Question: I had a core biopsy for calcium in my right breast that showed “focal atypical lobular hyperplasia” – my doctor recommended surgery but I chose to get a second opinion and that said my biopsy was benign and said there was no atypical lobular hyperplasia. I would prefer not to have surgery but I am confused that there could be two completely different diagnoses on my biopsy. Is this common?

Answer: Unfortunately, this happens–pathologists can disagree on diagnoses and that’s why I’d recommend you find out about the pathologists who made those diagnoses. This is relatively easy–you can ask your doctor if he/she knows if a breast pathologist read your biopsy or check on the internet–most hospitals or pathology groups will list their doctors’ training and areas of specialty. If you don’t get a satisfactory answer, consider getting a “tie-breaker” third opinion.

Consider the findings in this article about pathologists agreeing on the diagnosis of atypical lobular hyperplasia (link here to article). As you can see, there were a variety of diagnoses of a case that was sent out as part of a continuing education study for pathologists that represented classic atypical lobular hyperplasia. It’s an enlightening small study…

The main point here is that getting an accurate diagnosis on your core biopsy means surgery or no surgery for you — if there really is atypical lobular hyperplasia, some studies have shown that there can be a more serious lesion on the subsequent surgical biopsy and most doctors would recommend surgery for you.