breast mri w/ biopsy?

[mammoquest]

this is my 2nd posting. i was  concerned w/lump in breast. radiologist said standard mammo was only 70% effective in visibility of my dense breast tissue and no lump showed up on mammo or sono.
what to do?
i was referred to surgeon.
instead i went for 'aurora dedicated breast mri scanner with biopsy'(99% visibility). not only did we view the lump immediatley on computer screen, computer biopsy showed that lump was cyst  that did not show indications of cancerous  character. this biopsy was done on the computer screen, totally non-invasive , never touched my body. also available was mammo with CAD that zeros in on target spots onscreen and enlarges them for diagnosis. extremely advanced.
why isn't everywoman being told about these excellent and
life saving technologies?
see www.mebreastimaging.com for more info

[JuanitaD]

YUCK, I still opt for the biopsy.  Mam, do you work for this company, you sound like a advertisement for this imaging device.  
Did it occur to you that with all the problems with finances in the health care industry in recent years, this proceedure being used routinely would cause a severe backlog in palitable lump imaging?  I would be complaining about waiting several months for a appointment rather than 5 weeks.  
Although I am not elated about having a "needle poke", I would feel much better about having a actual piece of the lump studied under a microscope, than believe a machine can be 100 % accurate.
In these recent years the stress on Doctors to perform has given them less time to sit with the patient.  I believe the system in place now is much better than one with data from a machine determining treatment.
15 years ago I had Open Heart Surgery.  The doctor at the time was the Head of St. Michaels Hospital Toronto.  He turned me out saying I was fine after viewing results from the XRay, ECG and Stethacope.  I pleaded him do another ultrasound, like my previous one at another hospital ( with saline injection ).  To this day I am glad I had that "poke" It saved my life,  I had no atrial septum to speak of and it was the poke not the imaging that proved how I felt. On my medical file there is a letter of apology from that doctor, he wrote " this woman has reminded me there is a human side to treatment, to listen to the patient as well as clinical results" and mentions how easy it is to believe results of tests can be the only answer.
Way to go Surgeon!

[SusanKobes]

I just checked out the AuroraMRI.com site.  In ALL "Key Applications" it states, and I quote "may be indicated to identify", "may be indicated to detect", "may be indicated to evaluate"....and so on.  All with MAY.  The ONLY area the website states that it is most reliable is in imaging breasts to determine IMPLANT rupture or leakage.  And in all the case studies posted it states that Gadolium, a silvery metal that is used in TV screens, is injected IV.  So, seems you STILL get "poked".  Would rather have a biopsy than have TV screen material injected into my veins.

[SusanKobes]

Mammoqeust seems to own stock in the MRI.  I personally am going to be scheduled in the next day or so for a biopsy.  Not that the MRI doesn't sound helpful, but seems to me not to be the "end-all" that Mammoquest makes it out to be.  Makes sense that only a biopsy viewed under a microscope can determine a diagnosis for sure.

[SnowWoman]

I think most of us would agree that when it comes to a lump (palpable or otherwise), we want a definitive answer as to what it is and we don't want to have to wait weeks or months to get the answer.  No matter how the Dr. consoles us that things "look" OK on the mammo or ultrasound (or MRI) for most there's still doubt and until a sample is taken and looked at under the microscope we continue to worry.  I've been through this for over 20 years since my first lumpectomy in 1980 and have seen "new technologies" come and go.  (In the early 80's, it was "transillumination" that was going to revolutionize breast imaging.)  The MRI is a tool which should be used where appropriate and may very well definitively answer that you have a cyst (so can ultrasound) but when it's not a cyst, the peace of mind obtained by a biopsy beats all.  Thanks for the time and effort that everyone puts into this site.

[Geeb]

Surgeon - where (geographically) are you located?

[Rfrancis]

I agree with the above comment. Agree to Disagree. Though I think the breast MRI, is a great tool, but we can't loose sight that it's another tool to detect any abnormal spots,lumps...
I for one would like to Thank the Surgeon and RN in helping all of us who are desperate for answers or more information.
Thank You for this site.

[vermontgirl]

I think it is fair to say that MRIs do have a place in screening women for breast cancer in certain instances (even the American Cancer Society recently said this in their revised approach to finding breast cancer in its early stages).  
   That being said, if both the doc and I could feel a lump, I'd opt for a core needle biopsy right off the bat to get a definitive answer of what the lump really was. Not everyone has an aversion to being poked in order to get a definitive diagnosis of a lump.
   That being said--if I was ever diagnosed with bc again, I'd request a breast MRI prior to surgery so that we would have as much info as possible about the extent of the bc or to determine if there were potentially other smaller areas of bc in the breast that weren't large enough yet to be palapable or, with my extemely dense breast tissue, weren't showing up on the mammo.
  And finally--everyone is entitled to their opinion and hopefully we can all agree to disagree on this emotionally charged issue. And to Surgeon--thanks for devoting part of every day to answer our questions. I, for one, really appreciate it.

