Interpreting Mammograms: Architectural Distortion
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Is there such a thing as a mammography guided biopsy?
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Just replied to your same question in another thread.
Yes, it's a stereotactic biopsy. I provided a link with more information in my other post.
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For arch distortion, I was told yes there a way to biopsy that using mammo. I have the arch distortion also but first having a biospy on microcalcifications W mammo, but for the arch distortion in another area they said in my case they will likely do my biopsy by mri. It cannot be seen on US so cant use US in my case. Maybe in my case harder to see so mri over mammo. Not sure.
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Beesie…. it is supposed to be a hollow needle core biopsy.
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Yes there are mammogram guided biopsies. As mentioned above, they are called stereotactic biopsies. They are usually done on a dedicated machine where you lie on your stomach. Newer 3D mammo units can have a attachment to do these either sitting or standing up.
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My stereotactic biopsy is by mammo sitting up. I thought the sitting up was weird. Better to know its probably a newer machine then! Makes sense as itsa new facility.
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I've had several stereotactic biopsies over the past 15 years, at a couple of different facilities, and they were always done sitting up. Reading on this site about the ones done lying down, I was always glad to be sitting comfortably (well, relatively comfortably, considering that my breast was in a vice), facing the nurses and the Radiologists, who would always talk to me to keep me calm and keep my focus off the procedure. And with one that went very long (the Radiologist had difficulty accessing the calcifications), the nurse held a juice box so that I could have some sustenance.
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The both of my stereotactic biopsies I had I were on my belly with my breast in a hole and they were done that way. The Ultrasound guided hollow needle core, I was on my back for of them.
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Beesie-good to know. The juice box made me laugh! Love it-need some levity about now. I get my biopsy “sitting up” next thurs. for some microcalcifications. They did a 3D mammo (my first 3D I think only had 2d done before this at a diff facility). So I assume its 3d for the biopsy and prob using the attachment djmammo is referring to. I also get my mri for another breast issue on the same side, diff location (a distortion) the day before because my period messed up the original schedule (showed up early).
Oh how none of this waiting and worrying is good. If it wasnt for my family history (breast cancer plus ADH and just some benign fibrocystic changes) as well as my “heterogeneously dense breasts”, I might not be AS worried. Hard to say. Ive been getting the dense breast disclaimer for years and have confirmed fibrocystic changes on that side as of 10 years ago. (My only other breast mri ever) Sigh....
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Now they called me and moved my MRI to next month (July) because they want to see both the arch distortion plus the area they will mark with the biopsy next week (microcalcifications) at the same time. Doesnt make a ton of sense to me but...ok? I mean the biopy results will be known a week after biopsy, so why look at it again several weeks later when looking at the arch distortion? Weird. I mean theoretically they should know if its an issue way before then? Guess it doesnt matter except way more waiting.
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DJmammo, I have a question about the little marker jobbies they place after surgery. I had a surgical biopsy and they placed markers. Then I had a lumpectomy and they placed more markers. In the recovery room it was discovered that I was bleeding into the surgical site, my boob was the size of a basketball, I went back into surgery where they opened me up again, cauterized again, placed MORE markers and stitched everything together again.
Now my mamms look like my boob was in a duck hunting accident and is full of buckshot. If you connect all the dots it makes a picture of Sponge Bob Square Pants. How on earth is anyone supposed to tell anything by this mess of dots? I counted 13 of them on my last mammo, and there might have been some I missed!
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Question about architectual distortion: Since the imaging technology is so good now, will we start to see more people getting the architectual distortion label on their screening mammograms?
This is what I have as of now. I went to see the BS a couple of weeks ago and looking at my mammos and u/s couldn't even really see what the radiologist was seeing. The BS surgeon looked at my breast with the u/s machine in her office, but nothing stood out to her. I had my stereo this morning. I am hoping for best obviously, but prepping for the worst as I have a strong family history.
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One of the touted features of "3D" mammos is it's increased ability to detect architectural distortion. As with any new technology, the over-calling of findings will level out after a while.
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I know that since I am going through this process it would be best to stay off the internet, but that is proving hard for me. I read that 75% of AD come back malignant. Is AD the new early indicator of cancer with the new technology? I have a strong family history so I am aware of what might be headed my way after my biopsy results next week. AD was a new term to me and the first radiologist I saw had a hard time explaining it.
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Footballmama-I have the same finding after a 3d mammo. Did you have your stereotactic biopsy on a 3d machine? Or something else?
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Footballmama
AD is not a new concept nor a new term. Picture a smooth bed sheet on a bed. Then place a heavy weight on it for a few moments and then remove it. You will have a smooth bed sheet with a focal area of wrinkling in the center that looks different from its surroundings. That's AD.
For example: IDC develops into the classic spiculated or stellate (star shaped) mass. The area of distortion is in part the irregular margin of the tumor and in part the body's reaction to the tumor called the desmoplastic reaction. Together they look like that bed sheet that got crinkled up in one spot. It can be the earliest sign that something is going on in the breast before a definite mass is seen on a routine 2D mammo in a dense breast.
Since the 3D units can display the breast as a series of slices analogous to but not exactly like a CT scan, the AD can be better demonstrated in dense breasts.
