Expert: Claes-Gustaf Nordquist, M.D. - 8/14/2007

Question
Hello,
I am 30 and I recently had a mammogram and ultrasound because I found a lump in my left breast. The mass was not identified on the mammogram because of the extreme density of my breasts. The ultrasound report reads like this: a corresponding ovoid mass is identified, measuring approximately 2 cm in greatest length. The mass is solid and mostly well defined.
Impression:
Ultrasound confirms a ovoid solid mass corresponding to the palpable finding in the left breast. Based on its ultrasound appearance it very likely represents a fibroadenoma. Options could include excision or biopsy could be performed. BI-RADS 4.
My question is why is it a BI-RADS 4 and not BI-RADS 3  if it is probably benign? My surgeon recommended I should do the biopsy and I told him I would rather monitor it because the radiologist told me that there is a small chance she might get to my lungs with the needle since the lump is so close to my chest wall and I have small breast tissue. How safe is it to just monitor the lump and not get a biopsy?   Do multiple biopsies increase the chance of getting breast cancer? I am trying to avoid unnecessary biopsy if I can. Are BI-RADS ratings computer generated based on the shape and size of the mass or are they just a rating system to reflect the radiologist opinion?

Answer
If your breasts are that dense - making mammography more or useless - your ultrasound scans should be complemented with MRI breast scans for better radiological diagnostic ability. In this case based more or less ONLY on what is seen by ultrasound there is a high level of uncertainty involved. That is probably the reason for your high rating of 4 instead of 3 - to be on the safe side so to speak. Since it seems that the lump seen with ultrasound can also be felt (YOU did find it yourself, right?) I do not understand the biopsy difficulty as mentioned by your radiologist. To perform a thin needle aspiration biopsy with MINIMAL risks involved should really be easy and just routine! I strongly do suggest that such a biopsy is done so we know where we stand right now instead of just postponing things. A biopsy gives you a diagnosis, something not so easily obtained with radiology alone! There is NO increased cancer risk by multiple biopsies! Such a biopsy is NOT unnecessary and should therefore NOT be avoided! Ok?