Interpreting Your Report
Comments
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Difficult to say without seeing the report in its entirety.
The first finding you described is suspicious for the margins and its vertical orientation, a biopsy would definitely be indicated for those features and have a Birads 4.
Perhaps you also have what they feel are FA's and they are classifying those as B3. Was a 6 month follow up recommended for those?
A report can only have one Birad #. If there are two distinctly different findings present, the reader should use only the higher of the two Birads and clarify in the conclusion and recommendations.
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Thank you again, DJmammo. I didn't get the full report. I took a picture of the concerning part as I picked up the cd to bring to a specialist.
There were multiple Fibroadenomas on the report, and several cysts.
I think the radiologist made an error then, by giving it a birad score of 3. He does want me to follow up in six months and has scheduled a core needle biopsy. I'm wondering what the chances are that it is benign based on the three characteristics. Nothing else was mentioned in that report. The radiologist also said that it was worrisome because of where it was located. I don’t understand what that means.
I deeply appreciate what you do for us. It's scary and you are making a huge difference. Thank you!
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DJMammo, would you mind telling me if "4D" is a BI-RADS category? I know responding to these messages must take time and attention from the rest of your life, but if you're not too busy, I'm anxiously wondering if "4D" is worse than 4c or if it just means "Category 4, with Dense breasts".
Sorry to be asking a second time.
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Unfortunately, it doesn’t say if it’s in a duct or anything like that. The report only said 6cm from nipple at 5 o’clock. I wish the report was more detailed. I am waiting for an appointment with a cancer center near me that I think will explain more and cause less unnecessary fear. Thank glh
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Had a mammogram and ultrasound done last Thursday, and it shows Birad 4. No a b or c? A mixed solid and cystic mass in right breast. The periphery of mass appears isoechoic/potentially solid.
BIRADS 4-SUSPICIOUS (overall) Biopsy should be considered. Does the "solid" part lean toward cancer more so than not? Thank you in advance for any thoughts you can give. The time you take to give insight the best you can, means the world to us who are left trying to figure it out on our own until proof comes back one way or the other. Of course, the no abc doesnt help much with the anxiety, because I don't know if its on the low end of 4 or the high end of 4 towards a 5. GOD BLESS YOU!!!
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Hi djmammo
I have a few questions. I have a palpable lump on the upper inner quadrant of my left breast. I have subglandular silicone gel implants. I have heterogenously/extremely dense breasts. This lump is not visible even with the metal beads during mammo. This side also has a cluster of enlarged nodes. My previous lump was dx with ADH and some b9 stuff in my right breast measured over an inch wide and long and was only "kinda" seen after numerous views, but was palpable and caused a fair amount of pain. US report didn't mention the hilum but said the nodes were echogenic and recommended biopsy and surgical consult. I talked my surgeon into an mri since my PS said I need one ASAP. I also have pain when I take a deep breath under my right breast like on my breast bone. If this is early capsular contracture, can the MRI pick this up?
I just need to vent here. My surgeon felt the new lump and said it was nothing. I'm honestly sick to death of hearing this from her. She seems totally blasé about this and actually didn't even tell me my "atypia" (what she called it) was something I needed to keep an eye on. I actually didn't even look into the meaning of breast atypia until the beginning of the year when I realized my right breast pain was worse and I had another lump. I had to call my primary and talk with her to get the actual dx of the excisional bx 5 months after the fact. The moral of my story is to be your own advocate! This thing that was taken out last year was growing fast and was painful and yet everyone told me it was nothing and to not worry about it because it hurt. Drs really need to change how they talk to patients. After I figure out what the hell is wrong I'm changing surgeons.
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A simple cyst we leave alone. Anything solid is biopsied to exclude a malignancy. Same with those that are described as "cystic with solid elements".
The 4a, b, c designations is more of a "grading system" for the radiologist. We are evaluated every year on how many cancers we found, how many biopsies we recommended, how often we are right and how often we are wrong. The a b c reflects our level of suspicion that it might be a cancer, B5 being absolutely sure. It is reflected in our final score of false (+) and false (-)'s and is not really intended for patients to draw any conclusions. It is either cancer or it isn't. It either looks like a typical cancer or it doesn't. It is either interpreted by someone who reads 100 mammos a month or a 100 mammos a day. I rarely used the letters myself. A B4 is getting biopsied no matter what and there will be an answer forthcoming no matter what letter I add on to the B4.
opinion:
IMO the letters should go with the B3's as these will either not be biopsied for 6 months or not be biopsied at all. I would rather know how sure someone is that its BENIGN if its being left alone, rather than how sure they are its MALIGNANT if I'm getting a definite answer in short term.
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Perhaps I misread your post but i don't see an US description of the new lump, just of the nodes. How did they describe the lump or could they not see it?
