Interpreting Your Report
Comments
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I am sure your doc has a schedule for these things. Ins will pay for an MRI once a year with your history so it depends on how long ago you had the other one if they will pay, and depends on your doc re: their schedule of follow-up MRI's as regards time since surgery and time since end of radiation. They both affect the images and change over time so let them decide when to get the next MRI. They know what to expect to see when they stick to their routine timing.
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Thanks DJ Mammo. Your input is very much appreciated.
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Hi DJmammo,
I’m 27 and just had US result for left breast out today.
Indication:
Painful breast lump in 12 O’clock position left breast 3-4cm in size
Report:
No prior studies available for comparison at the time of reading
Ultasound of the left Breast
Ultrasound evaluation of the left breast demonstrates an oval Hypoechoic mass with partially indistinct and angular margin at 11 O’clock 3cm from nipple measuring 1.7 x 1.1 x 0.8cm. This lesion is palpable and corresponds to the side of tenderness.
Benign lymph nodes are seen in left axilla.
Impression
There is a solitary solid lesion with partially partially indistinct and angular margin at 11 O'clock position, 3cm from the nipple measuring 1.7 x 1.1 x 0.8cm.
This finding is palpable. Further evaluation is suggested
May need further action.
They had US on my right breast just now and i was asked to do biopsy for both side of the breast. No report was given for right breast US.
Stressing out right now:(
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(((((Yids))))) We understand how stressful this is. So, they have recommended a biopsy of the lumps or did you have one at the time of the US? Can you call for the report of the right breast? What are they suggesting? Breathe and take one moment at a time.
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yes, they recommended biopsy to be done as the don't like the shape of the left breast lump. They have scheduled for me to have it done in May 2018.
I will ask the report from them for right breast US. They only mentioned that they have to do biopsy for right breast as well. Should have asked it from them yesterday
Thank you for the reply
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I am new to these boards and am waiting to go do my genetic testing in mid may due to every woman in my family having breast ovarian and cervical cancer several times all before menopause as well as my aunt 48yrs old and cousin at 20 yrs old testing positive for brca1 gene and my sister 36 yrs old for colorectal cancer, so needless to say im 35 yrs old and worried due to multiple breast changes this year. I had an ultrasound done a few weeks ago but haven't been able to relax since. i feel like somethings wrong and now i have to wait 6 months for ultrasound and until may for genetic testing. Any help you could give me with interpreting my ultrasound results would be awesome.
Multiple hypoechoic masses bilaterally measuring approx. 9mm in greatest dimension in right and left breast, appearance most consistent with simple and mildly complex cystas well as intramammary lymph nodes. most suspicious appearing nodule occurs in the 10 oclock position of the right breast 1cm from the nipple and measures 6x3mm in size. repeat bilateral u/s recommended in 6 months to confirm stability with particular emphasis on lobulated nodule in the 10 oclock position of the right breast approx. 1cm from the nipple. birads category 3 probably benign findings
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hoping you can put my report into English for me. The radiologist only said there was one area she couldn’t say for sure was a cyst.
ultrasound is performed, showing right breast 12:30 o'clock
subareolar location 2 x 2 x 2 mm hypoechoic indeterminate nodule.
Otherwise, several benign
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appearing cysts are seen in the subareolar
right breast, the largest measuring 6
mm. No duct ectasia or
intraductal masses are seen. There is no sonographic evidence of
right axillary lymphadenopathy.
IMPRESSION:
Right breast 12:30 o'clock 2 mm probably benign nodule. Given
patient's clear nipple discharge, ultrasound
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guided core nee
dle
biopsy is recommended
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DJ MAMMO,
I am having trouble understanding my ultrasound report and am going nuts waiting for my genetic testing in mid may (the first opening they had). A little family history... every woman in my family has had breast ovarian and cervical cancer several times and some with a combination all before menopause including my mother at 30 yrs old with both breasts. and for genetic testing my aunt 48yrs old and cousin at 20 yrs old testing positive for brca1 gene and my sister 36 yrs old for colorectal cancer, so needless to say im 35 yrs old and worried due to multiple breast changes this year I have a lot of pain in my nipple almost like a hot iron going throught to my back and constant pain under both my arms. I had an ultrasound done a few weeks ago but haven't been able to relax since. i feel like somethings wrong and now i have to wait 6 months for ultrasound and until may for genetic testing. Any help you could give me with interpreting my ultrasound results would be awesome.
