings on xrays. When this happens it is best to seek opinions from a third course to be the tie breaker, if you will, so that you can get some definitive answers. you are underway now for those answers though. Making sure you are in the hands of breast specialists who see and treat an large volume of breast cancer is wise. pathology results take time so be patient. sit down with your doctor and let him know your anxiety and frustration regarding this fiasco. Write down your questions and be specific. You are now on track for answers--- focus on that rather than using your energy in looking backwards at your situation over the last year.
Question:  #2303 10/13/2002		Q:	The doctor said that my mammogram which I had over a month ago and they found a small spot on each breast. I have to wait now for 7 weeks to have a second mammmogram at the hospital. Why must I wait so long?
		A:	Call again and see if you can be moved up or ask if you can take your films to another breast imaging facility. Waiting is probably not medically risky but very anxiety provoking which is unnecessary. you deserve an answer sooner than 7 weeks.
Question:  #2304 10/08/2002		Q:	Hello, I have an 87 year old Aunt who recently had a lumpectomy(papillary carcinoma). We were told at the time of surgery that the margins were clear and she was a candidate for the new Mammocyte procedure. At the two week post op office visit we learned that the pathology report also revealed Multifolcal insitu carcinoma deep w/in the breast(non-invasive). Our options right now seem to be a total mastectomy or Tamoxifen orally. We want the course of treatment to obviously be beneficial, but the least invasive as possible, due to her age. Is treating this case with oral Tamoxifen indefinitely far fetched? Her surgeon seems to think she will succumb to something other than breast cancer down the road, so we feel why put her through such an invasive procedure. I should also mention she has been orally treating a low grade luekemia for a few years now. I am curious to learn the OPINION of the effiveness of Tamoxifen for treating breast cancer in the elderly. I realize it is not a cookbook recipe. Thank you.
		A:	It is always important to carefully look at the patient's medical condition and make sure that the treatment proposed won't do more harm than good. It is not uncommon to recommend tamoxifen rather than more surgery or adjuvant therapy like radiation. Tamoxifen can cause blood clots though so she needs to be free of a history of blood clots to be a good candidate for taking it. If she has other medical ailments then it makes sense that her doctor is saying that old age or other illnesses may very well be what causes her to one day pass away, and not have her cause of death be breast cancer. Breast cancer also commonly grows fairly slowly in elderly people. All of these things need to be considered and her quality of life maintained and respected.
Question:  #2305 10/08/2002		Q:	I had to have a stereostatic biopsy. I now have to go to a surgeon to remove tissue from around the area they marked with a wire. I had two areas of micro calcifications and one area 8mm that they really did not say what it was but on the report it mentions yellow-gray secretions at the bottom. I also have CAPPS and duct hyperplasia with atypia. I know I am going to the surgeon to r/o DCIS. I am assuming with everything I have read I have pre cancer cells and possibly DCIS. If my report comes back good should I expect to go on tomoxifen? My sisters or mother have never had breast cancer. I have an Aunt, 2 double first cousins that have and also one first cousin who has died from breast cancer in her 30's. I am 48. What treatment option would you reccommend? Thanks so much.
		A:	First wait and see what your biopsy results show, then if it comes back as DCIS you obviously will need breast cancer treatment. If it is premalignant findings then hormonal therapy in the form of tamoxifen may be recommended. you should see a medical oncologist who specializes in women who are high risk if that is the outcome of your biopsy results.
Question:  #2306 10/04/2002		Q:	Hi, I've just received the pathology report from a 2nd biopsy, a wire loc/excisional. The first one was done because of BIRADS4 microcalcifications.New calcifications had shown up after the 6 mth wait & see period. It was a stereotactic and they missed the tissue-no calcifications were found in the sample. So, I went in for a second opinion w/ a breast surgeon who did the needle loc. Calcifications were found in the sample at the time of surgery(it was radiographed) BUT.. the pathology report makes no mention of them being detected in the slide specimens. Findings say- Fibrocystic change with focal ductal hyperplasia, no evidence of carcinoma? I'm still worried though, because it sounds like maybe they didn't look at the specimens with the calcifications. Shouldn't they have been referenced in the microscopic findings? I'm concerned that they could still be missing something.
		A:	Get a second opinion on your pathology. You are welcome to do that here if you like. Just click on : www.hopkinsmedicine.org/breastcenter/team then click on pathology and in Dr. Argani's section is information about how to do this. It would be helpful to have the tissue block as well so that we can see what was taken out in its entirity. There certainly are times when no cancer is found and the outcome is ADH as was found in this case at this point. But you need to be sure...
Question:  #2307 10/04/2002		Q:	I had my excisional biopsy lump removed yesterday, also took tissue from around it. They sent it to lab. Doctor told my friend that it looked ok. Previous FNA results stated remove as soon as possible. My question is can they tell results just by looking at it without pathologist report. Will see my Doctor on Friday. Thanks
		A:	Tissue that is grossly cancerous does have a different appearance than healthy tissue, but only a pathologist looking at the tissue micrcoscopically can definitively tell if there is the presence of cancer cells or not. Hold tight until you get the news from the surgeon. We will hope for you that you get good news too.
Question:  #2308 09/30/2002		Q:	I had an excisional biopsy with the following results: "fibrous mastopathy with duct dilation, background fibrosis, papillomatosis and apocrine metaplasia. The aprocrine changes are rather extensive in some ducts and there is some degree of mild atypia. Patient should be followed." What exactly does that mean?
		A:	It means that there are some changes in the lining of the ducts of your breast--- enlargements of the ducts and cells that are slightly abnormal. Your doctor is being cautious in noting these and is recommending that you be followed more closely than the average "perfectly normal cell structure" breast patient. don't panic. It is better to side on caution than ignore it. For more details visit our pathology section on our website for translations of specific cell structure.
Question:  #2309 09/29/2002		Q:	I recently went for a routine baseline mammogram. At first the doctor saw small white dots and thought it was deodorant. After several other enlarged pictures she mentioned that she wanted to biopsy the area. She said they could be small calcium deposits which sometimes is related to pre cancerous cells. I am 36 years old. I have no history of breast cancer in my family. I had a breast reduction 14 years ago. How concerned should I be? Scared and confused. Thank you
		A:	What you are describin are microcalcifications that appear to be clustered together. When clustered, they can be a sign of very early stage breast cancer-- DCIS- noninvasive breast cancer. They also can just be calcium deposits that are doing no harm. A biopsy will definitively determine what it is. If it is cancer, it has probably been caught very early. these dots can only be seen on mammography and cannot be felt on clinical breast exam, thus proving the value of annual mammography. don't worry yet dear. If the biopsy is positive you are welcome to contact me for help. Lillie Shockney (shockli@jhmi.edu)
Question:  #2310 09/26/2002		Q:	During a breast biopsy for a cluster of microcalcifications my doctor came across a large pocket of pus. He said it was probably from mastitis which I had almost twenty years ago( I'm 45).How is that possible and what are the ramifications?
		A:	Ducts in the breast cancer hold fluid, including infection, for a long time. It would be unusual for it to be years though and may be a flare up of mastitis now that was low grade enough it didn't hurt or produce other symptoms. Having it treated now is the plan of action.