Expert: Claes-Gustaf Nordquist, M.D. - 11/24/2009

Question
I am a 47 year old female with negative mammo except for very dense breasts.  I had an ultrasound of axillary nodes due to enlargement, ruled as normal.  Both reports recommend MRI for a better view due to dense breast tissue. I also have spontaneous breast discharge that is anywhere from used dark motor oil color to creamy off white color, pulling sensation when lifting my R arm over my head, two enlarged lymph nodes in the r axilla, and when lifting my arm in any direction I have nipple retraction.  My insurance comapny has denied my breast MRI, and the local hospital will not schedule me for the dense breast mammo that I was willing to pay for out of pocket.  The surgeon is trying to formulate another plan. In the mean time I am stuck in the middle. Any suggestions on what needs to be done next?  I am thinking a biopsy of the axillary nodes at a minimum if insurance will pay...???  

Answer
I'm sorry that your insurance company has such a stupid and ignorant attitude (you MAY quote me if you want to). Yes biopsies of your lymph nodes should be possible to do (for example by fine/thin needle aspiration biopsies). However I'm a Swede living in Sweden, so I really do not understand American insurance policies. If possible I also think your doctor should try once more to convince them with regards to the virtues of MRI scanning of dense breasts which should be obvious to most people with ANY medical insight! Good luck!

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