Multiple hypoechoic masses bilaterally measuring approx. 9mm in greatest dimension in right and left breast, appearance most consistent with simple and mildly complex cysts well as intramammary lymph nodes. most suspicious appearing nodule occurs in the 10 oclock position of the right breast 1cm from the nipple and measures 6x3mm in size. repeat bilateral u/s recommended in 6 months to confirm stability with particular emphasis on lobulated nodule in the 10 oclock position of the right breast approx. 1cm from the nipple. birads category 3 probably benign findings
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2 mm is extremely small, and at that size it can actually be too small to tell what it is on ultrasound. It may be a cyst like the others or it may not, but sticking it with a needle will help figure it out.
It is likely not related to your nipple discharge as things that cause discharge grow in the ducts and this finding is not in a duct.
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A fairly routine sounding report. They feel there are multiple cysts ranging from some with clear fluid inside to some having (probable) debris in side them. One seems to stand out but they don't assign it any scary adjectives. When there are multiple such findings on both sides it is not unusual to have a check up in 6 months to reassess them rather than aspirate each and every one of them.
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Thank you DJ Mammo, you have put my mind at ease, the surgeon had me all freaked out talking about waiting on my genetic results to come back and then probably removing both breasts as well as ovaries and uterus. So I appreciate you taking the time to explain this to me. I know i'm new here but I can already tell everyone on theses boards values your opinion.
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Hi there,
Very happy to have found this group as I am a 34 year old woman that found a lump in her breast recently. I went in for an ultrasound today as per my doctors suggestion and I am not sure how exactly to interpret the results. My doctor is on vacation and I was hoping to ease my anxiety a little if anyone can help me understand my report. This is the info on report: Indication - Left breast mass 12 o'clock. Findings-In the 12 o'clock 2C position of the left breast cooresponding to the mass palpable on exam there is a 1.33 x 0.71 cm hypoechoic partially defined solid mass. A capsile can be seen around some of the edges of this lesion but other areas of the border are ill-defined and irregular. There is no increased Vascularity on Doppler. The anxillary nodes appear normal bilaterally. No other lesions are seen on either side. Conclusion: Moderately suspicious left breast mass as described above merits an ultrasound-guided core biopsy for histology. BIRADS 4B. Thanks in advance for your help!
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I received my radiology report today and here is what it says:
Examination of area of concern at 5:30 position of the left breast, 9cm from the nipple shows an approximately 2.3 X 2.0 X 2.0CM irregular, Hypoechoic mass. Bi-Rads 4C - High Suspicion for Malignancy. Letter: B4/5 Biopsy recommended.
Any insight you may have will be greatly appreciated.
Thanks!!
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DJ Mammo Thank you for your response! I will keep you in the loop. Hoping to get in for the biopsy soon so the waiting period can be over.
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Good morning djmammo!!! I’m sorry to be bothering you... I’m waiting for my biopsy this thursday, I had two mammos and an ultrasound last week, the findings in the mammo were inconclusive so they did the us... the results are:
In the 1:00 position there is a 17mm lobulated area with decreased echogenicity. This demostrated posterior shadowing with somewhat irregular lobulated margins. The apareance is suspicious for a small mass. The finding is suspicious for a small neoplasm and is recommended a biopsy
The remainder of the right breast is within the normal limits, no other dominant masses observed. No cystic structures observed. No architectural distorsion is demostrated.
Impression:
BIRADS 4B Intermediate suspicion for malignancy, bx recommended
Follow up: Biopsy
Can you give me any feedback? Thank you so much!!! I don’t know if it matters but I’m 36, with scattered fibroglandural areas...
