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Saturday, October 25, 2014
Stroma fibrosis that has grown
I had an MRI of an area of question in my breast 6 months ago. The diagnosis was stroma fibrosis. A repeat MRI was done last week and revealed the stroma fibrosis to have grown. The breast surgeon wants to remove the growth "to play it safe" telling me stroma fibrosis usually does not grow. What is your opinion on removal vs. watching the area and can stroma fibrosis (benign) actually be malignant?
If your breast surgeon suggests removing an area that has grown, I would completely agree. An MRI cannot tell if something is definitely fibrosis, it can only determine that something looks like fibrosis. If the area changes, a new direction of thought is indicated. MRIs can lead to false positive results (tests that look abnormal but are not cancer), but when there is a question, biopsy may be needed. You might ask your doctor if there is there a way to sample by needle, instead of an operation with a real excision and removal of the entire area. Some institutions do "second-look ultrasound" with needle biopsy, and if the area that is seen on MRI can be found, then a needle biopsy is done. Or an MRI-directed needle biopsy might be done. If you have not had a discussion about these possibilities with your breast surgeon, perhaps these specialized techniques are not available where you are, and a second opinion might help. But just waiting after biopsy has been advised does NOT seem like the correct plan. There are lots of factors here that I cannot assess-- why are you getting MRIs, have you had previous biopsies or cancer, what is the expertise of the center doing the MRI, how old are you and what risk factors do you have, etc. So discuss all that with your breast surgeon and/or get a second opinion.
Paula Silverman, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University