Last minute downgrade and biopsy cancelled

[AnneNC]

Yesterday after 3 hours of prep for a surgical biopsy, I was sent home and told instead to follow up with another mammogram in 6 months.  The details:  I am 49, post hysterectomy, on hormone supplement (vivelle patch), no family history of breast cancer.  I had an abnormal mammogram showing something close to the chest wall.  They could not identify it on the sonogram.  I had follow up mammograms, and although it was clearer in one view than the other, it could be seen in all views.  It was rated birads-4.  I went for a "dry run" on the stereotactic mamotome, and they found they could not get a good enough view from two angles. They then changed the scheduled procedure to a needle loc (?).  Pre-surgery they had me at the mammogram, and again could locate the mass clearly from one angle and with standard paddles, but were not comfortable that they had a clear location for injecting the dye and wire when they put on the open paddle.  As a result:  the radioligist downgraded his rating to a BIRAD-3, they took out my IV, and I was sent home to follow up in 6 months.  I am concerned.  By phone my surgeon told me they had probably rated it too highly to begin with due to number of lawsuits on missed breast cancer, and that the problem in pinpointing the spot reflected not just location (right up against my chest wall), but also that it was probaly just glandular tissue.  What do I do now?  If I get another opinion, should it be from a surgeon or a radiologist.  Am I overreacting to be concerned about this last minute cancellation?

[carme]

We do have lymph nodes under the sternum...something not discussed much yet, so how do you biopsy/etc. areas of "concern" on the chest wall near the sternum??? I'd certainly like to know since my cancer was there,(1 o'clock position).

[SnowWoman]

I had a biopsy of a lesion that like yours was back against the chest wall.  They wanted to do the wire insertion to mark the lesion for the surgeon using mammogram but they were only able to see it from one view.  Try as they might, they couldn't get it on any other view and they need two views to do the wire insertion.  So, I can see where this would be a problem in your case also where they couldn't clearly identify it on more than one view.  In my case, I was fortunate that they were able to see it with ultrasound and they ended up doing the wire insertion that way.  It turned out to be a fibroadenoma.  

It sounds like they were being aggressive in recommending the surgery in the first place and now they're backing off a bit since it is turning out to be a problem.  At our age, it pays to be cautious.  I would look for a second opinion from a surgeon and, if possible, one that specializes in breast surgery or a breast clinic.  It's very probable that this is not cancer but it would be good to get either verification or more reassurance that it is OK to wait.  Good luck.

[Liz S]

Wow - I can see how anti climatic that would be.....what about an MRI?  I have dense breasts and my lump wasn't visible at all on a mammogram or ultrasound but was caught by an MRI (as I understand an MRI doesn't show the cancer, but it does reveal increased blood supply which is a characteristic of cancer - and other things too)

I don't think it would be unreasonable to at least receive an MRI right away while you wait for your next mammogram.  Good luck.

[CCF-RN,MSN-rf]

Dear AnnNC:  If the story is as you present it, a second opinion may be a good idea, if for no other reason than your peace of mind.  You should see a breast specialist, perhaps one in an academic medical center who will have immediate access to radiologists who can review your mammogram films as well.