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The key findings regarding the mass are the decreased echogenicity (looks darker than surrounding tissue on the screen) the irregular borders and the posterior shadowing all of which are suspicious findings in general and would automatically trigger a biopsy recommendation. The use of the rather neutral term "neoplasm" (meaning something growing there that shouldn't be) denotes neither benign nor malignant. Vascularity of the mass was not addressed which is often helpful, nor did they mention the nodes under the arm which I always include in an US exam when a mass is encountered.
Were calcifications seen on the mammogram?
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Thank you for answering!!! They did found calcifications scattered in both breast, and check one structure that was in front of the suspicious area... this is the report of the second mammo, right before the ultrasound that I put the results of...
It say specifically: There are scattered fibroglandular densities throughout both breasts. There are multiple small calcifications scattered throughout both breasts as well. There is a 2.4 cm lobulated nodular opacity located in position 12:00 of right breast. There are several calcifications superimposed on this structure. Therefore, additionalmagnification views were performed and demostrated no abnormal suspicious grouped microcalcifications. There is persistence of the nodular opacity. The remainder of the breasts are symmetric. No other specific abnormallity is identified. Further evaluation with ultrasound is recommended. And I asked about the nodes and the us tech told me that they looked normal but no mention at all from the radiologist interpretation...
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yesterday I had a diagnostic 3D mammogram and US with scheduled biopsy on 4/24/18. The radiologist was very vague-speaking in doctor language- and abruptly left the room before I could ask any questions. The technician did tell me that a biopsy would not have been scheduled if it wasn't needed. Do I worry myself sick over this or is this saying probably benign? I do not understand what this report is saying Thank you.Study Result
Impression:
Indeterminate complex mass in the left breast at 8:00
No evidence of malignancy in the right breast
Recommendations:
Ultrasound-guided core biopsy of the left breast
The patient has been notified of the results.
BI-RADS: (4): Suspicious
Narrative
Exam: Left breast mammography with targeted left breast ultrasound, 4/17/2028
Clinical History: Callback from screening for focal a asymmetry within the lower inner quadrant of the left breast. Family history consists of a grandmother and aunt diagnosed with breast cancer.
Comparison: Comparison is made with prior mammograms dating back to 2014
Findings:
Density: The mammary tissue is heterogeneously dense, which may lower the sensitivity of mammography.
Screening mammogram:
Screening mammography demonstrated a focal asymmetry within the lower inner quadrant of the left breast. There are several adjacent oil cysts. No abnormality suspicious for malignancy within the right breast.
Diagnostic mammogram:
The patient returned for additional 3-D spot compression images and a full lateral image of the left breast.
Within the medial slightly inferior left breast at approximately 8:00 there is a persistent vague focal asymmetry. Numerous benign-appearing oil cysts are noted within the adjacent tissue. No suspicious area of distortion.
Diagnostic ultrasound:
Within the left breast at 8:00 2 cm from the nipple there is a cluster of complicated cysts versus complex mass measuring 1.1 x 0.4 x 0.6 cm likely correlating with the focal asymmetry identified on mammography. Several other fibrocystic changes andcalcified oil cysts are noted within the surrounding tissue. Ultrasound biopsy is recommended with careful correlation of clip placement on the postbiopsy mammogram.
Interrogation of the left axilla demonstrates normal lymph nodes.
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I got my report back and I go for a biopsy next week. It sounds good right??
A focused ultrasound was performed of the right breast. Corresponding to
the mammographic abnormality, at 12:00, retroareolar region is an irregular
hypoechoic mass with circumscribed margins measuring 9 x 6 x 6 mm. There
are similar-appearing masses at 1:00, retroareolar region, measuring 5 x 3
x 4 mm and 4 x 2 x 4 mm and at 12:00, 1 cm from the nipple, measuring 5 x 4
x 7 mm. At 10:00, 2 cm from the nipple, is a vague hypoechoic irregular
region, measuring 1.1 x 0.8 x 1.3 cm, which corresponds dense parenchyma or
a cluster of cysts.
IMPRESSION:
1. Right breast 12:00 9 mm mass is indeterminate although a benign etiology
is favored. Ultrasound-guided core needle biopsy is recommended to will be
arranged.
2. Multiple additional right breast masses are probably benign. Pending
benign pathology of the biopsy, these can be followed up in 6 months with
ultrasound.
