Interpreting Your Report
Comments
-
I am still wondering about the use of that term. Most dictation in radiology today is via voice recognition software, all of the transcriptionists were let go years ago in most places. I have to wonder if the software "misheard" something similar to "aggressive".
Do let us know how things go and what the biopsies show when the path comes back.
0 -
Thank you DJmammo for taking the time to look at this. I will let you know 🌷
0 -
Hi Djmammo;
Thank you so much as you have been so helpful. I received my biopsy result on yesterday and it is positive for cancer. I feel more empowered to move forward in the development of a plan nowthat I know what it is. I've learned so much more from this website than I knew 21 years ago when I faced my first bout and for that I am forever grateful. I've got a new found mission to raise my voice encourage women with dense breast to demand better imaging. I received diagnostic mammograms and a 3D tomo over a 20 year period and they did not detect my tumor. I am now anxious to know the histology so that I can anticipate my treatment plan post surgery. I am optingfor a BMX with immediate reconstruction.
0 -
hi djmammo, had my diagnostic mammogram and ultrasound yesterday and here is the report. It seems vague to me and while BIRADS is a 3 I am still not at ease. Does it sound like a biopsy is worthwhile or am I overreacting. I like to “trust but verify". Thanks!
Findings: In upper outer posterior right Breast there is a 9mm oval low-density nodule redemonstrated which has a benign appearance. On prior tomosynthesis this was likely a lymph node given the reninform configuration. There is also a persistent 6mm oval nodule in the 12:00 right Breast who’s is also of low density This also has more benign mammographic features on prior tomosynthesis Targeted ultrasounic evaluation does not demonstrate any correlate solid or cystic nodule.
Impression: 1. There are 2 sub centimeter benign-appearing nodules in the right breast. No ultrasound correlate can be identified. 6 month follow-up mammogram of the right breast is recommended to assess stability The need for additional ultrasound evaluation will be determined at that time
0 -
It sounds like the findings were there previously. Is there a date of prior exam on the report? What are the dates of the studies they compared it to? The report is not terribly detailed but there is enough information to go on for now.
In general in breast imaging, if the findings look benign and they have been stable for 2 or more years the current wisdom is to leave them alone. The "reniform configuration" (shaped like a kidney) is typical for a benign lymph node and 9mm is a reasonable size for a benign lymph node. They say less about the second one but they do mention it was there before also. Since it was a 3D mammo the borders of these things should have been adequately assessed. Also in general, if something has been there long enough a report may hardly mention it in a sentence likely starting with "Again seen is the ..." and thats fine for long standing benign findings.
My assumption is if these had enlarged from prior study they would have mentioned that, actually they would have been obliged to mention that fact along with the new measurements. The sonographer could not find them on that day but she also did not find a cancer. Did you have an US last time too?
I would keep the follow up appointment but I don't think there is reason to worry while you are waiting. Let me know the dates as mentioned above.
(PS: I do remember that phrase from the Reagan era. Here it is in the original Russian "Доверяй, но проверяй")
0 -
thanks djmammo
In November 2016 the finding was:
There is a small lowdensity nodule in the auxiliary tail of the right breast on the MLO view which is ovoid in shape measuring up to 7 mm which has the appearance of a benign intramammary lymph node
That is all it says so at best there was only one spot last time, now there are two and if this is the same it has slightly enlarged
Thoughts
0 -
2mm is not all that much in over a year's time. The difference in measurements from machine to machine is at least 1mm. So the question is whether the second one is new, or it was there last time and not mentioned since this last report says it was there previously i think: "This also has more benign mammographic features on prior tomosynthesis".
If you don't want to wait 6 months ask for a repeat ultrasound with a different tech scanning you. Things that size should show up on an ultrasound and be found fairly easily by an experienced tech.
0 -
thanks again djmammo. The tomosynthesis mammogram was just n February 2018 so it doesn't seem like they reference the 2016 report at all. Ugh, I guess reluctantly I may wait out the 6 month
0 -
Hi djmammo, I am new to the community, waiting for stereotactic core needle biopsy on 4/13. Been researching too much and was hoping you can give me your expert opinion. My mammogram report is not very specific, but states this:
“Breast density: heterogeneously dense, which may obscure small masses. Additional views confirm grouped coarse heterogeneous calcifications in the right breast middle depth 30mm from the nipple. They measure up to 2mm. They have increased in number when compared to prior imaging.”
My first calcifications were found mid 2016, birads3, f/u mammogram showed no change. I lost track of time and failed to come back for my 1 year f/u, so this new mammogram is quite late. I’m 40 years old, no previous hx of BC. My research is giving me mixed reviews, I know I shouldn’t research but easier said than done. Just anxious waiting for my biopsy, any further interpretation would be much appreciated!
