Digital Breast Tomo, Tumor, Surgery, Radiation…Wait

A month ago I wrote about what we thought was a cyst in my wife’s right breast, Following a digital breast tomosynthesis (DBT) and biopsy, the pathology report thought it benign but included a strong recommendation for surgical removal and follow-up pathology.

Our surgeon was disinclined to comment one way or the other until she could actually remove the lesion. She asked if we had questions and I candidly shared one of my clinical colleague’s cautionary observations…”surgeons are inclined to cut.” Our surgeon gave a patient smile and acknowledged the maxim but reiterated the risk of delay vs. gaining more complete information directly from the source. We agreed.

On the morning of surgery, just 2 weeks after the initial DBT screen and biopsy, our surgeon showed us the images she was consulting to plan her incision. Two reference markers had been inserted by the radiologist to help identify the lesion volume. One was a marker clip and the other a radioactive “seed.” She showed us how the two were oriented in the ultrasound, and the irregularity of the lesion itself. She also had a hand held device that zinged audibly when waved over the seed location. Both implants would be removed during the hospital day surgery.

My wife and I appreciated this explanatory bedside image detail. It defused some of the tension and was somehow reassuring. The healthcare professional in me understood the interoperability involved to make this possible on the surgeon’s laptop, as accessed via EMR. No CD transport…

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