BI-RADS 4A (Biopsy is recommended
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Sounds like they expect the biopsy to come back benign.
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@djmammo but how likely are they to be wrong??
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According to Johns Hopkins Hospital Breast Center, Birads 4 "...means that the findings on your mammogram are suspicious and that there is an approximately 20 percent to 35 percent chance that a breast cancer is present."
This is the "built-in error rate" if you will. Most suspicious findings that are biopsied to exclude cancer, are not cancer.
If you are asking what are the chances their interpretation is wrong, then there is really no way to tell. Would depend on the reputation of the breast center, experience of the radiologist reading the exam, the equipment, the techs, etc. They could be wrong that they think its benign but they could also be wrong that it looked suspicious enough to be biopsied in the first place. You will have your answer after the biopsy.
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Hi - I just received my MRI results back and am concerned.
Had diagnostic mammogram & US 6 months ago due to finding a lump in left breast. Came back w/ nothing showing on films & recommendation to FU in 6 months if I still felt like something was up. It's grown in the last 6 months, and now have "shooting pains" throughout whole breast intermittenly, so back in I go. Have strong family history of BC - sister and mother. Have MRI. Specifically for this lump. I get a disc this time. While certainly not someone who can read the images, I can clearly see it in them.
The report does not mention the mass at all in the impressions or findings - simply states no suspicious masses - no malignancies. Gives me BI RADS score of 2 (which is the score you get when you describe what you are saying is benign, right???). Recommends yearly screenings. Sends to my doctor. No mention at all of the mass that was the point of the MRI - whether benign, or not. The text is literally no different than my previous 5 years of normal screenings - could have been cut and pasted. My doctor simply sends me a message and says good news, it's all normal.
Am I crazy for expecting that this mass should have been addressed in the MRI findings? And can I get a second opinion, can I ask for it to be biopsied for my own peace of mind? I did send a message back to my doctor letting her know I was uncomfortable with the result, and asked if she had looked at the films - I haven't received an answer yet. It's grown significantly in 6 months. And again, I can't read these images with understanding, but it's not pretty looking on them at all, and it certainly stands out and is not something you would miss - it's like 3cm. Is it possible the radiologist just did a terrible job on interpretation? Or am I missing some secret code of how this stuff works and I'm truly fine and can stop imaging how my family will ever learn how to replace the toilet paper without me?
Any input here is appreciated.
Thanks -
Shannon
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This is fairly common outcome. You have to remember that not every "lump" you feel in a breast is a mass. MRI is the most sensitive exam there is for breast cancer, and yours was read as "no cancer". All three negative exams taken together, Mammo + US + MRI , are near 99% reliablenin excluding cancer.
"...but it's not pretty looking on them at all, and it certainly stands out and is not something you would miss - it's like 3cm."
Yes there is a 'secret code' that you are missing. It takes many many years for a practicing radiologist to become an expert in reading breast MRI. The best are trained and certified by the ACR, and my certificate hangs on the wall of my office. When errors are made reading them it is usually an "overcall", that is saying there might be a cancer when there isn't, not the other way around. Unless Andrea Bocelli read your study, it would be hard to miss a 3cm mass, benign or malignant.
Go to a breast surgeon and ask them to biopsy your mass as it will have to be done by palpation since it cannot be seen on imaging. Most radiologists will not attempt to biopsy something they cannot see. Let us know what the biopsy shows.
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Hi DJ Mammo. A moderator suggested on post here. I'm 53, have a strong family history of BC, and "extremely dense breasts" which have resulted in me having bilateral breast MRI's yearly which have always been negative.
I have a new clear discharge from a single duct of my right breast. My last bilateral MRI 11 months ago was negative. They moved my next one up due to the discharge. The report from that MRI a few days ago:
"On the right there in the anterior 6 o'clock position there is a new 0.3 x 0.8 cm linear nonmass enhancement. This represents a change from all prior exams. It is unlikely to be seen with targeted ultrasound. MR guided biopsy is recommended.
