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Date of last update: 10/21/2017.

Forum Name: Breast Cancer

Question: Standard Procedure for benign masses

 LJF64 - Sat Aug 21, 2010 11:45 am

I want to know if it is truly standard procedure to do bilateral lumpectomies for x2 radial scarring on Right Breast @ 1:00 and Left breast papillomatosis?

If so, then I wont be as nervous that I'm doing the right thing.

In addition, is it normal to have lymphadenopathy form after the bilateral core biopsies, especially inches away from the insertion site? I also noticed a localized cervical lymph node that just formed yesterday by the right SCM muscle that is tender to touch, but not red, no sinus problems, sore throat or fever. I also noticed this morning a non tender small palpable lymph node in the right supraclavicular area. I was wondering if this could be a virus that has caused me to be extremely fatigued for over 1.5 months, weak, weight loss, joint/bone/muscle pain? I do not want this new finding to interfere with my surgery next week on Wed. Aug 25th. I did have mono about 10 months ago and I was wondering if it is possible to have a relapse?

Thank you for your time.
 Dr.M.Aroon kamath - Thu Aug 26, 2010 3:04 am

User avatar Hi,
Your query is rather ambiguous. You indicate in your profile that you had undergone VATS(bilateral), but no details about the indication or further treatment(if any) are mentioned. You say that you have lymphadenopathy close to the core biopsy needle insertion site. No details about that as well. The description of the mammary lesions also is unclear.

In this situation, i can only confine myself to a general discussion about some of the important histological features seen in fibrocystic changes in the breast (FCC) and their risks for malignant change.

Histologically, the fibrocystic changes may be classified as,
- non-proliferative lesions and
- proliferative lesions.

Nonproliferative lesions include papillary apocrine change, epithelial-related calcifications, cysts, nonsclerosing adenosis, mild epithelial hyperplasia, as well as ductal ectasia, and periductal fibrosis.
Proliferative lesions without atypia include, moderate or florid ductal hyperplasia of the usual type, radial scar, sclerosing adenosis, and papillomatosis or intraductal papilloma.
Proliferative lesions with atypia include atypical ductal and lobular hyperplasia.

Women with nonproliferative lesions on breast biopsy have no elevation in breast cancer risk, whereas women with proliferative disease without atypia and women with atypical ductal or lobular hyperplasia have a greater breast cancer risk, with relative risks ranging from 1.3–1.9 and 3.9–13.0, respectively, according to various studies.

Thus, in each of these lesions, the subsequent risk for breast cancer is associated with
- the histologic appearance of the lesion,
- the age at biopsy, and
- the degree of family history of breast cancer.
The risk for breast cancer in young women with a diagnosis of atypical epithelial proliferation is twice the risk observed among women > 55 years. Some studies have indicated that a strong family history may increase breast cancer risk even in patients with nonproliferative lesions.

Radial scars and "radial scar-like" lesions: "radial scar-like" lesions are sometimes identified in mammograms. These lesions have a “black star” appearance with long, thin spicules radiating from a radiolucent central area.
Those measuring 1 to 9 mm are designated radial scars and that those which are 10 mm or more are termed complex sclerosing lesions. Some studies indicate that a carcinoma may be identified in nearly 50% of cases that demonstrated mammographic findings of radial scar.

Therefore, excisional rather than core needle biopsy is generally recommended. It is recommended that in cases of a mammographically suspected radial scar, all members of the management team as well as the patient should be made aware before the surgery, of the potential for a malignant pathologic diagnosis.

Various types of carcinoma have been seen in radial scars, but comedo-type ductal carcinoma in situ or grade 3 invasive ductal carcinoma are rarely encountered. Other investigators have hypothesized that radial scar is a form of early tubular carcinoma or that tubular carcinoma originates in this entity. Tubular carcinomas that consist of more than 75% tubular elements have a more favorable prognosis than invasive ductal carcinoma not otherwise specified.This has led to several authors to caution against extensive surgery for radial scars.

The significance of the lymph nodes that you mention can not be commented upon without more information regarding your past surgery. However, they must be investigated without delay.
Best wishes!

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