What questions should I ask when seeing a surgeon about a biopsy?

[CM]

My recent mammogram showed an abnormaltity.  I was given an ultrasound but nothing was seen.  I was then refered back to my doctor. During a breast exam he found a lump.  I have now been refered to a surgeon for a biopsy.  What questions or concerns should I have when I go for my appointment?  When I was given my appointment they said that it was a Class 4 and I needed to been seen ASAP.  What does Class 4 mean?

Thanks -- CM

[MED HELP INTERNATIONAL]

I just read the question posted by "Grannymac" and need to remind everyone that all questions MUST BE POSTED AS QUESTIONS.  If a question is posted under the "comments" area, it will not be answered.

Because this is a new forum, I've taken the liberty of copying GrannyMac's question and posting it as a separate question at the top of the forum.  Sadly, we can't do this on a regular basis, but we felt her question needed an answer.

Medical Professionals from The Cleveland Clinic Taussig Cancer Center will reply within a few days.

Cindy Thompson
Med Help International

[Grannymac]

I suspect your 'class 4' was more related to the mammogram.  I had a class 4 (category 4) mammogram on each breast...and a double biopsy done last week.  This week, I was diagnosed with 'invasive ductal carcinoma' of the right breast, and the margins were positive...

Class 4 mammograms are suspicious for cancer but not necessarily cancer.

My miracle is that the lump (a 1.4 cm lump) that prompted me to start this whole 'train ride' was negative!  A smaller (1.2 cm) lump underneath, and totally invisible on mammography (though the sonogram showed suspicion - a sonogram I wouldn't have taken but not for the bigger, non-malignant lum) was positive.  Doc said that without that bigger lump, the mammo would have been negative...scarey!

I'm in the Detroit area, so have some good places...Karmanos, U of Mich, etc.  The more I read about chemo in early stage (stage I) the more I think this is a decision I might make or encourage if it's not offered to me immediately...I wanna make sure any hitchhikers on the original tumor don't wander and set up housekeeping and have families 10 years down the road...want to evict all of 'em NOW!  The tumor is 1.2 cm, Nuclear Class II, Bloom-richardson Grade I (3-5)Mitotic 10.  I'm not totally sure what all that means - mitosis, if memory serves is cell division (geesh, long time from A&P in college, let alone biology)!  But, have no idea 10 out of what?  It says 0-11, and mine is 10...isn't that a 'high' normal?  Interestingly enough, the CEA and C15-3 blood tests were normal, C27.29 hasn't come back yet.

Should chemo be something I should at least embrace if offered, and suggest if not?  My oncologist is with the UMICH, and I"m getting a 2nd opinion at Karmanos this coming week.

Thanks!

[kriss]

Hi,

I heard the same type of 'classification' used
with my last 2 radiologists report.  

From my understanding Class 4 simply means
'suspicious' & biopsy recommended.
Classes 0-3 refer to either
'probably' benign, normal or 'xray not clear'.  

You can find a breakdown that is commonly
used at this address:

http://www.imaginis.com/breasthealth/acrbi.asp

Being that the 'classification' was told to you
before you have even had a biopsy, I'm pretty sure
that this is what your doctor is referring to and
not a staging of the lump itself.

Kris

[CM]

Thanks so much for the information.  It helps with some of the anxiety I am having about this.

CM

[CCF-RN,MSN-JS]

Dear CM,

The surgeon will discuss with you what type of biopsy they are recommending.  He/she will usually propose the least invasive method that can give the most information.   A question at this point may be: are there other options and if so what are the risks and benefits of each option.

Once the type of biopsy is decided upon, you should be given information regarding any preparatory procedures you need to follow before the procedure.  The information should also include what is involved with the actual biopsy procedure, care of the site after, and when you can expect to hear back from the surgeon regarding the results.  If you are unclear about any of this information, ask for clarification.

I have not heard of suspicious lumps being classified in terms of Class 4 etc.  This may be your particular institution