0 -
Hello Djmammo,
I am not sure why my BI-Rads were a 4. On Monday I am getting a Stereotactic Biopsy.on my right breast I'm already diagnosed with lcis and alh. My 3D mammography and ultrasound findings are:
Fibroglandular tissue is heterogeneity dense. This may obscure a small lesion on mammography. Small area of stable nodularity is noted in upper anterior aspect of the right breast. There is an area of focal asymmetry noted in the central left breast. There are a few benign calcifications noted in each breast. However, there is an area of loosely grouped punctate calcifications in the upper outer quadrant of the right breast not clearly seen previously. There are a few areas of loosely grouped calcifications in the medial aspect of the right breast only identified on craniofacial magnification view.
Everything I am reading says that loosely group calcification is b9. Is this overkill? Thank you!
0 -
Calcifications can be tricky to interpret as you need to take into consideration size, number, pattern, distribution, and behavior-over-time to decide if they could be related to disease. To confuse things more there are many benign conditions that show calcifications, many of which are similar to the malignant ones. As with the appearance of masses there is tremendous overlap in the appearance of benign and malignant calcifications. It takes many years of reading breast imaging to have decent insight into breast calcifications so don't sweat an unsuccessful Google search over the course of a week or two.
If your report discusses only calcifications then I am assuming there is no suspicious mass so that should take the anxiety down at least one notch. The primary concern would then be DCIS which can show a characteristic branching pattern which is not described in the above report. They mention a size of 2mm which is on the large size for an individual calcification, and as a rule the larger the better for benign causes.
The report unfortunately does not mention the size of the collection of calcs nor does it quantitate the increase in the calcs so hard to make a prediction at this point. What might help you cope while waiting for your biopsy is the fact that the calcs have been there for 2 years now, and a mass has not yet become evident on mammo which might be expected if these were malignant calcifications. Any change in the calcs does warrant a biopsy as there are many types of atypia that can present with calcs that, even though not cancer or DCIS, still have to be removed so they do not progress to a malignancy.
**Make sure you tell the office where you are having the stereo if you are on any "blood thinning" medications and they will likely tell you not to have any Motrin like meds for at least a week before the biopsy.
0 -
"Everything I am reading says that loosely group calcification is b9."
I'd hate to think my specialty could be replaced with a Google search.
As I have recently said in this forum calcifications can be tricky to interpret as you need to take into consideration size, number, pattern, distribution, and behavior-over-time to decide if they could be related to disease. To confuse things more there are many benign conditions that show calcifications, many of which are similar to the malignant ones. As with the appearance of masses there is tremendous overlap in the appearance of benign and malignant calcifications. It takes many years of reading breast imaging to have decent insight into breast calcifications so don't sweat a confusing Google search over the course of a week or two.
If you had loosely grouped calcifications that haven't changed in 10 years they are benign. If you have NEW loosely group calcifications they could be in an early cancer. Malignant appearing calcifications do not just appear fully formed in a classic distribution and say "here i am", they have to start somewhere perhaps with just a few randomly arranged in a small group. At this stage we can catch them when they are in the "atypia" phase before they become DCIS or worse.
If "overkill" means making sure you dont have cancer then yes perhaps it is overkill.
Birads 4 means "this might be cancer get a biopsy". There is no lower number to assign when a biopsy is recommended. Let us know how the biopsy goes and eventually the path result.
0 -
Djmammo, thank you for your response, I do feel a little more in control with this information. There is no mass, you are correct. My original calcs were first found when I had a bruise on my breast that didn't go away for months, which is why it was done before age 40. Would it be out of line or impossible for me to request a full report on my mammogram? I feel that the report I was given is just the 'summary' version since, as you said, there is no mention of size/shape/quantity of increase, nor does it mention the pattern. Does "grouped" equate to "clustered" in this case? Thank you in advance for your help, and Happy Easter!
0 -
In my case that's a word choice. The word "clustered" carries a little baggage with it so personally I use grouped when I want to be more neutral in my description and not wanting to convey that I think this is a cancer.
A complete report is yours for the asking. Call the facility and tell them you want the report and a CD with the images while you are at it. Some places have a patient portal where you can sign on and see all your reports. Ask about that too.
0 -
Hello! I’m awaiting the result of a core biopsy but looking for any information I can! I’m 38, an RN, family history of maternal grandmother breast cancer at 65. Menstruation began age 11. BCP for a total of 17 years, with year breaks for each of my 2 children, stopped almost a year ago.