On the left there is a new 0.3 x 0.4 cm rim-enhancing mass in the 10 o'clock position middle depth. Targeted ultrasound is recommended. If ultrasound is negative, MR biopsy will be needed."
I was told the right (with the nipple discharge) is Bi-rad 4b and the surprise finding on the left 4c.
Ultrasound could not locate either mass so they are now saying I need MRI guided biopsies on both breasts.
My questions: Is non-mass better or worse than mass? Does linear usually mean it is following a duct? Do they ever do BOTH biopsies during the same MRI? One nurse told me the contrast dissipates too quickly to do that but why not use two doctors at once? Is there a technical reason? The doctor seemed to indicate "rim enhancement" was not a good thing—what can you tell me about that? What else can you tell me about this report?
Thanks and sorry for the length!
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@djmammo Andrea Bocelli ....that made me snort!! Okay, that makes me feel way better that the report wasn’t just a template, which crossed my mind, and I’m good with accepting it not being cancer most definitely - I think my main concern is the lack of addressing it, and still giving it the rating of 2. It just didn’t go together for me and made me uneasy. I would have expected more of an explanation that it was a cyst or fat tissue or something. This gives me peace of mind and also a direction for further discussion with my doctor if I feel strongly enough about it. Thank you so very much!
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djmammo, I am hoping you could give me your opinion on my recent U/S report. Background is nonlactation mastitis May 2017; August/September 2017 retracted nipple and mass in retro areolar region; Sept./Oct. 2017 various ultrasounds which show complex fluid collection (1.5x1x1.1); Oct. 2017 Biopsy preformed due to lack of fluid which confirms inflammatory cells; and my most recent 6 month follow up report:
CLINICAL HISTORY: Post biopsy November 2017 [was actually October 10, 2017], inflammatory cells, retroareolar mass.
Comparison is made to bilateral mammogram and right breast ultrasound from September 2017.
The previously demonstrated hypoechoic soft tissue density in the retoareolar region has decreased in size now measuring approximately 7.5 cm in maximum dimension [see above the previous size so this seems like an error]. Minimal vascularity remains but there appears to be a decreased inflammatory change and no associated fluid collection on today's study. Overlying skin shows no significant thickening.
The patient report a previous biopsy demonstrating an infection. There is an ongoing palpable lump but no pain.
IMPRESSION: The palpable lump corresponds to some persistent hypoechoic soft tissue in the retroareolar region. This may reflect some residual grandulation tissue or scarring post infection. This could be followed clinically and certainly if there is a concern of change in size, further follow up ultrasound would be recommended in 3 to 6 months.
BI-RADS 2
So two questions:
1. Given the error in measurement, should I raise a fuss and ask that the report be amended? My concern is with future imaging if they rely solely on this report as reference my next imaging [if no change in size] will reflect about a 6 cm decrease in size.
2. Is it normal to have an abscess turn into a solid mass after a biopsy? Does their guess seem logical or am I right to continue to pursue having this lump resolved sooner rather than later? My GP is sending to a BS on my request.
Thanks for your insight.
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Is non-mass better or worse than mass?
Non-mass is often nothing, related to the enhancement of normal tissue being somewhat assymetric, other times it is DCIS. Mass is always something, either benign or malignant but will show different features depending on which it is.
Does linear usually mean it is following a duct?
The short answer is Yes.
Do they ever do BOTH biopsies during the same MRI?
I have never seen that. The MRI center usually only has one MRI-safe core vacuum biopsy device, and only one biopsy targeting set-up as they are both VERY expensive items. It would also be unusual to be able to find 2 rads who know how to do this type of procedure to available at the same time, that can be spared from their other duties.
One nurse told me the contrast dissipates too quickly to do that but why not use two doctors at once? Is there a technical reason?
True. See above.
The doctor seemed to indicate "rim enhancement" was not a good thing—what can you tell me about that?
That is one feature that is common to malignancies of the breast but no one finding is 100% reliable for that, we look at a half dozen or more features of a single finding to make a decision.
What else can you tell me about this report?
The findings are extremely small which is good for you but tough on the ones doing the biopsies. If the enhancement on the side of the discharge is in a duct, forward near the nipple, it may be the cause of the discharge.
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