MRI-Guided Breast Biopsy: Is It Always Needed?

Question
QUESTION: I am 36 y/o female with hx of breast cancer (mom was 38 had mascetomy),,finally went for 1 mammo 12/07...results were calcifications and 2 1 cm nodules found by u/s all in left breast....refered to surgeon who ordered biopsies of all 3....atypia for the calcifications, fibroadenoma for 1 nodule...adipose tissue for other....will have atypia and adipose nodule surgically excised (poss sampling error for the adipose)...i was sent for MRI of both breast before scheduling surgery which resulting in a 2.6 x 0.7 ovoid mass in upper outer quadrant on right breast...my question is this....the originally imaging and sono's that did not pick up any "issues" in right breast do not have the best result reputation, all other tests were preformed at Northshore/LIJ imaging which has a great reputation, however, were only done on left side....I was wondering if perhaps a sonogram of right should be considered and then a core biopsy guided by u/s considering the size and location it should be able to be seen on sono...I am terrified of going thru MRI machine and know that 6 months from now I will have to again regardless of biopsy results, so if I can save myself an extra trip I would like to....have a call into my surgeon to ask this..have MRI biospy scheduled for 3/24/08 but like I said would rather do a core needle guided by sono if possible..do you think this is a reasonable request and route?

ANSWER: I'm not sure I fully understand your question because if I understand what you have asked you tell me that you have had mammography & ultrasound of both breasts and later breast MRI scans of both breasts AND also biopsies of the lesions seen. In principle I would like you to have check ups in the future with 1. Mammographies, 2. breast ultrasound scans and 3. breast MRI scans all of both sides. I'm not sure it has to be done every 6 months. If needle biopsies are also done on ALL unclear lesions I think it can be done once per year. The reason I want ALL modalities used is that they do not quite see the same thing! They complement each other. If the lesion that should be checked by biopsy can be seen by ultrasound (and that I do not know) then the biopsy can be done using that method. If NOT you will have to do it by MRI (or stereotactically using mammography IF the lesion can be seen on mammography - I do not know that either). That is what is possible.


---------- FOLLOW-UP ----------

QUESTION: thank you for your quick response...i guess my question is shouldn't a lesion of that size (2 1/2 cm)be able to be seen on sonogram? I think the 1 and only bilateral sono was done at a place with poor imaging quality..all other mammos and sonos and biopsies were only of the left this was just picked up doing a bilateral mri...is it worth trying a sono first?

Answer
That depends on the lesion, not everything is seen by ultrasound. You can see much more by MRI. If your particular lesion can be seen with ultrasound I do not know. That is at present all I can tell you.
Of course ultrasound can be tried but it is quite possible that it will not work.