The optimum description of a lymph node gives the measurement of its cortex in millimeters and the appearance of the hilum which is made up of fat which is echogenic (light grey/white) on US. If the nodes are described as "echogenic" in over all appearance I hope that means they are mostly fatty.
MRI is very good for evaluating implants both saline and silicone and there are different imaging sequences for each to optimize the images. It is great for rupture, leaking of saline or silicone, more difficult to tell contracture which is primarily a clinical diagnosis.
See this article on imaging of common implant complications
Also, and this is important, pain when you inhale deeply can be a sign of inflammation in the lung or pleura (the membrane covering the lung) so I would mention that to your doctor(s).
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Thank you djmammo for giving your thoughts!
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Thank you. I wish I knew what my report means, then. I really appreciate your response.
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Hello DJmammo,
I was wondering if you could give any insight to my ultrasound report. My biopsy isn't for another week, because they are so busy, leaving me with nothing but worry. Any opinion on your end would be greatly appreciated.
Birads 4
8 mm 5 cm from nipple, suspicious abnormality
mass is solid/cystic, parallel orientation, somewhat ill-defined margins, and trace peripheral flow. Mass appears isoechoic/potentially solid.This corresponds with mammographic finding. Biopsy should be considered.
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they tried to find the lump on US but couldn’t. It can only be felt when I’m wearing my bra? I’m thinking it possibly sits behind the implant when I’m not wearing any support? Or the implant just obscures the view. I just have no idea why it isn’t palpable when I’m not in a bra or trying to “hold” them. I’m calling my dr today about the chest pain. It’s very bizarre.
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Lumps should be scanned in whatever position you need to be in to feel it whether its sitting up, lying down, on your side etc to have to best chance of seeing it.
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Thank you! It's good of you to volunteer your help this way.
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thank you so much for your help. Yes, I’m assuming that means there is no or only slightthickening of the cortex. I’m surprised at the lack of info on the nodes they supply compared to other US reports I’ve seen. I just read that article yesterday to learn about mri and implants so thank you. Maybe my right side is a lung issue. Guess I’m off to call the dr now.
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Hate to hear the ill-defined is worriesome, but that is all I have been doing since I received the report from Dr. Thank you
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DJmammo, thank you for the heads up on the lung possibility. I left a message for my dr and she’s having a test for a pulmonary embolism ran on me today. Seems to fit the chest pain and some other symptoms
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Hello DJmammo,
Just had my second Mammo on Saturday, last year's resulted in a call back which as it was a baseline didn't freak me out as much. This year's also resulted in a call back for diagnostic/poss ultrasound, I opted for a 3-D this year as opposed to the standard one from last year. All new findings as compared to last year. Last year was a duct on the upper outer left side that just throws fun shadows from what I recall.
They can't get me in until next Monday - which wouldn't be as rough if it wasn't over a long holiday weekend filled with out of town family members and their "how things?" litany. My PCP office just called and used the words "abnormality" and "concerning" so I asked them to please try and expedite the appointment.
Mainly looking for some piece of mind as some of these words are freaking me out...but phrases as "no definite evidence of malignancy" are vaguely reassuring but the worry outweighs that. Peace of mind for me goes both ways - even worse case scenarios are good for me weirdly - just need to know what I'm actually freaking out about.
41, no breast cancer family history, but we have pretty much every other cancer and weird medical condition.IMPRESSION:
RIGHT POSTEROLATERAL TINY ASYMMETRY AND LEFT POSTERIOR LOWER OUTER QUADRANT
NODULE SHOULD BE FURTHER EVALUATED WITH STRAIGHT LATERAL, RIGHT LATERALLY
EXAGGERATED CRANIOCAUDAL, AND SPOT COMPRESSION VIEWS AS WELL AS POSSIBLE
ULTRASOUND AT THIS TIME.
BI-RADS Assessment Category 0: Incomplete, needs additional imaging evaluation.
BD2
BILATERAL SCREENING DIGITAL MAMMOGRAPHY:
CLINICAL HISTORY: Routine screening.
TECHNIQUE: Craniocaudal and mediolateral oblique views of both breasts were
performed and are interpreted in conjunction with a computer assisted detection
(CAD) system.
COMPARISON: February 18, 2017.
FINDINGS: CC and MLO views of both breasts demonstrate scattered fibroglandular
tissue bilaterally. New tiny asymmetry possibly associated with architectural
distortion posteriorly near the nipple line on the right mediolateral oblique
images is not confidently identified in the craniocaudal projection. The
tomographic position suggests that it may lie far posterolaterally. There is
also a new small oval nodule posteriorly in the left lower outer quadrant. No
other definite evidence for malignancy is seen elsewhere in either breast.0 -
If this is the entire report verbatim then your radiologist gets a C- for this report. They get points for comparing to previous, and noticing a difference from that exam, and ordering the proper followup views but "tiny" is not in the Birads Lexicon. There are two new findings and they are both missing measurements in millimeters. No mention of presence or absence of calcifications either. The one with possible architectural distortion is likely the one your doc is worried about. The "oval" one less worrisome from its ultrashort description, no mention of its borders.
