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BIRAD 5 Surgical oncology consult, even with normal biopsy result?
Had MRI and they found an area that they classified as BIRAD 5. Turns out I’m also severely allergic to contrast so they could only do the MRI guided biopsy on me without contrast, only using marker from prior biopsy.
Pathology report came back normal but radiologist wrote an addendum that my imaging does not match biopsy result and strongly recommends surgical consult/removal, especially since I can’t have an MRI to follow up.
To be safe, I made an appointment with surgical oncology to figure out next steps… Is there a chance that the pathology report be a false negative like radiologist was suggesting ( 3 radiologists have been working on my case) and it is in fact cancer since biopsy was not as accurate because they couldn’t use contrast plus it’s a non-mass finding?
Also what should I expect at the surgical oncology consult?
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Hugs to you! Getting a BIRAD 5 for me was one of the worst part of the cancer journey.
Yes, surgical oncologist will want to get it out, because then they can see what it is for sure.
Since radiologist has deemed this to be 95% or greater likelihood of malignancy, I would err on the side of caution, but I don't know your age, prior experiences, etc.
I was young and tumors were very obvious so I can't speak to the ambiguity of the non-contrast biopsy verses the MRI.
Praying for you!
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1 ReactionJust turned 41 (found out about my BI-RADS 5 a couple days before my bday).
Went in for first mammo, they found a suspicious area and I went for diag mammo and US. Confirmed architectural distortion and had stereotatic biopsy. Also recommended MRI due to 21% lifetime risk and dense tissue.
Biopsy was normal but MRI was pushed heavily on me. MRI showed 4 additional areas of concern, plus the main reason they pushed for the MRI, an architectural distortion approx 4cm x 2cm x 3cm - adjacent to the original finding they biopsied. Recommended MRI biopsy - the 3 radiologists debated for the longest if they could even do it without contrast or do they premedicate me to try and prevent the allergic reaction to the contrast. I guess in the end my anaphylaxis risk was too great to attempt it with contrast and the BI-RADS 5 meant they already planned to recommended removal regardless of biopsy outcome.
In talking to the radiologist before 2nd biopsy, even the original normal biopsy result was discordant with their finding which is why they really pushed me to do the MRI - which confirmed what they suspected leading to the BI-RADS 5 category. He said in no uncertain terms that it needs to be removed, based on presentation in the diagnostic mammo which was only further supported by the MRI.
With my risk factors I’m definitely planning on having this removed. I guess it’s more wondering if after removal, there’s a chance they find it malignant and we’d have to figure out further treatment.
Side note, I also had a nearby clumped enhancement biopsied (normal) and 3 other areas US and marked for follow up in 6 months, all on same breast.
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1 Reactionleen83, I apologize for my post. I mistakenly assumed prostate. //www.mskcc.org/cancer-care/patient-education/contrast-enhanced-mammogram The imaging takes longer but uses an iodinized contrast with no gadolinium.
Oh no problem!!… I started reading into what you linked and I got a bit confused.
Thanks, I asked for it to be removed so as not to divert your thread.
I've heard about the CME but at 73, I've never even had a mammogram. It's a little surprising that the radiologists weren't aware of or didn't recommend CME. Bi Rads has an accuracy of 66% with contrast.
Praying it's benign.
@leen83 unfun about your birthday, sorry to hear.
Probably it's going to come back as something, given the distortions and the other factors you mentioned. If they are giving it a BIRAD 5 they have signed off on the fact that they see it as having a 95% change of malignancy, so they are preparing for that.
Once they can get it out they will want to get the findings ASAP to your Primary Care Doc so they can get in touch with whomever you may need for oncology.
Treatment-wise it'll depend on what's best to get it all gone the easiest -- if you can use hormone blockers or is surgery is enough or do you have to go old school with chemo and radiation and things. Luckily there are great folks here who have been through it.
Let us know how it goes.
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2 ReactionsThank you @seathink for all the info - it really helps more than you know. I find a lot of comfort in information and knowing a possibility in what to expect, even if it’s not sunshine and rainbows.
I would rather prepare for the worst and hope for the best - going in knowing that there’s a high likelihood they’ll find something so it doesn’t hit me like a bus - all the discordance is awful.
I’m actually now distrusting of positive news with this whole ordeal - Its been an endless cycle since April of getting told bad news, then good news, then a “just kidding” we take the good news back. I never used to answer the phone from unknown numbers but now I anxiously answer every single call in case it’s from someone on my medical team.
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1 ReactionI was the same way, my husband and I would call it Schrodinger's Cancer, especially in the beginning -- will it be Stage 3 or 4 -- and we still have that habit for most scans.
I read a planning tip that if something even only has a 3% chance of happening you ought to have a contingency for it, and I like that. Both of our families are more of the willful positively camp, which made it hard because they just didn't want to hear any reality, but at least my spouse and I were on the same page.