I found a lump, had mammo and ultrasound with the result of BIRAD 4a- 2.8x2.9x1.6 “f and n” complex mass, solid hypogenic with cystic component, focal assymetry in that area. Was described to me as having a vascular component. Cyst next to this area was aspirated during biopsy and was hemmorhagic. My doctor said to me “this looks suspicious. If you had said that you didn’t want a biopsy I would have strongly suggested it.”
I guess I’m analyzing my risk of cancer here. Any help is appreciated while I wait for the results coming in a few days. Thanks in advance for any help you can give!!
0 -
A_RN4
The report says Birads 4a, that’s the lowest level of suspicion in the category that gets a biopsy if that helps.
Your mass has mixed features so it could go either way and as it was already biopsied my 2 cents is really of little value. Your Rad thought it was suspicious enough to biopsy. It will either be benign or it won’t. Take a deep breath and don’t google while you are waiting.
0 -
Hi, You were so right! I had my MRI and the results were "inconclusive" so now I need a US guided biopsy. More waiting,,,
0 -
I posted this as a separate thread but then noticed this post--I hope it's ok to post here as well. I'm trying to interpret my MRI results (BIRADS 4, biopsy done), which followed from a mammogram showing architectural distortion. Report reads in part:
"There is linear non-mass enhancement at 3 o'clock, lower inner quadrant that extends to the lower outer quadrant and to the nipple areolar complex, with heterogeneous internal enhancement measuring 36 x 17 x 16 mm (AP x SI x ML). This finding corresponds to the area of architectural distortion seen on mammogram. Computer aided evaluation of the enhancement kinetics demonstrates initial phase worst curve enhancement is fast 91%, and delayed phase worst curve enhancement is washout 5%."
I found a paper which reads "Early enhancement (2 minutes after agent injection), during which the initial rise of the enhanced curve can be divided into "slow", "medium", and "rapid". An initial peak signal intensity within 90 seconds >90% is defined as rapid enhancement, which is highly suggestive of malignancy".
So it sounds like that fast 91% enhancement is pretty bad? I'm not sure how to interpret the washout number. I'm obviously pretty scared, especially given the size and the fact that heterogeneous internal enhancement is apparently also bad.
0 -
Don't feel bad about not understanding a breast mri report. Those technical descriptions are not meant for you or for your doctor. They are for other radiologists who read the next test you have done. Non-breast imaging radiologists aren't familiar with these either. The Impression, Recommendation and Birads are for you and your doctor. Google will not certify anyone in breast imaging.
More than just the kinetic curves are taken into account when making a diagnosis on BrMRI and they apply differently to a mass vs. non-mass type enhancement. Having any kind of enhancement that corresponds specifically to a mammographic abnormality will get you a biopsy. The odds of a non-mass abnormality being something bad are less than that of a true mass enhancing on the images but they are not 0%.
Let us know what the path shows.
0 -
Thank you for your reply, I really appreciate it.
0 -
New here so hope it I’m asking question in correct place. Thank you in advance, quite worried. I'm 66 years old & had abnormality on annual mammogram. Was called back for diagnostic mammogram & ultrasound . Report says hypoechoic nodule, 8mm by 5mm high with somewhat irregular margins, some low level internal echoes, no internal vascularity or shadowing. Suspicious Bi-Rads Category 4.
Awaiting biopsy next week. Radiologist didn't speak to me however my regular doctor told me had an 80% chance of being benign. I've read that the irregular margins bring it much higher chance of maliguency. Do. These margins makeA malignancy much more possible? With this be more like A 4c?t
0 -
Hi DJ Mammo,
I was diagnosed last April with DCIS, GRADE 3 with comedo necrosis. I had a lumpectomy and 7 weeks of whole breast radiation. As I was beginning radiation, I had an MRI which was recommended by Dr. Lagios who I went to for a second opinion. He wanted to make sure there was no residual dcis before starting radiation. This is what the report stated:
In the lower outer left breast there is a 6x4 mm focus of non enhancement which demonstrates increased signal intensity on the T2-weighted sequence and is surrounded by a 1mm uniform rim of slow progressive enhancement. This is consistent with the lumpectomy site with a uniform layer of granulation tissue. Along the anterior/medial aspect of this cavity, inferiorly, there is one area where the enhancement extends to 3mm.
There is no other abnormal enhancement in the left breast to suggest additional neoplasm.
Impression: There is a uniform rim of granulation tissue surrounding the lumpectomy site in the lower outer left breast, with only one area of thickening of this enhancement, along the anterior/medial aspect of the cavity, inferiorly. This extends up to 3mm. No other additional areas of enhancement to suggest additional neoplasm. Surgical and oncologic follow-up is recommended.
