Digital Breast Tomo, Tumor, Surgery, Radiation…Wait

Tom Zimmerman

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 or delays had been necessary from the cross-town women’s health center where the images had been acquired just 90 minutes earlier. One less concern for the patient and her husband in the midst of this unnerving process.

As the team wheeled their way towards surgery, I was given a small card with colored bars and a six-digit patient number. During the next few hours I was able to track my wife’s color-coded progress through prep, surgery and recovery – all on a large flat screen monitor in the surgery waiting room. No need (excuse) to harass the receptionist, and no worries when I went down to the cafeteria to grab coffee.

Within minutes of the colored status bar turning ‘blue,” for recovery, our surgeon found me. Still in scrubs she said the tumor (no longer cyst or lesion) was excised with “good margins.” Studying my blank expression, she added, “It was encapsulated…all contained, a good thing.”

But not all good. The encapsulated tumor was indeed cancerous. So, with a fair likelihood of reoccurrence (20%), our patient is currently completing her eighth of twenty targeted radiation treatments. Fortunately, chemotherapy isn’t indicated at this point and we expect some temporary fatigue and skin discomfort during the next six weeks. Not temporary, I suspect, will be the awareness of how quickly cancer can move to the top of your daily priority list.

I also have a renewed appreciation for what we do in our daily work (my wife also works in healthcare). Technology makes a difference. From early diagnosis to informed decision making and lifesaving treatment plans, we had contact with products and applications that become game changers in the hands of kind and dedicated professionals.

My heart goes out to patients and families who have much greater struggles than ours. Please be encouraged in all you do.

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