Botched Biopsy?

[Sheriannz]

I have reason to believe my stereotactic biopsy was taken in the WRONG QUADRANT of my breast.


BACKGROUND:

Jan. 27, 2009 : A six month follow-up mammogram revealed; "Apparent increase in clustered punctate calfications in the LOWER inner quadrant of the right breast demonstrated in only the craniocaudal view." BIRADS CATEGORY 4 Suspicious abnormality.

Feb. 3, 2009: Stereotactic Biopsy was performed.   Biopsy report reads: "Scout and stereotactic images of the right breast calcifications measuring 15 mm in diameter, in the UPPER inner quadrant were obtained."  

When I brought this discrepancy to the attention of the Radiologist/Surgeon he issued the following Addendum to the mammorgraphic report: "The original mammographic report for this exam dated 01/27/09, indicates that the area of punctate calcifications in question is in the "right LOWER inner quadrant." This is an error. The calcifications are instead centered in the right UPPER inner quadrant, which corresponds to the area of calfications sampled under stereotactic guidance."

After receiving the Addendum to the mammorgrahic report I contacted the Radiologist/Surgeon and asked him how often an error like this happens.  He stated that an error of this nature only happens once or twice a year throughout the entire Radiology Department.  His only explanation of the error was that he must have "misspoken" while dictating the Mammography Report.  

To reassure myself that was indeed the case I requested my previous Mammography Reports and to my astonishment I discovered there are reference studies dating back to 2005 identifying the punctate calcifications in question located in the LOWER inner quadrant of the right breast.

Should I ask the Radiologist to issue an Addendum to the mammography dated 07/22/08 because he "misspoke"
in that report as well.  And, should there be an Addendum to the mammography dated 01/17/07 where another  Radiologist describes the "small loosely grouped cluster of calcifications in the right 6 o'clock position." (LOWER portion of the breast.)

I've made an appointment with a Breast Surgeon to review my films which I will carry to her in a folder as well as the mammography reports dating back to 2005.  But, I have to wait one full month (March 19)  ...  

Is there anything else I should be doing until then?  

Thank you so much for your support.

[RITZGAL]

This is intruiging to say the very least.  In my case, as they did the stereotactic, the radiologist explained step by step what they were doing.  I'm pretty sure they said they compared the after mam with the before mam to make sure they biopsied the right place, as well as documenting any residual calcifications still in the breast.  Hopefully, this was part of your procedure and therefore your benign report is indeed of the correct quadrant that should have been biopsied.  Don't your reports indicate 2 o'clock, or 6 o'clock, etc. to further identify the location?  At any rate your new surgeon will sort this out.  I do want to thank you for posting. this.  I went to a well known women's hosp that has a breast center with doctors listed in America's Best Doctors.  Because of your post, I carefully re-read all of my reports.  And guess what?  There are two errors.  One is similar to your report error. It states a cyst in the outer quadrant, corresponding to palpable lump. (This palpable lump was inner quadrant).  But this did not have anyting to do with the calcifications they found on the other breast.  But there is an error making reference to a wrong date for the comparison mam concerning the calcifications.   I noted that the radiologist dictates and someone else transcribes.  It could be an error on either part.  I've also been contacted by this center advising me to make my mam appts. 4 mos in advance due to the influx of patients since all of the breast cancer awareness programs.  Well, I think therein lies the problem.   They do have quality control assurance in place. . I do believe that they take extra measures and cross check at procedure time because they may be overwhealmed with pts. But it's not enough, obviously. I still have confidence in them, but will definitely have this straightened out,  because as you say, "The system is only as good as we demand it to be."

[Sheriannz]

Thanks for your continued input.

Regarding your statement that you "would be very pleased to get a benign report on the biopsy."  I was thrilled to get a benign report on my biopsy...  Only to be followed two days later by that terrible sinking feeling that comes when I discovered there was a discrepancy in the location of the suspicious calcifications (lower quadrant ) and the location of the biopsy samples (upper quadrant.)  

