Expert: Claes-Gustaf Nordquist, M.D. - 11/14/2010

Question
QUESTION: started with bloody discharge and swelling to left breast may2009, told by doctors is an absess and given antibiotics. diagnostic mammo and ultrasound done june 2009. results stated there may be minimal ductal dilation. also that there was a small area of decreased echogenicity with slightly irregular margins in the 6 oclock position.stated may reflect changes due to recent infection. measured 1 cm. told to have f/u mammo in 4-6 months. now fast forward to sept 09 when i requested further  testing and a radiologist was going to do a ductogram but looked at my films and changed to an mri. mri done and 7 cm cancerous lesion noted at 6 oclock. my mammo was rated a birads 3. i am wondering if more should have been done diagnostically from june findings and what role does echogenicity play in diagnosing tumors as well as irregular margins?

ANSWER: An ultrasound guided needle biopsy of your lesion seen by ultrasound probably would have given the correct diagnosis right away! Or an MRI scan already at that date since the findings obviously were unclear. Or actually both these measures since they should both have been done in this unclear situation.




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

QUESTION: what does the research say about the growth proliferation rate of a her2 estrogen positive tumor? also what role does decreased echogenicity play in diagnosing a cyst vs tunor?

ANSWER: Tumors like patients are individuals not identical copies/clones. However her2 positive tumors are usually more aggressive but they also usually respond to some chemotherapy. Estrogen & progesteron positive tumors respond to hormonal treatment. They do not differ normally otherwise from most other breast cancers. Echogenicity can not be that much used to evaluate a breast lesion. To be SURE what it is you NEED to do a biopsy. And you can guide that needle biopsy to the lesion by ultrasound so once you can see something there is no problem in doing a biopsy of it! So unless you are SURE (and can explain clearly in an acceptable way) why you are sure of what you are seeing there is really no excuse for not doing a biopsy!




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QUESTION: so my next question is how do i find out if my prognosis would have been better if biopsied and treated earlier? my thought is i would not have been a stage 3 c in may or june as i was the end of sept.  

Answer
Oh, that can not be known with absolute certainty but in general the earlier (when the tumor is smaller and with less risk that it has spread) a tumor is found the better it is. Closer than that I do not think we can come.



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