Breast lump biopsy

[guru]

So my wife felt something, went in for breast cancer screening at Sukhumvit Hospital, had a mammogram/ultrasound and the report said BIRADS 4a with a biopsy recommendation. 

The doctor tried to take a biopsy sample using a syringe but he said the mass was solid and could not obtain a sample. He has now recommended surgical excision for biopsy.

 

For the surgery, he gave a choice of outpatient local anaesthetic at 27k or 1 night stay general anaesthetic at 89k. He recommends the general. My wife didn’t cope too well with the syringe needle pain today nor the sight of blood but there wasn’t any local anaesthetic used. 

 

Is it worth getting a second opinion elsewhere or does this sound standard? 

Ta

[The Fugitive]

17 minutes ago, guru said:

So my wife felt something, went in for breast cancer screening at Sukhumvit Hospital, had a mammogram/ultrasound and the report said BIRADS 4a with a biopsy recommendation. 

The doctor tried to take a biopsy sample using a syringe but he said the mass was solid and could not obtain a sample. He has now recommended surgical excision for biopsy.

 

For the surgery, he gave a choice of outpatient local anaesthetic at 27k or 1 night stay general anaesthetic at 89k. He recommends the general. My wife didn’t cope too well with the syringe needle pain today nor the sight of blood but there wasn’t any local anaesthetic used. 

 

Is it worth getting a second opinion elsewhere or does this sound standard? 

Ta

Any doctor should warn you that a general anaesthetic carries it's own risk. For this reason, local would be my preferred option when available.

[HauptmannUK]

4A suggests relatively low likelihood of cancer (<10%).  Wife's sister was a 4C.  Had a biopsy with local at Udon govt hospital. I took her to the appointment.  Seemed fine - in and out quickly and she didn't complain.  She ended up needing a mastectomy. That was about four years ago and she's been fine since.

[timendres]

4 minutes ago, The Fugitive said:

Any doctor should warn you that a general anaesthetic carries it's own risk. For this reason, local would be my preferred option when available.

Agreed. With proper pain killers, the biopsy should not be too painful. When I had my biopsy on the side of my face, novacaine was administered and I felt nothing.

[The Fugitive]

5 minutes ago, timendres said:

Agreed. With proper pain killers, the biopsy should not be too painful. When I had my biopsy on the side of my face, novacaine was administered and I felt nothing.

My Mrs had five Schwannoma tumours cut out of a leg under local anaesthetic at a Thai Government Regional Hospital. No pain involved whatsoever.

[Sheryl]

For a solid mass rated BIRADs 4a biopsy is indeed standard and normally done under local. If necessary an oral or IV tranquiluzer may be given to reduce anxiety. This is much safer than general anesthesia.

 

The preferred approach is something called Vacuum assisted breast biopsy (VABB) with ultrasound guidance. This is also a needle but very large gauge , enough to get a solid mass, and attached to a vacuum device. I do not know if Sukhumvit Hospital does this.

 

There is a small hospital in Bangkok purely for breast issues, run by one of the   country's foremost breast surgeons, a woman. Most of the  staff are also women and the whole ambience is designed to make women feel at ease. I suggest getting all records from Sukhumvit Hospital and taking your wife there for the biopsy.

 

www.namarak.com

 

 

[guru]

Thank you to everyone and especially Sheryl. We will certainly try namarak and this VABB procedure sounds better. My wife was extremely anxious about surgery. 

[tandor]

good luck to your wife.

[ChipButty]

Best of luck to your wife, my wife is no 6 years on from the operation she' doing fine I found the hospitals good my wife had the operation done here in Phuket but then switched to a hospital in Bangkok for further treatment, 

[guru]

On 7/19/2023 at 7:45 PM, Sheryl said:

For a solid mass rated BIRADs 4a biopsy is indeed standard and normally done under local. If necessary an oral or IV tranquiluzer may be given to reduce anxiety. This is much safer than general anesthesia.

 

The preferred approach is something called Vacuum assisted breast biopsy (VABB) with ultrasound guidance. This is also a needle but very large gauge , enough to get a solid mass, and attached to a vacuum device. I do not know if Sukhumvit Hospital does this.

 

There is a small hospital in Bangkok purely for breast issues, run by one of the   country's foremost breast surgeons, a woman. Most of the  staff are also women and the whole ambience is designed to make women feel at ease. I suggest getting all records from Sukhumvit Hospital and taking your wife there for the biopsy.

 

www.namarak.com

 

 

We’ve made contact with Namarak and they’ve quoted 63k for VABB. They have requested that we have all the records in hand from Sukhumvit hospital before they will schedule an appointment. We got a dvd yesterday of the imaging but still waiting for the signed doctor records as he wasn’t there. 
 