I went ahead with radiation. No follow-up or procedures were recommended based on this report.
I just had my annual mammogram. A few days later I received a call from the technician saying that the radiologist wanted to know if I had had any surgery after that last MRI. I said no just radiation. They called me for additional images on the left breast. Now my new surgeon (my last one has retired) is concerned about the 3mm area on that MRI last year. Could that have been residual dcis? He's s going to confer with the radiologist and get back to me.
I was wondering if you could help me decipher that MRI report. Thanks for any input you could provide.
0 -
Dr djmammo,
I am 44 years old with a family history of breast cancer. I had my screening mammogram every year and called back for diagnostic mammogram and ultra sound last week. I was told that I might have BC and was scheduled a biopsy in three weeks. I am so terrified and don't know what to do. Below is my report:
Findings:
The breast is heterogeneously dense, which may obscure small mass. There is persistent architectural distortion with a few calcification located centrally within the upper inner quadrant right breast at mid depth. This was evaluated further with ultra sound. There are no suspicious masses, calcifications, or areas of architectural distortions.
Bilateral complete diagnostic breast ultrasound was performed.
Right Breast: At 1:00 3cm from nipple, there is an irregular hypoechoic mass measuring 1.1cmx0.7cmx1.0cm with central echogenic foci consistent with calcification corresponding to the mammogram detected architectural distortion. There is no right axially adenopathy.
Left Breast: There is an incidental 0.7cm cyst at 2:00 4cm from nipple. No other solid or cystic masses are seen.
Impression:
1.1 cm 1:00 right breast mass is at high suspicious of malignancy. Ultrasound guided biopsy is recommended.
BI-RADS: 4C – high suspicion of malignancy.
Can you explain the report to me and share your insights? Based on my research this is really like BC. I am so worried but the biopsy won't happen until three weeks later. I can't do anything now. Thank you so much!
0 -
Post operative breast MRI is particularly tricky to read as the margin of the lumpectomy cavity will enhance because of the healing process. Granulation tissue is produced as part of the healing process and it is very vascular and will enhance. One part of this enhancing ring is a little thicker than the rest of the ring so it was mentioned in the report. This should be compared to the pre-op MRI and the path report to see if it coincides with any prior abnormality on the MRI and either a positive or a close margin on the lumpectomy specimen. It could be a small focus of DCIS or it could just be uneven healing too. This discussion should be held between your oncologist and the radiologist unless this concern came from them already having discussed it.
What was on the new mammogram that made them call you back? Can you post that report?
0 -
I sounds from the report that the interpreting radiologist does think that what they found is a small breast cancer. They said the nodes look ok on that side on US which is a good sign.
I assume you will have an US guided biopsy. Here is a good explanation of an US guided biopsy.
I doubt three weeks will make any difference in your prognosis or treatment plan. Good luck.
0 -
Thank you so much djmammo for the quick response. When you say it is a small breast cancer, do you mean in terms of the size it is small? Does that count for anything? It is just so hard to face it - especially hard to wait for three weeks to get the final confirmation!
0 -
DJ Mammo,
When I was called back for more images on the left breast, they asked if I had surgery on that breast since my last MRI. I said no, just radiation. The technician told me that nothing was wrong, they just wanted to image the exact same spot they imaged last year when they found the DCIS. They never re-imaged my right breast so I was surprised when they told me they wanted to do the stereotactic biopsy on that one. My surgeon called me in for a consult about this biopsy. It is scheduled in 2 weeks. This is when he showed concern about the MRI results from last year on the left breast. He said although this mammogram might not have shown the 3mm issue, that could be because it's small enough that the mammogram wouldn't have picked it up. He is following up with the Radiologist on that.
I am just wondering if I should have another MRI on the left breast to rule out more DCIS. It makes me nervous that something could still be there.
This is what my preliminary report says from my digital diagnostic mammogram from 3/21/18:
Indication: status post left lumpectomy and radiation therapy for grade 3 DCIS with closely approximated margins. The carcinoma was manifested as micro calcifications on her 3/24/17 mammogram.
Findings: the breast tissue is heterogeneously dense, composed of 51-75% fibroglandular tissue. This tissue may obscure the detection of small masses.
There is new surgical scarring in the left breast. Magnification views demonstrate the calcifications to have been removed. There has been no worrisome change on the left.
The patient has had a previous benign stereotactic biopsy in the central aspect of the right mid breast in 2014. There are some calcifications superior to the clip. A biopsy of these calcifications is recommended.
RECOMMENDATION: Stereotactic biopsy, right breast 12:00 position.
ACR Category 4 - Suspicious finding
Thank you for your input DJ Mammo!
0