Your "needle in the hay stack" analogy doesn't fit in my case because there's a small cluster of calcifications (benign) located in the upper quadrant easily seen on flim.      

I'm puzzled how you could conclude from the "information availabe the correct area was biopsied."

To recap:

   When questioned the Radiolgist/Surgeon confirmed the biopsy was taken from the upper quadrant.  He then altered the Interpretation and Impression portions of the last mammogram (changing the suspect area from the lower to upper quadrant) to match the biopsy location.  This is in direct conflict with the findings of mammograms dating back to 2005 identifying the suspect area in the lower quadrant.

I will get a second opinion and I will follow up with disciplinary action if necessary.  I owe it to myself and my fellow sisters.  The system is only as good as we demand it to be.  

[japdip]

I personally would be very pleased to get a benign report on the biopsy. The scattered calcifications are normal and the chance of obtaining any of them with the needle would be like the needle in the haystack thing .. not likely.  RE: the mammography used in Stereotactic Bx -- the unit used for guidance during these biopsies is very different from the one used for mammograms; it's specific to this purpose and views the breast in a different manner without need for the various angles used for the study.  I feel from teh info available that the correct area was biopsied. I think in the future it would be to your benefit to have your care provided by a different institution as well as different Physicians. Trust is the most important thing between us and our medical care providers. It's obvious that you have 0 trust in your present providers and that is not good for all concerned; especially you. Although this isn't something that I would do under the same circumstances you could just start over somewhere else. I'm not sure your Insurance would cover it but you could try since you have such serious doubts.  

[Sheriannz]

Hi japdip,

1) The biopsy report indicated "No evidence of malignant neoplasm."
2)  The stereotactic biopsy report reads: "The individual tissue specimens were radiographed.  Calcifications were present in the specimen radiograph."  HOWEVER,
I have scattered calcifications (benign) in both breasts.  So, the fact that calcifications were present in the samples doesn't mean the correct quadrant was necessarily biopsied, right?

Will you be kind enough to amplify on your statement, "Stereotactic Biopsy is done under special mammography guidance I would go with calcifications in the lower quad."

Here's a detail that might shed some light on the issue.  The mammography states that the new calcifications are only visible from the craniocaudal view.  During the biopsy, if the mammography paddles are pressed laterally on the breast and the "approach was craniocaudal" how would the calcifications in question be visible to the Radiologist?  

Any insights would be greatly appreciated.

[Sheriannz]

Hi RITZGAL,

Yes, I'm going to consult a different Doctor.  She is an excellent breast surgeon.  I'll be thinking of you on March 12 and hoping that your biopsy is negative.  

In some respects waiting is the hardest part...

[japdip]

Very interesting ... I'm glad you did post this complete explanation. Since the Stereotactic Biopsy is done under special mammography guidance I would go with the calcifications in the Lower Quad. Any grouping or cluster of microcalcifications will require a biopsy of some type and be rated BIRADS 4. The month wait isn't anything to be concerned about ... and I would be  doing exactly what you are to get some better answers. I'm guessing that you will take a look at those films when you pick them up; you would probably be able to tell where the elusive calcifications are located ... look for a group of tiny white dots and see which quadrant you think they are in .... I can hardly wait to hear what you find out after your visit to the Breast Surgeon. You still haven't said anything about the Pathology report .... that will certainly tell you if the calcifications were indeed biopsied.     Thanks for posting .....

[RITZGAL]

Sounds to me like you are on the right track.  I take it this is a different surgeon you are going to consult.  I would get the old mammogram films as well as the reports.  I think one month is not a worry.  I believe punctate means round calcs.  From what I understand, it is the pleomorphic calcs that usually cause the BIRAD 4 .  But since you had an increase in calcs, this probably warrants biopsy.  I was told after my biopsy findings of ADH with pleomorphic calcs and an increase in calcs since 6 mo earlier mammogram, that I could wait up to two months before my excisional biopsy without undue concern.  (I had to wait until I got a cardiac echo out of the way).  So don't worry and get this straightened out.  Don't forget to post.  And my surgery is 3/12.  I will post to you as well.  Again, good luck and God speed.