We can manage Namarak’s 63k VABB (Bumrungrad’s price is 71k on their website)  but just in case anybody knows of anywhere cheaper for the same procedure then that would also help in case funds are needed for any next steps.

She is Thai and has basic AIA insurance through her work. I can’t imagine they will pay all or much of the 63k but we will submit and see what they say. She also has social security and her hospital for that is Sikarin. 
 

Thank you to all for your advice and kind words. 

 

[USNret]

Don’t know anything about AIA, but why wouldn’t they pay for this?

[ChipButty]

2 hours ago, guru said:

We’ve made contact with Namarak and they’ve quoted 63k for VABB. They have requested that we have all the records in hand from Sukhumvit hospital before they will schedule an appointment. We got a dvd yesterday of the imaging but still waiting for the signed doctor records as he wasn’t there. 
 

We can manage Namarak’s 63k VABB (Bumrungrad’s price is 71k on their website)  but just in case anybody knows of anywhere cheaper for the same procedure then that would also help in case funds are needed for any next steps.

She is Thai and has basic AIA insurance through her work. I can’t imagine they will pay all or much of the 63k but we will submit and see what they say. She also has social security and her hospital for that is Sikarin. 
 

Thank you to all for your advice and kind words. 

 

I'll ask my wife which hospital she went to 

 

http://www.rajavithi.go.th 

Edited July 21, 2023 by ChipButty

[guru]

1 hour ago, USNret said:

Don’t know anything about AIA, but why wouldn’t they pay for this?

They may well pay and fingers crossed they do but I fear the plan she has via her company is basic and does not have very high coverage. For the imaging and aborted biopsy sample attempt, we had to pay Sukhumvit Hospital the majority of the bill in excess of what AIA covered. 

[guru]

1 hour ago, ChipButty said:

I'll ask my wife which hospital she went to 

 

http://www.rajavithi.go.th 

Thanks butty.

 

I don’t suppose you know if they have this vacuum assisted biopsy equipment there? My wife would ideally like to avoid surgical excision biopsy and hopefully namarak or elsewhere will be able to obtain a biopsy sample using this vacuum assisted needle method suggested by Sheryl. The syringe needle method attempted at Sukhumvit hospital could not obtain a sample. 
 

 

[ChipButty]

46 minutes ago, guru said:

Thanks butty.

 

I don’t suppose you know if they have this vacuum assisted biopsy equipment there? My wife would ideally like to avoid surgical excision biopsy and hopefully namarak or elsewhere will be able to obtain a biopsy sample using this vacuum assisted needle method suggested by Sheryl. The syringe needle method attempted at Sukhumvit hospital could not obtain a sample. 
 

 

Not sure as my wife had the biopsy done here in Phuket over 6 years ago, I remember it was a needle then, 

 

I know she had a friend that went to Chula, and another who is going to the same hospital I quoted, 

Edited July 21, 2023 by ChipButty

[Sheryl]

6 hours ago, guru said:

Thanks butty.

 

I don’t suppose you know if they have this vacuum assisted biopsy equipment there? My wife would ideally like to avoid surgical excision biopsy and hopefully namarak or elsewhere will be able to obtain a biopsy sample using this vacuum assisted needle method suggested by Sheryl. The syringe needle method attempted at Sukhumvit hospital could not obtain a sample. 
 

 

Rajawithi is a government hospital. While it is possible (not sure) that they do VABB pain relief for the procedure may not be optimal and waits etc will be long and time for doctor explanations limited.

 

From what you describe of her anxiety over this I really suggest you take her to Namarak. Even the decor is soothing.

[guru]

Yes we agree with you Sheryl and will use Namarak. Ideally we wanted to go down this weekend but the hold up is Sukhumvit Hospital and her doctor records. She went on Thursday and they gave the imaging dvd straight away but no records. She called again yesterday and they said still not ready and it takes 5-7 days. I don’t quite understand why it takes so long and Namarak don’t want to schedule an appointment until we have the records in our hands. 

[guru]

So at the request of the nurse at Namarak we finally got the doctor’s report from Sukhumvit hospital which took 6 days. 
 

My wife phoned Namarak back saying we have the doctor’s report and imaging dvd in hand as requested so we would now like to schedule an appointment. The nurse now said that the earliest doctor available tomorrow insists she re-does a mammogram and ultrasound with Namarak. Eh? If that’s the case then why ask for her records in hand before scheduling an appointment. It was only last Wednesday she had it done at Sukhumvit Hospital and my wife says the mammogram was quite painful and would prefer not to redo if not absolutely necessary. The nurse then said there’s a different doctor available later in the day who isn’t insisting it’s redone and will look at what we’ve got before making a decision so she chose that one. That’s exactly what the nurse told us on the phone last week. 
Anyway we are going to Namarak tomorrow in any case. 

