Expert: Claes-Gustaf Nordquist, M.D. - 3/17/2005

Question
Dear Dr. Norquist,
My 76 year old mother has just been diagnosed with lobular ca. She faithfully has had mammograms done every year for the past 10 to 15 years. In 2001 a mass was seen and diagnosed as fibrocystic. The imaging center has kept a close watch on this mass in 2002, along with having an ultrasound done with no changes, as well as 2003 and 2004. She always has her mammo's done in January and this year noted a change in the size. They called her back and did another ultra sound and recommended she see a surgeon. Two weeks ago she had a Tru-cut needle core bx done and this was when the diagnosis was made. She is scheduled for surgery tomorrow 3/18/05 in which thet are doing the sentinel node frozen to see if it matastizied to the lymphs. My question is if mammo's are done every year and this mass was watched for 4 years what are her chances of this cancer spreading to the lymphs or other areas of the body? Also, she did notice the mass got a little larger late Sept/early Oct. of 2004, and already had a GYN appointment for the beginning of Dec.
Does  her prognosis look good?

         Thank-You,
          Carol  

Answer
To make any serious evaluation I would need to see the pathology report after surgery. I'm astonished that a thin needle aspiration cytologic biopsy was not done when the lesion was first found instead of just waiting and watching. Mammograms are fine BUT they do NOT give you a pathology report. However I do know that there is some reluctance in using that kind of biopsy in the U.S. (the old "was not invented here"-syndrome & an UNFOUNDED fear of spreading cancer cells that more than 40 years of uncomplicated European clinical use has proved wrong). Or if you do not have that method available why not a surgical biopsy when you have a patient of this age? Instead of just waiting? Sorry, do need the pathology in order to give you the best reply I can give!