I had a feeling that the results from my ultrasound experience was too good to be true. I left the hospital on Monday after it thinking that the lumps found on MRI went away; that they were maybe a small cyst that dissolved or something cycle related. Wrong.
Dr. Colette called today and explained to me that they likely didn't disappear. Instead, they are just too small to be picked up by ultrasound and in an area that ultrasound isn't as reliable for anyway. My options now are to do MRI guided biopsy or just wait until surgery time (or move up the surgery date.)
MRI guided biopsy, based solely on what I've googled, doesn't sound particularly enjoyable. I'll take you with me on my google tour for the night. According to radiologyinfo.com, "Most women report little or no pain." It sounds like a typical breast MRI but a device will be used to "gently compress between two compression plates." I'd like to see if these same (probably male) authors called mammography gentle compression. "One [compression plate] is marked with a grid structure. Using computer software, the radiologist measures the position of the lesion with respect to the grid and calculates the position and depth of the needle placement." They go on to discuss how the area will be numbed and a core needle will remove a small amount of the tissue 3-6 times. I have three areas of concern, so rinse and repeat for more like 9-18 times. This could be 2-3 hours of hanging out in superman position on the MRI table. But we'd know exactly what these abnormal areas are and what we need to do (if anything) about them.
Waiting until surgery, however, means that we go into it not knowing what will be in there and potentially what we could be up against. It could be nothing--just a false positive. It could be just the start of irregular cell growth like atypical ductal or lobular hyperplasia. Those are the easy things. I'm not even going to write the other things that are flashing through my mind that it could be or what they could end up being after 2 months of waiting.
If we wait until surgery and the intraoperative (while I'm knocked out) pathology report comes back bad, we have to be "intellectually honest" as Dr. Colette likes to say about all of our decisions to save skin, nipples, and/or reconstruction methods. She'll make the best decision she can for me because I'm going to be knocked out on the operating table at this point and won't be able to voice my opinions. I could wake up with a completely different result that I what I closed my eyes expecting.
The intraoperative initial pathology could come back good, but they will still do more detailed examination of all of the tissue that will take a week to process. This means that surgery would use all the methods that I carefully agonized to make a decision over, and I would wake up without any surprises. But a week later if that final pathology report comes back with a bad finding, we would need to do modifications. Now we couldn't go back into surgery and remove the skin at this point, but this would mean that my nipples would need to be removed. The only positive either way, is that I'll be free from almost all tissue that further cancer could grow already at that point.
I asked Dr. Colette what she wants me to do. I told her that I don't know what my abnormal results looked like in comparison to those with cancer or those with normal healthy tissue. I trust her opinion, and even though she told me the choice is mine, I need her to give me guidance on this. She said that she has her thoughts, but wants to consult with a colleague first to get an outsider's perspective. We'll meet again next week to decide.
I guess I better start working on that before surgery to-do list because I know that if we take the wait and see method, that I'm going to want to move up my surgery date a few weeks!