[The Fugitive]

1 hour ago, guru said:

So at the request of the nurse at Namarak we finally got the doctor’s report from Sukhumvit hospital which took 6 days. 
 

My wife phoned Namarak back saying we have the doctor’s report and imaging dvd in hand as requested so we would now like to schedule an appointment. The nurse now said that the earliest doctor available tomorrow insists she re-does a mammogram and ultrasound with Namarak. Eh? If that’s the case then why ask for her records in hand before scheduling an appointment. It was only last Wednesday she had it done at Sukhumvit Hospital and my wife says the mammogram was quite painful and would prefer not to redo if not absolutely necessary. The nurse then said there’s a different doctor available later in the day who isn’t insisting it’s redone and will look at what we’ve got before making a decision so she chose that one. That’s exactly what the nurse told us on the phone last week. 
Anyway we are going to Namarak tomorrow in any case. 

Thanks for the up-date!

[guru]

 

Well these last 10 days have been a bit of a rollercoaster but educational. 

 

We arrived at Namarak today and saw a lovely, gentle female Doctor. She read the Sukhumvit Hospital Doctor’s report and Radiologist’s report, looked at the mammogram and ultra sound images. 

 

She said the ultrasound was not clear enough so ordered another. So into see the Namarak radiologist who said she was sure it was a liquid cyst as she was performing the ultrasound. 

 

Back into the Doctor who agreed with her breast specialist radiologist who downgraded Sukhumvit Hospital’s Birads 4a to Birads 3 with less than 2% malignancy risk. According to the Doctor, Birads classification is down to radiologist’s interpretation and experience. 

 

She then said she can do a fine needle aspiration today. We said the Sukhumvit Hospital Doctor already tried that but said it was solid. However, she was not confident he went down far enough and thus misinterpreted. Furthermore, he was a general Doctor and didn’t use ultrasound to guide his needle. 

 

Anyway the Namarak Doctor did the fine needle aspiration using a local anaesthetic (Sukhumvit hospital didn’t offer any local anaesthetic - hence my wife’s pain last week). No pain today and a full syringe of liquid was extracted which looked normal to the Doctor who said no need for biopsy. Back in 6 months to Namarak for next check up. 

 

If we had listened to Sukhumvit Hospital, she would have had an unnecessary 89k surgical excision biopsy under general anesthetic with the associated risks and scar. Today was 6k as classed as out-patient so AIA only paid 1500 baht. If we had waited a week for insurance to pre-approve the cashier said we could have probably got away with it being classed as an in-patient procedure and AIA would have paid in full but we wanted a conclusion today. 

 

Thank you Sheryl for recommending Namarak. It truly is a gentle, relaxing, professional set up and we thoroughly recommend it. My wife also says thank you and if she ever meets you she says she’s buying you dinner. 

[The Fugitive]

26 minutes ago, guru said:

 

Well these last 10 days have been a bit of a rollercoaster but educational. 

 

We arrived at Namarak today and saw a lovely, gentle female Doctor. She read the Sukhumvit Hospital Doctor’s report and Radiologist’s report, looked at the mammogram and ultra sound images. 

 

She said the ultrasound was not clear enough so ordered another. So into see the Namarak radiologist who said she was sure it was a liquid cyst as she was performing the ultrasound. 

 

Back into the Doctor who agreed with her breast specialist radiologist who downgraded Sukhumvit Hospital’s Birads 4a to Birads 3 with less than 2% malignancy risk. According to the Doctor, Birads classification is down to radiologist’s interpretation and experience. 

 

She then said she can do a fine needle aspiration today. We said the Sukhumvit Hospital Doctor already tried that but said it was solid. However, she was not confident he went down far enough and thus misinterpreted. Furthermore, he was a general Doctor and didn’t use ultrasound to guide his needle. 

 

Anyway the Namarak Doctor did the fine needle aspiration using a local anaesthetic (Sukhumvit hospital didn’t offer any local anaesthetic - hence my wife’s pain last week). No pain today and a full syringe of liquid was extracted which looked normal to the Doctor who said no need for biopsy. Back in 6 months to Namarak for next check up. 

 

If we had listened to Sukhumvit Hospital, she would have had an unnecessary 89k surgical excision biopsy under general anesthetic with the associated risks and scar. Today was 6k as classed as out-patient so AIA only paid 1500 baht. If we had waited a week for insurance to pre-approve the cashier said we could have probably got away with it being classed as an in-patient procedure and AIA would have paid in full but we wanted a conclusion today. 

 

Thank you Sheryl for recommending Namarak. It truly is a gentle, relaxing, professional set up and we thoroughly recommend it. My wife also says thank you and if she ever meets you she says she’s buying you dinner. 

Fantastic outcome!