Re: Do I need a third opinion?

[jordanna]

Please help, I'm frustrated and confused. I had breast biopsy in Houston  in April  04 because of mammogram noted microcalcificatons.  No family history, no discharge, no pain, no lumps, take no hormone supplements.
After the biopsy, the doctor, who specializes in breast surgery, recommended surgery to excise the breast lesion.  A visit to another doctor for a second opinion resulted in a complete opposite opinion of: no surgery necessary.  

Please advise as best you can, based upon the results of my report which follows:
Diagnosis:
Stereotatic biopsy, right breast:
-Localized area of florid intraductal hyperplasia with microcalcification, no neoplasm identified
-Mild fibrocystic changes with stromal fibrosis noted

Comment: The microcalcifications identified in the lesion are compatible with thoseidentified on the specimen radiograph that has been  provided with this tissue

Gross Description:
The specimen is labeled "right breast microcalcificatons" and consists of six needle cores ranging in the size from 2.1 to 0.4 cm, and measuring 2.5 x 1.0 . 0. 3 cm in aggregate, submitted entirely.


Microscopic:
The histologic sections contain multiple cores and core fragments of breast tissue. Three of these have a localized area of ductular proliferation with marked intraductal hyperplasia. There is focal intraductal microcalcification. The connective tissue has changes compatible with a small radial scar in this area. A small area of intraductal papilloma formation is also noted. No invasive malignant neoplasm is found.

Third Opinion?

[CCF-RN,MSN-JS]

Dear jordanna, The sample reported on above is benign - no malignancy (no cancer or pre-cancer).  The decision about whether to pursue further tissue sample of the lesion, by removing the entire lesion, is based on such factors as the size of the lesion, and the comfort that what has been obtained is an adequate sample.  If you feel you have had good explanations about how both of the specialists have arrived at their respective opinions and are still uncertain about which opinion to follow, then a third opinion from a breast specialist as a tie breaker is always an option.

[surgeon]

This is where it comes down to playing odds, I suppose: the basic question is to what extent it's possible, with your report, that there is something else there. It would be easy if it had been found that the calcifications were associated with a totally bland process, such as fibrocystic change; or, on the other hand, if along with the florid hyperplasia, there was "atypia." In the first examle, it would be quite definite that no further surgery was needed; and in the other case, it would be clear that there was a significant possibility that cancer could also be there. In your case, florid hyperplasia means extra growth going on in the ducts, which is to some degree a risk factor for breast cancer (not huge, but measurable) but not having "atypia," which means changes not only in growth but in cell characteristics that are of more concern, the chance of finding adjacent cancer is very low. But it's not absolutely zero. Since there's no way to know for sure, but since the chances are very great it's ok, it comes down to deciding whether it would make you feel better to go ahead now and be sure, recognizing it's highly likely the surgery will show nothing more, or to follow along with serial exams and mammograms carefully -- which, in my opinion, would be every six months for at least a couple of years.

[jordanna]

Thank you to both CCF-FN, MSN-JS and C2 Surgeon. My gut instincts and research are in line with yours. While it might make me feel better to go in now and know for sure (even though the odds are that it is beign), I do have a concern that by going in the result would  scar tissue which might make future mammograms harder to read. Also, it is my understanding the conditions found (micro calcifications, hyperplasia, radial scar) frequently continue/repeat, and I don't want to  get into a cycle of biopsies/excision each time, with no peace of mind or body.

By the way, Thank you and God Bless you. I have felt that I could depend upon your forum sometimes more than  my own physicians. Please expect a donation from me in the next few days. What a gift you provide. What a tribute to healing and help.

With sincere appreciation and respect,
J