Palpable mass and tests that follow

[quietlywaiting]

I am a 32 year old woman who found a rather large palpable mass on the upper/middle right side of my right breast. I do not routinely do self-breast exams and found the problem after I noticed that my right armpit seemed to be swollen.  The lump seems to not be round, it is firm and doesn't move(like it is attached to something).  My doctor, a general internal medicene resident checked it out for me and was also able to feel it.  It seems to take up about a 2 inch space and you can feel fiborous tissue around/over it.  The doctor has me schedualed for a diagnositic mammogram and an ultra-sound w/ possible biopsy.  She assured me that the day of the tests(tomorrow)I will definately have an answer (cancer or not cancer).  My family history is questionable; my mother had a lumpectomy in her 30's, but cannot remember what the dr's findings were and did not follow-up.....my mother's mother died at the age of 73 of cancer, but it was never defined as to where it oridginated we were told "she is full of cancer" and that she died of the complications of the cancer in her lungs.  I would like to know two things: 1)is it possible to get a definate answer on the same day as the tests and 2)what are my chances that this is a totally benign condition?  I appreciate any help you can give me.
thank you

[CCF-RN,MSN-rf]

Dear quietlywaiting:  Lumps can be many things but a new palpable lump requires further investigation.  A mammogram may help to determine if this looks suspicious radiographically and if a biopsy may be warranted.  An ultrasound is best at differentiating between solid and fluid-filled (cysts) lumps.  Both tests can provide levels of suspicion and can sometimes rule out cancer (if there is a cyst, for example), but neither test can absolutely diagnose cancer.  If a biopsy is warranted, some biopsies can be immediately performed and the tissue can be immediately read by a pathologist for an "immediate" result.  However, pathologists will often run additional tests on the tissue and a "final" result may not be available for a few days to a week.  If the mammogram and/or ultrasound are suspicious, you should discuss with the surgeon which type of biopsy may be best for your particular situation.

[surgeon]

It's certainly possible to get the results the same day, especially if the sample is a fine-needle aspirate, which doesn't require overnite fixation before cutting it. It will depend on what sort of biopsy is done, and how willing the lab is to expedite it. As to the chances it's benign: it's really not possible to give a meaningful answer without examing the lump directly. But remember that by far the majority of breast lumps are benign, especially at your age.

[quietlywaiting]

Thanks so much for your responses to my questions.  I had the mammogram and ultra-sound yesterday and am more confused now than ever.  It did not show up at all on either test.  The technitions for both tests could feel the lump, and the radiologist also felt it.  But it did not show up on the film or the ultrasound.  I do not understand this and the only comment the radiologist made was that my "reg physician woul have to decide what they want to do about it".  She has not contacted me yet.  Should I quit worrying now?  If you have any further advice or can explain why something everyone can feel does not show up I'd appreciate it.  Thanks.

[surgeon]

when a lump shows neither on mammogram nor ultrasound it makes it much less likely to be cancer, but doesn't absolutely rule it out. When to do a biopsy depends not only on the xray images but on the nature of the lump itself, as well as the woman's history and level of concern. Often it takes a doctor with more expertise than an internal medicine resident or a radiologist when it comes to evaluating the feel of the lump itself. That means seeing a breast surgeon. It might well be what's called "mammary dysplasia," which is sort of a fancy way of saying lumpiness. A needle aspiration biopsy, which is the one I referred to as being amenable to instant analysis, is often a good way to get info without a bigger biopsy. If a lump feels benign (as judged by an expert), and if the xrays are benign (as yours are), and if the needle aspiration sample is benign (all three together are referred to as the "triple test"), the chance of missing cancer is close to zero.

[quietlywaiting]

Thanks again for the prompt response.  My doctor's Medical Assistant said that she would call back on Friday, today is Tuesday, this will be the ultimate in dumb questions; should I call HER back again?  Or would seeking a second oppinion at this point be wiser?  If so, how do I go about seeking one?  
I am sorry to keep being a bother with this, but I am still unsure as to how I feel about this whole deal.
Thanks once again.

[Kelly 110]

I, too , have the exact same thing as you are explaining. I had a mass that did not show up on either ultrasound or mamo. They did remove the lump due to family history and reports came back to be a Lipoma and some fibrocystic changes. However- I do still have a mass at the same location of the lumpectomy- Dr. says could be scar tissue. My OBGYN has issued another ultrasound to be sure. I am 29 going on 30 with 2 children. Let me know how yours has turned out. Kelly 110