Biopsy all or just 2 - Fibroidenoma

[dji411]

I am 41 years old had my first mammograms and follow -up Ultrasound.  U/S findings indicated 2 masses one bilobed, both well defined and hypoechoic and a cyst in my Rt; 2 masses one elongated, hypoechoic, containing internal hyperechooic area and most likely corresponds to the mammogram abnormality. It is not definitively characteristic of an intramammary lymph node. U/S guided biopsies recommended for all of them, non are palpable.

U/S biopsies on 4/2 at a different Hosp., the Rad. have reviewed my mammograms and ultrasounds results only wants to biopsy the largest abnormality in each breast and that the other biopsies are not necessary. I spoke with the Rad. who said I have 9 or 10 fibroadenomas (not 4-5) which all look normal, when there are so many they normally biopsy the largest or most atypic ones first and that I follow up with a breast surgeon there and have them follow me annually. If I had them all biopsied I would be there all day and that no one in good conscience would remove them all because they would have to remove more than half of my breasts. He said that he has been doing this for 25 years and that I don't have breast cancer although he would not say that with 100% certainty when I asked. I am keeping the appointment to have the 2 biopsies next Friday and am scheduling an appointment with a Breast Surgeon on Monday. I know that fibroadenoma is good news for me just don't know how he can be so sure. I am going to reputable Breast Cancer Hosp.  

Should I insist on having them all biosped?  Can you really dx Fibroidenoma from just Mammo & U/S?

[CCF-RN,MSN-rf]

Dear dji411:  Fibroadenomas are distinct on a mammogram or ultrasound.  Most cancers also have a distinct appearance on mammogram.  It is common to have multiple fibroadenomas and uncommon to have multiple cancers.  The reason to biopsy a fibroadenoma is usually to be certain that it is a fibroadenoma.  Otherwise, there is no reason to biopsy or remove these.  It makes sense to biopsy the largest or atypic ones to assure you that these are benign and then have a good monitoring program. Once your baseline is established, changes will be easier to detect on future mammograms or U/S.

[surgeon]

Whereas it's true that one can't be 100% certain by xray/US only, it's pretty safe to make certain assumptions: cancer has a typical way it looks, as do fibroadenomata. In addition, it's quite common to have several fibroadenomata, and rare to have multiple cancers. And, since it's your first-time images, when something shows that is highly likely to be ok, it often makes sense to check simply by letting time pass and re-imaging. So sampling only the largest areas makes sense; it's a pretty safe bet that if all the areas are characterisitic of fibroadenoma, and you sample a couple, the rest are ok, too; and you can confirm that by re-xraying in a few months. It'll be useful to see what your breast surgeon thinks, as well.

[dji411]

Thanks for responding so quickly,  your words are very encouraging and I feel somewhat relieved.  This site has been an excellent source for me.