Cyst and biopsy questions

[blueskyabq]

First I will thank for IdahoGal for her promptly response and help. For all of you others, in case you did not see my 2 questions posted earlier, here are my questions.  If any of you know any information, please post it here, it will be greatly appreciated!

I have also right breast diagnosis as BIRAD 4  - a tiny cluster of calcification. I meet my BS last Thur, and she think waiting cannot solve the problem, I scheduled a Fri surgery, will do the same procedure as IdahoGal (if you joint her discussions).  This site is really a supported and help.  As a new member at the stage of diagnosis, I would like to thank for all ladies help and kindness to me and other members.

I do have 2 questions, to ask anyone had previous experience or know something about it.

1. As my coming surgery, wire localization excision biopsy.  I need go to one radiology center to do needle wiring localization procedure, then drive miles away (not myself though) to a local day surgery center to do surgery.  I don't know after wiring, is OK to carry by car for miles away to do surgery?  Will wire be move during transit then cause inaccurate? Because the surgery is based on the wire guide excision  Should I talk to my surgeon to ask to do both in the same facility?  I knew this after the person who schedule the surgery for me.   I think should be done in the same hospital?  Anyone ever heard the similar situation?  Will this increase the possibility for infection?  

I was told that because the day surgery has no that kind of radiology?  I guess because that day my surgeon will do surgery in that hospital.  But that hospital is a big one, may be just the day surgery has no this facility?  The good thing though is the radiology center is te one I did my mammogram, may be more familiar my situation, as a plus side?

2. I also have done one other procedure this afternoon.  It was on the other side of breast.  It shows on both mammogram and Ultrasound as a nodule and biopsy was recommended by the 1st radiologist.  I went to seek 2nd opinion, and he said it may be just a cyst, needle aspiration was recommended.  My surgeon, read over the reports, and did needle aspiration first. She said if fluid come out the lump gone, then it will be done, if it is solid then will do biopsy.  So when needle aspiration showed that fluid came out, then the nodule was gone from ultrasound. So she say need not biopsy on this one.  But the big question here is I has been read if the fluid is clear then is cyst.  But the fluid came out of my one  is light yellow color and like toothpaste, thick.   My surgeon said that may be dry.  I asked if need to send out for pathology check.  She told me that is not needed because that may cause false positive, like finding atypical cells or something, and the lump is gone, you cannot do anything.  So she told me just do follow up with US in 6 mo.  

Anyone had or heard similar story?  The bottom line is, should I have a peace of mind now for this results - what a thick, toothpaste fluid also means cyst?  As long as the nodule is not solid, then it is benign?

Thanks in advance for information and help!
  

[lynnchat]

This is what my specimen B was: The specimen is labeled "sterotatic core biopsies of anterior breast mass with microcalcifications" and consists of yellow pale creamy cores of breast tissue showing an aggregate weight of 6 grams and submitted in toto, cell buttons "B1" and "B2".

[blueskyabq]

So what is the end?  about the wire?  Hope that will not affect you much?  And hope you will recover from surgery soon.  Wish you the best!

I am really appreciate that you share your experience with me.  It look like I will do the same travel with the wire.  I will be very careful and hope they do what they say - the wire will not moved, it will properly placed.

I was told after wire insert, hey will put a cup or wrap or something to hold it, and there is a hood, so wire will not moved.  I hope.  My husband will drive me, hope it work out for me.

BTW, for my case, wire will be placed by radiology guide, not MRI.

[nycsass]

One more post to clarify.
My hospital didn't have the technology needed to place my wires with MRI but the Radiologist's practice did. I had a wonderful Radiation Oncologist  She actually calmed me while I was in a most awkward position and while she placed my wires. Therefore, I was very comfortable.
I was uncomfortable with was  traveling via taxi---I live in NYC-- and wouldn't have been able to take a bus or train with my wires. I didn't know one of my wires had wandered  during transit until my surgeon told me  in recovery.

[nycsass]

I had this procedure and went by cab to the outpatient dept of a hospital with my son assisting me in and out of cabs etc. I was not comfortable and after my surgery my doctor told me that one wire was  not visible when she began to do surgery. She had to the call the radiation oncologist and go over my MRI films to locate my missing wire together. You are right to be concerned about your situation. My surgeon also investigated an abnormality on my same breast  which she also had wired. It was removed biopsied and diagnosed as a papilloma.

[blueskyabq]

You are right, I have to thinking about this.  I will call again tomorrow,  Nowadays, it is very hard to reach a Dr or surgeon, they will not call back and not to think of it is necessary an issue or need to call back. Almost every time I called, they are with patient and cannot answer the phone.

Thanks for you advise.

[braveheart2]

I think you need to go with the place where you feel the most confident. The whole experience is stressful enough without worrying about what the health professionals are up to...would it be worthwhile having a second opinion with a different surgeon who does wire assisted excisional biopsies in the same facility as the radiology center? If not, can you ask to speak to your original surgeon about your concerns prior to the procedure?

