Expert: Claes-Gustaf Nordquist, M.D. - 10/26/2008

Question
QUESTION: I had a mastectomy for dcis on the R side in 2006.  I had an MRI to check status of saline implant and the L showed intense enhancement of the parenchyma. I had an ultrasound which showed an irregular shaped 0.4x0.3x0.5 nodule with blood flow within it in zone 1-2 at 1-2 o'clock.  Biopsy recommended.  I think it is cancer.....again.

ANSWER: It is possible. But nothing is sure until verified by biopsy. Since this can be clearly seen by ultrasound scan I do recommend an ultrasound guided needle biopsy! Have it done as fast as possible! The lesion is so small that the prognosis of it - even if cancerous - with therapy now is excellent! Good luck!


---------- FOLLOW-UP ----------

QUESTION: I have had 2 biopsies on L breast.  First results proliferative fibrocystic changes with moderate intraductal hyperplasia and intraductal papilloma. Cystically dialated glands with apocrine metaplasia and calcium oxylate crystals.  Second, fibrocystic changes, encompassing stromal fibrosis, cystic change, apocrine metaplasia, and intrluminal calcium oxylate calcifications. With this history, and the current information provided in original question, in your opinion, what are the odds this will be a cancerous nodule?  I am prepared for a diagnosis of cancer and know I will choose the mastectomy again so that I can be somewhat free of the fear of breast cancer.  Hopefully it will not metatasize to other organs.  My R cancer was ER-/PR-/positve for Her2 overexpression, diploid with s-phase fraction of 2.4%.  Stage 1 dcis, no rads, no chemo.  Thank you for your effiency and expert opinions.

Answer
Neither biopsy shows a cancer or even anything that can be regarded as cancer suspect. What is shown are typical fibrocystic changes combined with some hyperplasia in milk ducts that MAY in the future develop into some precancerous changes. I personally think that nothing needs to be done at the moment but if you want something to be done it would only be necessary to remove the lesion itself. With this small size that should not be any problem. With regards to your right side cancer you do not mention its size but you mention that it was a stage 1 and at the same time that it was a cancer in situ. However a cancer in situ is a stage 0 cancer. For a stage 1 it must have shown some tendency to invade its surroundings. That is more likely too if a mastectomy was done since even without radiation therapy and chemotherapy I think it may have been hard to persuade a surgeon to do a mastectomy even with Her2 overexpression and with no hormonal receptors with only a cancer in situ.