Nodule near chest wall

[jmhk]

My ultrasound showed a dark circular area near the chest wall. The radiologist did not want to do an ultrasound guided biopsy because of its location--too close to muscle and lung. My surgeon said it could be biopsied successfully, but that it was most likely not malignant since most cancer does not occur in this area. She suggests a 4 month followup. If it has not changed, she says to leave it alone. However, the radiologist said since I am on Lupron and Arimidex the area in question might not grow because these medications stop or slow cancer growth, therefore it could still be cancer. How dangerous is doing a biopsy near or on the chest wall? Also, can these medications really keep cancers from growing?

[autodiva]

A related discussion, Breast lump near chest wall was started.

[jmhk]

I neglected to say that I had a lumpectomy for invasive ductal carcinoma in January 2004.I had radiation but did not need chemo.  These new nodules are in the same breast as was the cancer. I was ER/PR+ and HER/2+. I was 53 but still getting my period regularly. My oncologist felt Arimidex would be better than Tamoxifen--I forget exactly why. But I have to have lupron to shut down my ovaries so I can take Arimidex. My surgeon has suggested that I need to have only an annual mammo with no ultrasound and no MRI. Should I be monitored more closely since I've had cancer and my breasts are very dense and I tend to get many cysts?

[CCF-RN,MSN-JS]

Dear jmhk, The location of the area of concern is taken into account when determining the type of biopsy to be done.  An area closer to the chest wall would be more difficult to biopsy using an ultrasound guided biopsy and may require more of a surgical approach.  With any procedure there are some risks, depending on where this area is it may require an incision, which is more invasive than a ultrasound guided biopsy.  The decision regarding whether to biopsy or not is not based only on location, but on how suspicious the finding is.  You would need to discuss this with more with your physicians, putting this finding in better context for you.

These medications are used in the treatment of breast cancers. They are classified as hormone therapies.  The Arimidex is an aromatase inhibitor which means it interferes with an enzyme used in the conversion of certain hormones - androgens, into estrogen.  Lupron is used to shut down the ovaries production of estrogen.  The idea of using these medications to treat breast cancers that are responsive to estrogen, is that by decreasing the bodies estrogen this would interfere with the stimulation of tumor cells to grow.  You don't say why you are on the Arimidex and Lupron - again the discussion of their role in your individual situation would need to be discussed with your physicians.

[Mel273]

I too have a nodule close to the chest wall which they are watching.  I am scheduled for a 6 month MRI follow-up in October.  The only way it can be biopsied is surgically because of where it is located.  I feel for you because I know the nodule is there.  I am currently taking tamoxifen which they say may shrink or cause the nodule to disappear.  I am curious to see what your response is.  Best of luck to you!

[surgeon]

Location ought not have much role in deciding WHETHER to do a biopsy: the fact that cancer is more or less common in a particular area really doesn't compute. Location may dictate what kind of biopsy to do; if they can't "shoot" it with a guided biopsy needle, then a wire can be placed in the area to guide a surgical biopsy. What's more important in deciding whether to biopsy or follow is the nature of the finding: round and smooth suggests somthing innocent. If it has very innocent characteristics, and it sounds like yours probably does, and if the biopsy would be more complicated because of location, and if everyone including you is comfortable with followup, then it makes sense.