fibroglandular tissue

[Kimbi]

Hello,

I had my rt breast excised Nov 07 in which an 80 gram elliptical 8x7x6.5 cm portion was removed from the 12 o'clock position.

Microscopic sections revealed extensive replacement of breast tissue by patchy to well differentiated invasive mammary adenocarcinoma. An inconspicuous component of of ductal carcinoma-In-Situ is present.

Findings: 1.6CM intermediate grade Ductal Carcinoma In Situ, solid cribriform  Type, with central necrosis & calcifications. Ratio CIS/INVASIVE: 20/80.
Calcifications: Associated with Ductal Carcinoma IN Situ & benign findings.
Estrogen receptors= Positive (3+90%)
Progestrone receptors= Positive (2+,10%).

I followed this with an ultra sound & MRI  in Mar/April 08  - then had a core biopsy a few days after the MRI in the 3 o'clock position of same rt breast.  The core biopsy proved to be benign.

At the urging of my Dr as I was having varied symptoms relative to my ( hypothroidism) thyroid dramatically being out of balance and very low, I has a PET scan for me. Here is the result of this:


PET/CT Ltd skull to mid thigh

Patient received 16.3 mCi of F-18 FDG & was imaged after 1 hr of resting in quiet room.Blood glucose was 97 mg/dL at time of examination. Previous right lumpectomy Dec 07 with reportedly known residual neoplasia in superior aspect of rt breast.

Both breast demonstrate activity compatible with fibroglandular tissue. However, this is somewhat more focal & asymmetrically prominent w/in the rt breast in 9 to 10 oclock position. Distribution of radiotracer is otherwise physiologic throughoutthe remainder of examination. The activity in the rt breast demonstrates an SUV of up to 2.9.

Impression: Increased activity w/in the rt breast as described above, which is felt to be suspicious for residual neoplasia. No other evidence of metabolically active neoplasia is identified throughout the remaining visualization portions of the body.

So, pls help me interpret all this!!
I'm vascillating between having the rt breast re excised & await the biopsy results - Or just having a mastectomy w/o awaiting any further test results. My great concern in choosing the latter procedure is that I am fearful living alone & wheelchair bound - that recovery from a complete mastectomy will be too much for me to manage!

Your advice is welcomed!!!
Kind regards, Kim

[PaulMD]

Hi.

Your PET scan shows the possibility of indeed a residual tumor on the right breast, but these asymmetries may also be due to breast architectural changes brought about by the previous surgery.  The biopsy would really confirm if there is really residual tumor.  If this is indeed the case then options would include a re-excision procedure, or a mastectomy altogether.  The decision will depend on the amount of breast tissue remaining and both the preference of you and your doctor.

Regards and God bless.

[Kimbi]

Thank you so very much for this advice. When you said "The biopsy would really confirm if there is really residual tumor," does this mean I should have another biopsy before re-excision? Guess I thought it would need to be re-excised in order for the biopsy to take place.

If this is the case, then can this biopsy be done while I am under anesthesia as they can do that with lymph nodes, I'm told.

Your reply is greatly appreciated.
Kind regards & shalom,
Kimberley