The followup mammo will take views not previously obtained including on taken straight on from the side without tilting the machine (90 degree lateral) and the other will be like the top-down one (cranio-caudal) but instead of facing forward they will have you turn so that the tissue all the way out to the outside of the breast is better seen (exaggerated lateral CC). If anything is seen on those they may do magnification views in those positions followed by an US if the finding persists and appears "real".
Let us know how it goes.
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Hi Djmammo,
Hoping you can help me interpret this portion of my Breast MRI report:
2.2 x 1.5 x 2.7 cm T2 hypointense but enhancing ill-defined mass is identified in the 11 o'clock position 12 cm from the nipple. This demonstrates peak enhancement of 101%, initial phase enhancement that is 44% rapid and 32% medium and delayed phase enhancement that is 3% washout, 17% plateauing and 80% persistent.
THERE IS A 2.2 X 1.5 X 2.7 CM ILL-DEFINED ENHANCING MASS DEEPER IN THE 11 O'CLOCK POSITION WITH SUSPICIOUS ENHANCEMENT KINETICS. RECOMMEND ULTRASOUND-GUIDED BIOPSY FOR FURTHER CHARACTERIZATION.
BIRADS 4
I'm currently awaiting the pathology from my biopsy on 3/22. Not too hopeful as the second look ultrasound has worrisome terms such as internal echogenicity, taller than wider, angular margins, etc. Also of interest, the first ultrasound of this same lesion was determined to have no vascular flow
Hopeful for the best but prepared for the worst.
Thanks.
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You have chosen the proper attitude in all this in hoping/preparing. I often use this or a similar phrase with patients.
I often complain when reports don't include enough information, but this one contains a little too much but better too much than insufficient. I usually don't include all those percentages, just a mention of which delayed phase curve is dominant.
There are a few things that concern me. First is the size, nearly 3 cm in greatest dimension. Ill defined is the second, benign things usually have a very well defined border on MRI. There is rapid enhancement with contrast which means its fairly vascular, and that could go either way.
The key to the enhancement kinetics on MRI is how the contrast leaves the mass. If it just continues to enhance throughout the entire exam, that is a favorable sign. This is called persistent enhancement and yours shows 80% persistent. Plateau is when the mass enhances an once it has it stays in a steady state thought the exam, no change up or down. Yours shows 17% of the mass behaving this way. The vessels in a cancer are abnormal and they leak like a sieve. This causes the contrast to clear very quickly from the mass and is referred to as "wash out". Yours has only 3% washout.
Now there is a great deal of overlap of these signs and graphs and they are interpreted with the images in mind. They are based in statistics and there are exceptions to all rules. Let us know what the path shows. Good luck.
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Thank you, so I'm supposed to be a little concerned but not completely freaking out losing my mind - got it! I'm a single mom to elementary kids with no family close by-so my anxiety goes full blown when there's some medical thing without an answer.
... I copied and pasted it directly from MyChart so that's all I get. "Tiny" means nothing to me as it's too subjective. I was thinking it was missing some important information that would have been helpful for me be able to put it in the right box in my head. The AD was what was causing me the most worry so it's nice to know I'm not off base there. I'll be there Monday morning unless I can annoy them enough to get me in earlier and I'll let you know how that shakes out. I'll probably push for the US just to make sure I'm not losing my mind on "what ifs"
thank you for following up!
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Hi, thank you for being so helpful. I will be having biopsies on a couple of suspicious lesions in my right breast (previous CA in left).
But my Ultrasound/Mammo report also describes "an aggressive nodular density in the right breast upper outer quadrant" this is an area I have been having pain in and my doctor has advised seeing BSurgeon, but I can't find any info on what this actually means. Thank you so much, Kylie
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Although that is not a recognized term in the Birads Lexicon, if they really used the term "aggressive", I would have to assume they meant "highly suspicious". If that is the case that will need to be biopsied.
Was that the only description of that mass?
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Thank you for your reply djmammo. The report reads:
There are coarse benign calcifications bilaterally and there is an aggressive nodular density in the right breast upper outer quadrant.
No dominant mass or suspicious griuped microcalcifications or parenchymal distortion is seen.
On Ultrasound there are scattered solid and cystic nodules throughout the right breast.
At 9 Oclock, 7.5cm from the nipple there is a new slightly irregular ovoid solid area measuring 8 x 5 x 6mm. An elongated hypoechoic area, 9 Oclock, 10cm from nipple is noted measuring 20 x 5mm. This appears slightly kore irregular than on the previous study. It appears to have slightly increased in size. No further change is seen in either breast.
My last mammo was a year ago. Thanks
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Thanks for your reply. I found out today i do have breast cancer so wont send original report. So glad i had a mammogram as it cant be seen on ultrasound.
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