[virg m]

I second Japdip's comment! I appreciate your opinion Doc.

[surgeon]

Oh yeah, and one more thing (don't you wish this site had an edit button for posts?). Since you imply I'm an insensitive boor, I'd add (you'll have to trust me on this one, which you clearly don't) that I'm listed in the "Guide to Top Doctors" and in the very large clinic in which I work (not the cleveland clinic, I might add) we send surveys to our patients. I'm one of the only ones who's gotten 100% positive feedback -- which includes such issues as giving enough time, encouraging questions, explaining things, inviting participation in the process. When I see a woman with a breast problem, I spend more time than with any other issue, and we come to understanding and a plan for care mutually. I have no axe to grind. I have MRI available if and when I want to use it. Ok, that's it. I've said what I have to say. The fact is that MRI gave an answer that, based on your original post, could likely have been gotten quicker, cheaper, and more reliably by other modalities. But as they say, no harm, no foul.

[surgeon]

In re-reading one of your flames, you said no one could find the lump. From this I conclude you felt it but no one else could. And, I assume, that you couldn't find it at the time they were examining you, either, or else they would have felt what you felt.  Which, if correct, means it would have gone away. Which is what cysts can do, but not cancer. In that case, I'd have ordered a mammogram, and if ok, would have had you come back for a recheck. As it turns out, that would have been exactly the right thing, avoiding an unnecessary test. Moreover, since (I assume) no one could feel the lump you were concerned about, there's no way to know if what was found on the MRI was in fact what  you were feeling. And, your opinion of surgeons aside, I am VERY familiar with MRI and its use in the breast. I've also seen it be tragically wrong, as is true for any test. What I have NEVER done, in 25 years of treating women with breast problems, is fail to diagnose breast cancer in a timely manner. NEVER.

[surgeon]

Ok, let's cool it down a bit. Your original post said you were concerned about a lump. Yes? That means you had a lump, or else how were you concerned about it??? If there's a lump, by definition, it's something you felt. If it can be felt, it can be poked. No need to search. So, either you had a lump, or you mis-stated your original post. If you had a lump, then I would not have started with a mammogram or ultrasound because, as you found, they don't always show it. And if there's a lump, even if the images don't show it, it's there and needs some sort of attention, be it a biopsy, or careful observation. So clarify your original statement that you were concerned about a lump, or let it go!!! I guess we're both glad you didn't come to me!

[mammoquest]

Dear Surgeon;
You are glad I didn't come to you because I have too much information that is current and true that you are not familiar with and don't like because it is not your standard fare and doesn't fit in with your "poke & seek " invasive philosophy.
In this age of excellent technology, WE DON'T NEED TO BE POKED!
You need to carefully re-read all I have stated on this site without professional bias and with an open mind that is focused on PATIENT WELFARE not personal bias.My experience is profound in that only the MRI was able to allow us TO SEE THE LUMP IN QUESTION. You are insensitive to believe that your "poking" would be preferable to any woman that could instead be offered a clear picture of what is going on in her breast. You are simply trying to force your method upon her instead of allowing her to SEE THE LUMP CLEARLY and be aware of ALL OPTIONS OPEN TO HER.
If you are ready to disregard standard proceedure of mammo, ultra, and MRI in favor of blindly poking at lumps, then perhaps no one would be glad to come see you.
Please educate yourself as to what is going on in this world of cutting edge technology by visiting www.auroramri.com and see what the rest of the world is reaching out for . Thank You.
P.S. I have stated all information for the benefit of women everywhere and advise all to visit www.auroramri.com to find out more. I shall not reply to Surgeon on this question again, as , unlike Surgeon, I am concerned with women's health, not engageing in p-ssing contest.

[japdip]

Way to go Doc ....... but don't waste any more valuable time on this one.

[mammoquest]

Dear surgeon;
P.S. Did you really say you would start "poking " my as yet unlocated and undiagnosed lump without the aid of standard procedure (mammo,ultra,MRI)? Caveat Emptor Indeed!

