Breast Imaging Biopsy and Pathology Results

Getting Your Breast Biopsy Results

 

Your results will be available to you and your doctor within 3-6 business days. Results will be in your medical record, sent to your doctor, and available for you in MyChart on the day that they are signed by the pathologist. A member of the Breast Center team will contact you within 1-2 business days (8am-5pm; not weekends or holidays) of your results becoming available. They will explain your biopsy results. They will discuss if and when any more tests or referrals to a Breast Center provider are needed.

 

Second Review Process

 

The first pathology report may not be the final decision on what should be done after your breast biopsy. An important second step is a second review. This is known as "radiologic-pathologic correlation." During this second review, the radiologists (breast imaging doctors) look at your breast X-rays and discuss biopsy results with the pathologists to make sure that they match.

 

In many cases a Breast Center team member shares the results of this second review at the same time as your initial pathology results (within 1-2 business days). However, this second review process may take a few extra days (up to a week) if further review is required to make a final decision. The reason for this 2nd review is to ensure that you are given the best advice for your next steps. Results will be described this way:

  • Concordant: if the images and pathology results match
  • Discordant: if the images and pathology results do not match
  • Insufficient: if extra tissue is needed to make a final decision

Understanding Your Results

 

Breast biopsy results can be confusing and hard to understand. Your health care provider or a Breast Center team member will explain the results and help you with the next steps in your care.

 

For a "benign" or normal result, no more appointments or x-rays may be needed. For a result that is high risk or a cancer, you will be scheduled to meet with a Breast Center provider. A Breast Center team member will talk with you by phone before this appointment.

 

See below for a description of other terms you may see in your report. A member of the Breast Center team will review this when they call you.

 

Precancerous and Cancerous Results

 

Ductal Carcinoma in Situ (DCIS)

  • Cancer cells are found inside the milk ducts of the breast (non-invasive). These cells have not spread outside of the milk ducts on this biopsy. This is a Stage 0 cancer and is sometimes referred to as "pre-cancer." There are other diagnoses that are very similar to DCIS, such as Encapsulated Papillary Carcinoma and Solid Papillary Carcinoma. These are less common forms of "pre-cancer."
  • We suggest that you meet with a breast surgeon to discuss treatment options. Treatment options are based on your health and personal preferences.

Invasive Carcinoma

  • Cancer cells have spread outside of the ducts. It can also be called "infiltrating" carcinoma.
  • There are many types of invasive carcinoma. The most common are invasive ductal carcinoma and invasive lobular carcinoma. Other less common types are tubular carcinoma, mucinous carcinoma, medullary carcinoma, micropapillary carcinoma, metaplastic carcinoma, adenoid cystic carcinoma. The word "invasive" may not be included in your line diagnosis for these less common subtypes.
  • The word "invasive" or "infiltrating" does not mean it has spread beyond your breast, but that this type of cancer can spread beyond the breast. Your doctor will talk more about your treatment options and staging of your breast cancer at your appointment.

Grade and Stage of Breast Cancer 

  • Grade: Describes how the cells look under the microscope and how different the cells are from normal breast tissue cells.
  • Stage: There are 2 types of staging. The clinical stage describes your cancer before surgery. The pathologic stage describes the cancer after the final results are known after surgery including if it has spread to the lymph nodes or "glands." 
  • Your doctor will discuss each of these in more detail at your appointment.

Receptors

 

Both Invasive and In-situ cancer cells will be tested to determine which "receptors" the cancer cells express. Every cancer is unique. For breast cancer there are several "receptors" that help guide treatment and the risk of the cancer. The primary receptors are the hormone receptors: estrogen and progesterone. HER-2/neu is another receptor sometimes expressed in breast cancer that may be used for treatment.  Invasive cancers are tested for all three. DCIS is only tested for estrogen and progesterone receptors. These receptors or features may be described on your pathology report. Your Breast Team provider will explain this in detail at your appointment.   

 

"High Risk" Results

 

These results do not indicate cancer but can increase your risk for breast cancer in the future.

 

Atypical Ductal Hyperplasia (ADH)/Flat Epithelial Atypia (FEA)

  • Atypical Ductal Hyperplasia (ADH) describes small groups of abnormal cells in the duct of the breast. This is not a cancer, but puts you at higher risk for breast cancer.
  • We suggest that you meet with a surgeon to discuss treatment options. Surgery to remove this area along with more frequent breast imaging may or may not be recommended.
  • The surgeon will discuss the best treatment for you based on your family history, health, lifestyle and personal preferences.
  • Flat Epithelial Atypia (FEA) is also a group of abnormal cells in the duct of the breast. FEA is less likely to be associated with cancer than ADH. We suggest that you meet with a surgeon to discuss treatment options which may include follow-up mammograms. 

Lobular Carcinoma in Situ (LCIS)/Atypical Lobular Hyperplasia (ALH)

  • Abnormal cells form in the ducts or lobules of the breast. LCIS and ALH are different than DCIS. LCIS contains more abnormal cells than ALH. These are much less likely to be associated with cancer than DCIS. Even though these are not a cancer, both conditions put you at a higher risk for breast cancer.
  • We suggest that you meet with a surgeon to discuss treatment options. Surgery to remove this area along with more frequent breast imaging may or may not be recommended. The surgeon will discuss the best treatment for you based on your family history, health, lifestyle and personal preferences.

Phyllodes Tumor

  • A phyllodes tumor is often a benign collection of both connective tissue and glands within the breast. In rare cases, these are malignant (cancer).
  • Phyllodes tumors require surgery to completely remove them and to prevent regrowth.
  • These tumors can grow quickly causing a lump you can feel or see.
  • We suggest that you meet with a surgeon to discuss these findings in more detail.

Radial Scar or Complex Sclerosing Lesion

  • This is a benign or non-cancer condition. Radial scars are not cancer, but they may look like breast cancer on a mammogram or ultrasound.
  • Often an appointment with a surgeon is recommended to discuss results and treatment options. In some cases, follow-up imaging is recommended.

Benign (Not Cancer) Results

 

Intraductal Papilloma

  • An intraductal papilloma is a lump that develops in one or more of the milk ducts of the breast. Often, only routine follow-up imaging is recommended after a biopsy shows a papilloma.
  • We will arrange an appointment with a breast center surgeon to discuss your treatment options if you have the any of the following:
    • If the papilloma also contains atypical cells (abnormal but not cancerous).
    • If you have multiple intraductal papillomas.
    • If you have nipple discharge or other symptoms along with the papilloma.

Pseudoangiomatous Stromal Hyperplasia (PASH)

  • PASH is a benign or non-cancer condition where a collection of connective tissue forms a lesion in the breast.
  • This does not put you at a higher risk of breast cancer. 
  • If the abnormality associated with the PASH is a mass, you may be scheduled with a Breast Team provider to discuss removing the mass if it is growing or painful.

Fibroadenoma

  • Fibroadenomas are a benign mass of firm, rubbery tissue. They are made up of glandular (lobule and duct) and connective tissue (the tissue that holds things together) and are very common. These masses do not increase your risk of cancer.
  • If a fibroadenoma is large (more than 2 inches), begins to grow or is causing pain, you may want or be advised to have it removed. If these cases, an appointment with a breast provider can be arranged. Otherwise you can continue with regular breast exams or mammograms.

Other Types of Results

 

There are many other types of pathology found on breast biopsy which are very common. These include fibrocystic changes, sclerosing adenosis, usual ductal hyperplasia, apocrine metaplasia, duct ectasia, fibroadenomatoid change, and benign calcifications. A breast center team member will discuss these results and next steps with you when they call you with your results.