Post-Surgery follow-up: How frequently did you have follow-up?

Posted by cjketts @cjketts, Nov 19, 2023

Ten months ago I had a lumpectomy, that according to the pathology report removed a 2mm dcis tumor, with 8mm clean margins. At my 6 month follow-up diagnostic mammogram and ultrasound, the results showed that an area “ is favored to represent evolving postsurgical collection. Short-term follow-up ultrasound in 3 months is recommended. BI-RADS 3: Probably benign.” No problem, after 3 months, I had another ultrasound, with the same results, “favored to represent evolving postoperative change/collection. Short-term follow-up ultrasound in 3 months is recommended. BI-RADS 3: Probably benign.”

Is this normal to have so many follow-ups? Should I be looking to have my imaging done at another center, to get a second opinion? The same doctor is interpreting the results each time.

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Those results are very non-specific. I would ask for more detail. A radiologist should be able to be more clear on whether they think what they’re seeing is scar tissue, or re-arranged glandular or fat tissue, or what.

Here is what my results “impression” were after a one year follow-up. They did an MRI instead of a mammogram and US because I have dense breasts and the original cancer had very little calcifications, very difficult to see on a mammogram.
1. New bilateral mastopexy changes and right segmentectomy changes. This is a new baseline study post-treatment.
2. Asymmetric nodular enhancing foci along the curvilinear scar within the central LEFT breast are all likely related to rearrangement of the internal glandular tissue. Six months MRI follow-up is recommended. ACR BI-RADS Category 3, Probable Benign. Recommend 6 month follow-up MRI. Patient would be due for her annual mammogram at that time as well.
Extra-Mammary Actionable Findings/Recommendations: None

They then provided a full report. Not sure if you want to read all this, but it does add more detail. It may give you some terms to ask about, such as, Is it a foci? Scar? Central or along suture line? Glandular tissue? What area is it located in? Is there a mass?
Although I had an MRI which is a comprehensive procedure an ultrasound should give the radiologist a clue as to whether they’re seeing a fluid filled cyst, fibroglandular tissue, a lighter gray fat area or white fibrous tissue. Maybe the area they are looking at is very vague, but I’d ask for a more in-depth explanation. If you talk with them, they should be able to explain it better.

My Full Report, if you want to read it.
Findings: The breast composition is heterogeneous fibroglandular tissue. There is mild early background parenchymal enhancement.
RIGHT BREAST Mastopexy and segmentectomy changes with surgical clips are new. No suspicious enhancement in the posterior lateral right breast or chest wall suspicious for residual or recurrent disease. No mass, non-mass enhancement, or asymmetric enhancement suspicious for malignancy in the rest of the breast.
Nodal Basins: A 0.7 cm round axillary level I node is unchanged. No malignant appearing lymphadenopathy in the visualized axillary or internal mammary regions detected.
LEFT BREAST Mastopexy changes are new. Nodular enhancement along the scar site in the central breast (series 12: image 516, series 17: images 16, 79) are all likely related to the tissue rearrangement. Since this is a new baseline exam post-treatment, six months follow-up is recommended. If the findings are stable, then return to annual surveillance is recommended.
Nodal Basins: No malignant appearing lymphadenopathy in the visualized axillary or internal mammary regions detected.

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@cjketts, it sounds like your doctor is keeping a close eye on you, which is good. But at the same time, it sounds like more clarity would be helpful. As @triciaot suggests, can you get more specific results? I would start by asking more questions.

You might find this related discussion helpful:
- Bi-Rad 3? Confused and want to know what questions to ask oncologist?
https://connect.mayoclinic.org/discussion/bi-rad-3/

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Followup are good. My initial cancer did not show up on mammo or ultra sound. I felt lump and immediately had mammo. It did not show up. I had ultra sound but had to point to spot I felt. Do not have confidence in mammo or ultrasound. Had mri and cancer showed up.

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