[mammoquest]

Dear Surgeon;
Regarding your response (C6) YOU STILL DON'T GET IT.
How could you have "poked a lump" that was unidentified as mammo and ultra  couldn't find it? Would you just "keep poking" blindly until you hit something something ? Is that O.K. with any woman? Please understand that NO ONE COULD FIND THE LUMP UNTIL WE DID THE MRI!
We also strongly disagree with your utterly invasive methods of "seek & poke!" How much more intelligent to see without invasive methods what this lump is and where and the surrounding area that will be inclusive in the diagnosis. The trouble with you surgeons is that you are trained to "poke" and be clinically oriented to the exclusion of newer more user friendly methods, simply because they AREN'T THE METHODS YOU HAVE BEEN TRAINED TO DO. Let's be honest. Only the MRI found and definitively and accurately imaged the lump then recognized
as a cyst and gave immediate and clear indication that it was benign. You are denying the validity of this information because you are unfamiliar with it, but it's out there, and women are now empowered to participate and take control of how analysis & diagnosis will be handled . We are surprised that you make light of this as Early Diagnosis will be able to save many lives and save women from excessive "poking " , biopsies , and unnecessary surgery.Thank You.

[surgeon]

I did get it: you were talking about a lump. To me that means something that can be felt. If it can be felt, imaging is often unnecessary. Had you seen me, I'd have recommended a needle poke: it's a small needle, most women say they hardly felt a thing, and we'd have had your answer right then and there. No waiting to schedule a study. Most women, in my experience would trade a (literally) 5 second needle poke with nearly no pain with an instant answer, for waiting for scheduled study. And the RN answer was correct: no image can give a definite answer that something is cancer. No doctor would treat a woman for cancer on the basis of MRI findings alone. So, once again, assuming you had a lump, which is what you said, had you seen me we'd have answered the whole question in a few seconds: no sonogram, no mammogram, no MRI.  Since it was a cyst, we'd have gotten fluid out, the lump would now be GONE, and you'd have walked out a happy woman. Had it not been a cyst, then more would have been needed, NOT including an MRI. To speak in terms of the price of a life is a bit out of context for your situation, since a cyst is not life-threatening. And in the big picture, unfortunately cost/benefit IS an issue. There are centers making tons of money by turning technologies into consumer-driven objects of desire: whole body scans, certain MRI procedures, etc. Caveat emptor.

[mammoquest]

Dear CCF-RN;
You are obviously not aware of the 'Aurora Dedicated Breast MRI Scanner With Biopsy ' breastscanner. It provides an on screen reading of area in question and has biopsy reading capability
that is determined by methods other than conventional invasive.
Yes a traditional biopsy is a tissue sample, however the above machine is capable of reading the questioned area onscreen and providing indication of prescence of cancer . I disagree with your comment that " MRI is not the answer to breast screening"
as my cyst was not able to be found with mammo or ultrasound, but only and immediately by the MRI. Your statement that "to date there is no biopsy that is non-invasive " reflects a need to keep more abreast of the developments in this field.Please research "Aurora Dedicated Breast MRI" to become more familiar with non - invasive biopsy and other early detection capability of this breastscanner. thank you.

[mammoquest]

dear surgeon;
in response to c1 above, you didn't get it!
CYST WAS NOT VISIBLE ON MAMMO OR SONOGRAM.
it was only THE BREAST MRI that  found the source of the lump which we clearly saw as a benign cyst.
we need Breast MRI to increase early detection and there really is no refuting that!
thank you

[mammoquest]

dear surgeon;
i think everyone would agree, you can't put  a price on the value of a life. it was worth any money to have the peace of mind of immediate diagnosis that excluded the possibility of cancer. you'r suggestion of needle biopsy may sound good to you, but women generally would rather avoid the pain and discomfort administered by it.maybe we should try to increase the availability of this advanced technology instead of trying to downplay it's importance.

[surgeon]

Since you had a lump, the surgeon could have poked a needle in it, drained the cyst, and that would have been the end of it. Definitive, quick, and 1/10 the price of MRI. Or, if it hadn't been a cyst, the needle would have sampled the tissue and likely have given a diagnosis. Had the MRI not shown it to be a cyst, you still would have needed a needle or other form of "invasive" biopsy, because no image can diagnose cancer with certainty. Your experience was positive, but in fact was way more expensive and complicated that it needed to be, and only ended things because you had a cyst. Which could have been much more easily and simply and more cheaply diagnosed than it was. In the best of all possible worlds, everyone could have any test they want, regardless of cost. In the world of tax cuts, national and state debt, inaccessible health care, out of control healthcare costs, people still need to think in terms of what's cost-effective and sensible.

[CCF-RN,MSN-rf]

Dear mammoquest:  An MRI may be of benefit to some women, particularly those with dense breast tissue.  It is not the answer to breast screening in general and is usually best used in comparison to mammography.  MRI can differentiate between solid and cystic structures but it is NOT a biopsy.  To date, there is no biopsy that is non-invasive.  A biopsy is a tissue sample that is sent to pathology.