fibroedenoma with atypical ductal hyperplasia

My biopsy results are in and after removing the fibroadenoma with an ultrasound guided biopsy this is the exact wording on the pathology report.  "Complex fibroepithelial lesion with a few areas of small foci of aytpical ductal hyperplasia."  The report includes the following recommendation:  "Due to the focal atypical ductal hyperplasia and unusual stromal proliferation, re-escision of the area is recommended to more fully evaluate the surrounding breast tissue."

My question is why do I need more surgery??  Can't this just be carefully watched/monitored?  I'm only 35 years old with zero risk factors.  I've had the lump for over 7 years and my first mammogram this year.  All of a sudden the lump has gone from nothing to worry about to possible cancer.  I'm tyring to understand why I need more tissue removed that could result in a large scar and possible disfigurement.

Thank you

[marydenise]

They are recommending the re-excison because that is the "standard of care" for a pathology diagnosis of atypical ductal hyperplasia (ADH). Plus you have that additional finding of "unusual stromal proliferation."

I'm not familiar with that latter finding, but I do know a bit about ADH. I had an ADH pathology diagnosis, as well, from a stereotactic core biopsy for suspicious calcs on my left breast that I had on August 17. I am now scheduled for a surgical excision on October 24 where the surgeon will remove the entire area.

My surgeon told me that with ADH there's a 11-17% chance that it's not really just ADH and instead either DCIS or IDC. The only way they can know for sure is if they take out all of the tissue, in my case, or in your case, probably get a clear margin around where your fibroadenoma was removed. They will then examine this additional tissue and see if they find anything else.

In my view, you could just wait and be carefully watched/monitored. Although, I would find out more about that "unusual stromal proliferation" finding. Have you talked with your surgeon?

I can certainly understand your concerns for additional surgery and scars and possible disfigurement. And for what. I thought long and hard about doing the surgical biopsy theyre' going to do on me. Especially, in my case, when my Breast MRI was BiRad 1.

But for my part, in August 2006 I had a 2cm IDC on my right breast that I had to have a lumpectomy for. And so, even with only a 11-17% chance that this left breast issue is any sort of cancer, I chose to do it. I seem to be on the "wrong side of the %'s" lately. With my luck, it is cancer.

But again, IMO, think about what YOU are comfortable with. If you're comfortable being carefully watched/monitored, then wait. Because ANY doctor you go to will give you the same diagnosis. You need a re-exsicion. Because that is the "standard of care."

[sunset0777]

Thank you for your comments.  I hope your surgery goes well!  I met with my surgeon today and am probably going to wait.  She said about a 10% chance of it being something.  They idea of having a surgery for such a small likelihood just to be told it's nothing really bothers me.  Especially since there are alternatives such as just being monitored.  So I'm going to think about it for a while.

[marydenise]

I think that you're right on, with your decision. There's no need to rush into, anything. Just wait and see. You'll be monitored, and if anything changes, there will be plenty of time to take the appropriate actions and you'll be fine.

I've read studies that it could take years and years for those atypical cells to turn into, anything, and even then, most of the time, they don't. They've discoverd a lot of DCIS during the autopsies of dead women, who died from another cause. When they're like ... old.

After four years of going through this breast cancer mill (my 2006 right breast cancer, arose from a false-negative stereotactic biopsy in November, 2002) I've finally realized there is PLENTY of time. I had breast cancer for 4 years before they successfully cut it out. And I'm fine.

In my case, after the 2002 biopsy, I did get screenings, but not religiously. Plus, that 2002 biopsy had caused this HUGE hematoma, that masked the growing cancer. After the biopsy, I had this huge lump, in my right breast.

From the biopsy, itself. It was only until it receded, enough, could the actual cancer be seen.And that was four years, later.

But again, IMO you're doing the right thing. If I had zero risk factors, like you, I would NOT be having that surgical biopsy on October 24. It's just too low of chance that it's anything, for such an invasive procedure.

But I don't have zero risk factors. I have high risk factors. So, I'm doing it.  And, hopefully, I won't have yet ANOTHER major hematoma, from a breast procedure. I also had a major horrible hematoma with my 2006 lumpectomy; but not with my August, 2007 steretactic. Just minor bruising, with the latter.

But I have been taking my Vitamin K, now, for months. So here's hoping. My surgeon will just cut out the 1cm of calcs and say it's no problem. And I'll just walk away, with minor bruising. She's fully aware, of my bleeding tendencies, and has told me she will take extra care, cutting out the 1cm.

But to just repeat, I think you're doing the right and prudent thing.

Just wait and see and be monitored. You'll be fine. And if a problem develops, it will be caught, in time.

Win/win.