Pathology report

[susabeth]

I am 39 and have just had my second tumor removed from my right breast.  I had a mammagraphy that found calcifications on 4/1.  I went to the surgeon on 4/9 who decided the tumor looked no-cancerous but did a fine needle biopsy an planned to remove the tumor the following week.  The fine needle cam back inconclusive on the day I had it done.  The following week before my surgery the further tests on the fine needle came back invasive stage one cancer.  I chose to have the tumor out as scheduled.  They gave me all the worst case before the surgery like removing nodes and chemo.  They found the tumor self contained and did not do the nodes.  After inspection of the tumor they said they mad a mistake an there was no cancer at all.  The pathology report says fibroadenomea with florid ductal hyperplasia with atypical non-neoplastic cells and calcifications.  It also says the diagnosis of carcinoma was based on poor cell cohesion and high cellularity of an apparent monomorphous cell population.  I am very confused.  I can't understand how a mistake like this could be made and why they were adiment about me having cancer one minute and not having the next.  I guess the damage has been psychological but I need answers.  Thanks for your time, Susan

[surgeon]

the chance of recurrance is very very low, and more likely to occur within skin than on the chest wall. Most people think there's not a reason to refuse reconstruction on the basis of masking recurrance.

[teakettle2]

I've recently had a right total mastectomy for DCIS   I chose not to have reconstruction out of fear that cancer would be masked by the implant.  The post surgical biopsy and sentinel node biospy (got some others too) all were negative...no invasive cancer.  It was all contained to the ducts and has been described as stage 0.  I take tamoxifen now.  Any numbers for risks associated with doing reconstruction and not finding cancer?  and since no invasive cancer was found is it really a worry that it would come back on my chest wall?

[surgeon]

I'd look at it as a glass half-full: meaning, you didn't have more surgery than necessary, and you ended up with excellent news. Fine-needle aspiration is very accurate, but no test we do is perfect. What you described are all characteristics associated with cancer, and raising the suspicion is not at all surprising. I've seen very benign-looking smears turn out to be cancer; and vice-versa. It takes the big picture to put it all together. If a lump is worrisome, then even if the FNA is ok, it needs to be removed. If the FNA is worrisome but the lump feels like a fibroademona, I'd tell the woman the lump needs to come out, and it might be benign and it might not. The bottom line is you got exactly the procedure you needed and no more, and came out with good news. Preparing you for bad news ahead of time was not unreasonable; some people do it differently from others.

[CCF-RN,MSN-JS]

Dear Susan, In a fine needle aspiration the specimen sample is only that which was found in the bore of the needle.  I cannot say for sure what was seen by the pathologist with the initial biopsy, however hyperplasia is an increase in # of cells, and atypical is some abnormality.  Using this information in conjunction to the findings from other tests (mammogram, ultrasound +/or physical exam) leads to determining the next recommendation.  If this came back as initially inconclusive it is likely that a second biopsy to obtain more tissue would have been recommended, to be on the safe side.