Expert: Claes-Gustaf Nordquist, M.D. - 10/12/2009

Question
QUESTION: I (Age 39) with no family hx of breast cancer, had a very large palpable mass in right outer edge (10 o'clock on large breasts)that I found on exam.  Mammo showed only dense breast tissue.  US showed "large conglomerate of multiobulated complex cysts", and radiologist further stated "I highly doubt whether any of this is malignant".  I guess my surgeon agreed and said he also thought it was just a cyst, let's remove it or watch it.  Open biopsy confirmed IDC, Grade 3, 2.5 cm, ER,PR and Her2 Negative with KI-67 of 90%.  MRI reconfirmed more cancer.  Had second lumpectomy with SNB additional 4.2 cm tumor removed IDC and every thing else the same with one positive lymph node.  I would like to know why was I not given a Core needle biopsy?  It probably would have saved me some surgeries, because subsequently I found out I am BRCA 2 positive and had bilateral mystectomy.  Is it possible that I would have benefited from neo-adjuvant chemo?  Are there specific clinical findings that the surgeon uses when he decides on which kind of biopsy?  Thank You in Advance!

ANSWER: I would have ordered a core needle biopsy. I have never relied only on mammography. I have always since the early 1970ies used some form of needle biopsy (fine/thin needle aspiration biopsy or wide bore core needle biopsy) together with mammography (and ultrasound scans - and later also MRI scans) to ensure a correct diagnosis. However in parts of the USA needle biopsies are still for some unclear reason not popular with at least some doctors. I do not really know why. It is sad!


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

QUESTION: Thank You so much for your opinion, but do you think I should have had neo-adjuvant chemo?  Bottom line my tumor was 6.7 cm T3aN1Micro.  Everything I have read so far says yes, I should have had it.  What are your thoughts and what meds would you have used?  Thanks Again

Answer
Yes I do. I also think mastectomy should have been done at once. No "lumpectomies" in this situation! Presurgical radiation therapy was also a possibility but I think I would have preferred chemotherapy. I will not discuss precise medication since to do that much more knowledge of your case than I have is needed.