MRI finding: Why do the ultrasound before biopsy?

Funny you ask. I’ve been on Kisqali and Letrozole 5 years now post surgery and radiation for recurrent breast cancer in chest wall ( had double mastectomies round 1). Oncologist said I could go off Kisqali for better quality of life since Letrozole does the heavy lifting and Kisqali is heavier on side effects. I just need to get a breast MRI and Signatera test first. If both are negative then I can stop Kisqali. The breast MRI just showed an area of focus on left chest (cancer on right both times before) so Tuesday I will have an ultrasound (notified in portal and voicemail). If they can’t tell what it is, I’ll have another MRI in 6 months. Like you, I thought the MRI showed a much better picture than ultrasound. I guess just different? And if unclear, I’d rather do a biopsy than wait 6 months and take Kisqali 6 more months. I will have lots of questions for the radiologist on Tuesday! Signatera (my first one) results are not back yet. It sounds like for both of us they were hoping the ultrasound could rule out any concerns. Ultrasounds are easy and inexpensive in comparison to MRIs and biopsies. Best of luck to you. I hope we both have a happy report soon.

Yes, it makes sense. In my case the ultrasound found nothing. "No correlation" with the mammogram. I would want to have that area biopsied. Just my opinion. Sometimes I wonder if the insurance companies want the to proceed with the ultrasounds first.

@debdeb1 , I recently went through the stress of an abnormal test on my remaining breast, after a mastectomy to the other breast one year ago. In the past I was never stressed about being called back for additional images, but this time I was concerned. So, I understand the anxiety that goes along with what you are facing.
I have had all three types of biopsies. The ultrasound biopsy was the easiest for me. My guess is that your doctor was hoping that they could see the spot on ultrasound, so they could do the US guided biopsy. Because they confirmed that they can only see this spot on an MRI, they want to use that modality to do the biopsy. For me, MRI was the least comfortable type of breast biopsy, just because of the position that you are in for the procedure. Some people may tolerate it better than others, and my clinic was very good about trying to keep me comfortable during the procedure.
https://www.mayoclinic.org/tests-procedures/breast-biopsy/about/pac-20384812
The radiologists determined that my spot was an overly dense area of tissue. Nothing to worry about. I'll be scanned again in 6 months.
Please let us know how it goes for you.

@lls8000
Lisa, that makes perfect sense for my case too that they would hope to see whatever it is on the US for an easier biopsy. I’m sure the radiologist prefers US biopsy to MRI too. Breast MRIs are so hard on me with that superwoman position and pressure points. I have a rare neuropathy with pressure points being a major issue. I hope they have a clear picture on my ultrasound tomorrow. Thanks for your input.

@californiazebra They just scheduled mine for December 22.

@debdeb1
So they didn’t see anything on the ultrasound but this radiologist took the time to compare the breast MRI to past ones. He saw the 3 mm nodule in the current MRI was also there in 2020 and appeared just the same. It wasn’t there in 2015 or 2017, but he said 5 years of no changes indicates it’s benign so he has no concerns. Next breast MRI in 12 months. If the radiologist that read the MRI a couple weeks ago had taken the time to compare with previous MRIs, I could have skipped the ultrasound. Now I’m just waiting on the Signatera results. They said two more weeks. I hope you receive equally good news!

Hi there:

This is my first time posting in this group and I just want to say thank you to you all for being here. I really need some support.I was diagnosed June 2024 with DCIS in the left breast after my first abnormal mammo at age 57. Both my mom and her sister had breast cancer, but my genetic testing was normal, as was theirs. Pathology after lumpectomy showed IDC stage 1, estrogen low positive, progesterone negative, HER2+. I had 3 mos chemo, radiation and 1 year Herceptin. My mammo and sono were normal in June 2025. I just had an MRI, and they found an "indeterminate non-mass enhancement" in the lumpetomy site, where there is known benign fat necrosis. Now I need a biopsy, scheduled for 12/17. my surgeon has said he is not concerned, and thinks it is part of the scarring.

Right before my cancer diagnosis I went through a very painful divorce. The past three years have been almost unbearably difficult at times, and despite my 3 adult daughters and wonderful friends, sometimes I feel so alone and it is so hard to keep hope even when the doctor says he is not concerned. If he thinks it is fine why do I need another biopsy!?! I know it is the best course of action, I am just scared and feel lots of dread. And it is hard to try to hold the joy of the holiday season through all of this. I have continued to work through all of this and tried to power through but I need support from people who understand.

Thank you for reading this and I am sending prayers and hope and quiet support to all of you.

@cairistin I entirely understand your feeling of fear about this biopsy. I have been in your shoes, and even when the doc says it is just to be sure, it is anxiety producing.
I have a few tips I use, they might or might not be helpful to you. The first is just keeping busy doing whatever I can think of.
The second is giving myself a set time to worry, for instance 30 minutes in the morning. Then when I start to think about it during the day, I can say to myself that I will think about that during my worry time and now is not that time. This allows to me to kind of hack into my brain and refocus on whatever the task is at the time.
My initial diagnosis was between Thanksgiving and Christmas, I remember how hard that was. Looking back the fact that my family rallied to be around that year was such a blessing. I remember trying to be present while I awaited my first chemo scheduled for Jan, 2nd.
Maybe this is the time to lean in to the holidays?
Do you have a lot of holiday plans? Family get togethers?

@auntieoakley Keeping my self busy but biggest which sure for all of us is when you wake up in middle of night and start thinking about it. When that has been happening just starting repeating prayers and that has helped.

@auntieoakley thank you so much for this. It is very helpful. I know that tests and biopsies will be part of my new normal. It is the impact on my mental health that is the hardest part. Ironically, I am an LCSW and a therapist working in a school and in private practice. I know a lot about skills to decrease anxiety, but somehow it all goes out the window when I am flooded with anxiety myself! Just hearing your words reminded me I am not alone, and I loved the idea about worry time.

This was the holiday season I was starting to allow joy to come back in, after so much pain of divorce and cancer for me and my daughters. I don't want to ose that, So yes, I am here and I am healing and I will try to lean in. And praying certainly helps too.

I hope for peace and joy for you this holiday. For all of you.

With hugs and love,

Cairistin