I am not sure if that 75% you quoted reflects the new 3D or the old 2D technology but I would say the vast majority of AD that can be visualized as a mass on US will be malignant. The ones that cannot be seen on US usually turn out to be a radial scar in my experience.
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I am a 40 year old who just went for my first mammogram this past month. The mammogram identified a spot on my left breast, which then resulted in a follow up ultrasound and mammogram. They are now sending me for a biopsy next week.
They noted an architectural distortion in my left breast in an area that I had aspirated (it was a cyst) twice in my late 20s. Is there still a chance that this is benign and related to that cyst? How long does it normally take to get the results of the biopsy? I am a nervous wreck and a mom of two young kiddos who need me.
Thank you for your help.
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Can you post the ultrasound report?
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The ultrasound report says this: A focal area of architectural distortion persists within the upper outer quadrant of the left breast. This measures approximate 1.3cm in maximal dimension. The remaining breast parenchyma is unremarkable.
Ultrasound of the left breast demonstrates an ill-defined hypoechoic maaa with associated posterior shadowing at the 12 o'clock position posterity. This measures 1.3x0.8x0.8 cm sonographically. The surrounding breast parenchyma is unremarkable.
BI-RADs 4: Suspicious abnormality. Biopsy should be considered.
Breast composition C: Heterogeneously dense.
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The architectural distortion would not be related to a prior cyst aspiration.
The US findings of an irregular mass with posterior shadowing makes this suspicious for IDC. A biopsy will tell the story.
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Thanks for the quick response, djmammo. Is there a high likelihood it is cancer from that reading?
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I consider that this particular description indicates a high likelihood.
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Thanks. I feel like this just came out of nowhere since I'm so young (40). How quickly will they be able to identify my prognosis and stage of cancer? This isn't a death sentence, right?
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The biopsy will tell the grade of the tumor, examination of the lumpectomy specimen will give additional information. Stage will be determined by lymph node sampling at surgery and by imaging of other parts of the body perhaps by PET scan.
In general cancers measuring 1.4cm and under have the best prognosis if nodes are negative.
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Went through a third round of ultrasounds/mammograms at a top hospital near me. Had a biopsy where they took 7 samples. It came back benign, but they are recommending that I see a surgeon to have what they are calling a radial scar removed. They did not think there is a chance of cancer. Should I still be worried? Do you know how much of the breast they remove when this happens? I see a surgeon in a week and a half. Thank you so much!
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All radial scars are removed as there is a very small chance of malignancy associated with them. I assume they might get up to a 1cm margin around it but your surgeon can answer that more accurately for you.
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Thanks so much, djmammo. Do you know what the urgency is on this kind of surgery? Do they want patients to do it asap, or can it wait a few months?
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Gosh, I hope this is still an active thread. My name is Ashley and I actually posted on another forum on this site but it occurred to me that this would be a good place to also post to see if you could give me your opinion? It is greatly appreciated.🙏🏻
• 6 months ago: persistent Architectural Distortion on 2D and 3D Mammo. No Ultrasound correlate. Biopsy done with benign findings.Here is the report from 6 months ago:
"The findings are benign. Fibrocystic changes could be a reason for the architectural distortion but these results are technically nonspecific. Surgical consultation is recommended for possible excision. At minimum, short term follow up in 6 months"
The benign pathology 6 months ago was apocrine metaplasia, microcysts, and Usual Ductal Hyperplasia.
Q: What does it mean if my biopsy results are “non-specific" to the area of concern? (The AD) Does that mean it does not correlate?
3 days ago I proceeded with an excisional surgery to remove the 1cm area of AD & surrounding tissue. Just curious on what your second opinion Is on this?
• Present day:
@ 6 month follow up 6/29/2020:
1cm AD was re-identified in same spot at the 3:00 o' clock position medially, with biopsy clip close to it. Ultrasound noted a 4x4x4mm cyst with obscured margins also at the 3:00 position but was deemed non-suspicious on report. Sent to breast surgeon to discuss these findings upon recommendation.Wide excision 7/16
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Hi Ashley
Not sure I you're still on the forum. I'm just wondering why they did excisional surgery if you had benign results with your biopsy. Was there something atypical? Thanks!
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6 monthes ago
Impression
Right breast: The right breast has focal asymmetries in the
superolateral quadrant posteriorly and in the anterior 3rd slightly
superior to the nipple for which right breast diagnostic mammography
and ultrasound are recommended.
Left breast: No mammographic evidence of malignancy.
BI-RADS CATEGORY:
Category: 0 - Incomplete; needs additional imaging evaluation
Diagnostic results
Impression
Right breast mammographic asymmetries have no corresponding
sonographic abnormality. No findings worrisome for malignancy.
Six-month follow-up recommended to confirm stability.
BI-RADS CATEGORY:
BI-RADS category 3 - Probably Benign.
Recommendation: Six-month follow-up right breast with mammography
6 mos follow up
RIGHT BREAST MAMMOGRAMS:
Density: The breasts are almost entirely fatty.
The upper outer quadrant of the right breast has increasing
fibroglandular density compared to the prior exam with slight
architectural distortion.
Otherwise no new suspicious masses or calcifications are identified.
This study was interpreted with CAD. Markers: Circle- skin lesion;
triangle- palpable abnormality
No ultrasound correlation
Schedule biopsy immediate. Biopsy this Wednesday.
Should I be concerned?
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