Bear in mind that it is normal for the surgeon to send the tissue+wire to the radiolgist for checking while you are still sedated/sleeping -- it is necessary to X-ray the tissue to be sure they have got the suspicious area by visualizing the microcalcifications in the biopsied sample. Once this has been confirmed, your tissue is sent to pathology for analysis.

Please keep us posted on what you decide! We are thinking of you.

[blueskyabq]

Thank you both for your experience and advises.  I talked to the surgeon's office, I only had chance to talk to the person who schedule my surgery, not the surgeon.

She told me, the surgeon had patients did the same thing all the time.  Because the day surgery center and the hospital it belongs to will not perform wire localization!

One other hospital which can have both in same facility, but the surgeon dose not do surgery there.  The other one, need to wait until Oct, I will have no one here to drive me and that hospital, surgeon did not use the radiologist there because there were problem with the radiologist before.  The radiology center the surgeon will use, have good radiologists who worked all the time with the surgeon and have better understanding each other.  Is this a plus? BTW, this radiology center is the one did my mammogram.

I also found out that after surgeon cut the area, and when I will still sleep, the surgeon need to send the cutout including the wire to that radiology center to check if all calcification is out, if not then the radiology center will call surgeon to cut more and such.  They may feel very conformable to do those back and forth, I don't.  I asked at the time tissue is out, how in the phone can say clear which direction need cut more out without at the surgery center?  I was told they did this all the time, they marked, they know each other for the things they were doing.

I also have another concern, the tissue will send to that radiology center for check, not send to pathology Lab for check directly, I hope they will not mess up with other patient's tissue - one more transit means one more chance to mess up.

Anyway, after all talks and think, I believe I don't have better choice.  Since if I choose in other hospital, then what if the radiologist she never used or used before but had some problems, then may be worse!

I just hope the things will go smooth and urn out fine, at least for now.

[braveheart2]

Having just had my wire-guided excisional biopsy yesterday, it seems incredible that anyone would suggest you travel between phase 1, wire insertion, and phase 2, surgical excision.

The radiology MD who performs the wire placement is skilled in this technique, which requires X-ray guidance to be sure the wire is properly inserted into the correct location. Even though the wire has the little hook at the end and is taped into position, it is a very delicate system. My radiology MD & tech advised me not to move my arm too vigorously on that side for fear of moving the wire prior to surgery. Of course, if the wire moves you will have a surgical excision of the wrong area...to me, that is too great a risk. After all, you don't want to have to go through this again!

I agree with kittyluv's advice to request a facility that can perform both the wire insertion and excisional biopsy in the same facility.

Regarding your second question, I have had no useful experience on the topic of cysts. Please let us know how it all turns out for you!

[blueskyabq]

Thank you very much, you said what I concerned.  I called this morning to my surgeon's office, I was told that the person scheduled the surgery with me will call back, if she need make sure from surgeon, she will check with the surgeon.  Now is noon, noon call me back yet.  I am very concerned.  I called again, still no response.  

I call day surgery center to check is they have radiology on site.  I was told that the center has a potable radiology, if no enough for this procedure, the nearby main hospital which this day surgery center belongs to have radiology and this hospital is a large hospital.

You are right, this is should not be a common practice, less patient safety considerations.  Thank you for your advise again, I will talk to request same facility for both or change the surgery center to meet this requirement.

[kittyluv1]

Hi!
Having just completed an excisional biopsy with pre-op wire localization, I can understand your concerns regarding traveling to another site once the wires  have been put in place. Although the wire is very thin, and after placement, is secured in place using tape, I still felt concerned that my movements could affect the placement.  I was assured by the radiology staff that the wires are deeply inserted and the only way to dislodge it would be to pull on it.
I was transported from the radiology center to the out-pt surgery department of the hospital and was then wheeled by gurney to the operating room.  I did not make this trip by myself and would not recommend that you do so.  (Patient liability issues can arise.)  I would much prefer that once the wires are inserted that professionals be accountable for their proper placement and maintenance.
That being said,  I would like to know if you can possibly re-work the scheduling of your surgery to address this issue.  I am somewhat surprised that the radiology center would allow you to travel by yourself (even with someone else driving) once they have placed the wires.  I would recommend that the wire localization and surgery be done at the same facility.
As far as the aspiration of the cyst goes -- the lump is gone at this time, so no further treatment would be indicated. (Can't treat what isn't there)
The recommendation for followup in 6 months with an US seems very reasonable.  Obviously, if you felt any differences during your breast self-exams, you could seek appropriate medical attention sooner than 6 months.  I can't verify that the color or composition of the fluid removed during the needle aspiration can definitely assure that the lump (cyst) was benign.  I would follow your surgeon's recommendations.  Based on their level of expertise, and on your comfort level, this seems appropriate.
Best wishes to you and please keep us posted on your progress.
My excisional biopsy went very well : no complications, minimal discomfort and the results were benign!  Hopefully, you will have the same results.