Interpreting Your Report
Comments
-
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.
Absolutely ask for it to be amended for the reason you indicated. Very important. If they were comparing images and it was actually smaller, thats a good sign.
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.
Actually become a solid mass? No. Become more firm and look "solid" because there is no more free fluid it it ? Yes. Like pudding may get more "solid" over time.
Radiologists rarely get excited about things that get smaller no matter what they are, as cancers dont get smaller and that is their main concern. If this thing is bothering you a surgeon could scoop it out for you.
0 -
DJ Mammo, Thanks so much for the very clear and concise answers to my questions. Would you be so kind as to allow a follow up?
They have scheduled me for "both schedule slots" for the MRI guided biopsies (one on each breast) for the same morning. Does this mean twice as long in the machine? Twice as many pushing in's and pulling out's? Twice getting a dose of contrast? If so, it seems a bit much especially when due to two open spine surgeries it's a little tough to manage my normal breast MRI's which I get each year. Should I request they be done on separate days? Or is it really a matter of doing both at once takes less time overall and is worth sticking it out? I am claustrophobic but manage my yearly MRI's without medication by imaging calming scenes and using mental distractions. But I'm usually right at the end of my abilities to manage the physical cramping and mental anxiety as the MRI is just wrapping up. I don't want to screw up the schedules of those trying to help me because I wimp out on them!
Second, you mentioned my biopsy sites are small (which I'm glad!) but correctly hitting two small spaces may take longer right? Might it take longer than usual to "hit" such small targets? Should I figure that fact into the above decision?
Finally, I understand they do a follow up mammo immediately after the biopsy and that is not generally painful since you are still fairly numb. If I have two done over two back to back appointments, wouldn't the first breast numbness wear off before the mammo's were done? Or do they do a biopsy and then mammo and then a biopsy and mammo?
Again, you are more appreciated than you know! This is a wonderful thing you do for all of us!!
Deep Waters
0 -
Thanks so much for the reply djmammo! I called the imaging center and they are having the rad make the change and sending it off to my doctor. 😊
0 -
I had my excision biopsy on Thursday. waiting for pathology report which is expected on Tuesday or Wednesday. Meanwhile, I have a couple of questions/concerns:
First, my BS had said, prior to surgery, that she felt my mass was benign, during needle location, they found another small mass on procedure 3D mammoth. She removed both the initial mass along with this new "little something." She put me on Tramadol, but I seem to be allergic to it.... I itch everywhere. I had asked her about Advil and the like, and she said not until the pathology comes back. So...is she, now, thinking that the original mass might actually be malignant, the new little mass, both? Or is she just being cautious?
As a reminder, the original mass results were:
Sonographic examination fright outer breast demonstrate a focus of hypo echoic, shadowing breast parenchyma, measuring approximately 2.5 chin maximum diameter, ill-defined, with possible associated architectural distortion.
The pathology report that came back following core needle biopsy said: pathology demonstrated remote hyalinized fat necrosis (3-4 mm) with fibro-fatty tissue. No breast ducts or lobules and no micro calcifications present.
Finally, here are the findings from the needle location 3D mammo: Prelocalization ultrasound examination reveals a circumscribed mass with mixed echogenicity in the right breast at 9:00 12 cm from the nipple, measuring 2.1 x 0.8 x 1.8 cm.At the time of wire localization, a smaller adjacent mass was identified inferior to the dominant finding, measuring 1.0 x 0.4 cm.Specimen radiography reveals the dominant mass with tissue marker, adjacent smaller mass and distal hookwire.
Granted, Tuesday and Wednesday are not that far away, but I don't do well with the wait. Im wondering what your thoughts might be on all of this. Thanks!
0 -
nancy, they told you not to take Advil because it is an anticoagulent and could increase your bruising and chances of developing a hematoma, not anything to do with the pathology.
0 -
Since I have never seen a bilateral MRI biopsy done in one day, these would be good questions to ask the people at your breast center.
0 -
If the path report was benign, why was the excision done ? Did the path not match the pictures? What was the original target? The mass or the calcifications?
The path report sounds like an area of old injury or prior surgery. Is there history of either?
0 -
DJ Mammo,
Thanks--I'll ask and post here so others know.
Deep Waters
0 -
DJMammo-
"If the path report was benign, why was the excision done ?"
The path report was discordant with the imaging. Imaging found a 2.5 cm area with all the bad adjectives. The path report came back with a 3-4 mm fatty necrosis.
"Did the path not match the pictures? What was the original target? The mass or the calcifications?"
There were no calcifications. The original target was the 2.5 cm nonpalpable mass.
"The path report sounds like an area of old injury or prior surgery. Is there history of either?"
I have no history of any injury or prior surgery on this breast.
0 -
Well, that is the proper protocol/sequence of events, a sort of fail-safe in case things don't match up. Inconvenient but necessary.
Usually, a discordance occurs when the target looks bad and the bx report is "normal breast tissue" as if the target was missed. When an actual benign entity is identified on path, then one must decide if there is any way that this particular entity can have that appearance on imaging, in other words, "could fat necrosis present as only an area of parenchymal shadowing?" (I see they didn't say 'shadowing mass'). Also, the report of the biopsy procedure should have stated if the marker placed corresponded to the area they intended to sample. You might check on that.
Fat necrosis is benign but it does not occur spontaneously like cysts or fibroadenomas, it is associated with trauma, disruption of fatty tissue. The term hyalinized suggests that the trauma likely occurred in the remote past. Keep us in the loop.
0 -
Hi,
I'm trying to get some information about my MRI Report. In 2011, I had left breast DCIS and was treated with a lumpectomy and SAVI radiation. I had my first MRI last week and received the report which states:
FINDINGS:
Right breast: Dense fibroglandular tissue, with no suspicious ductal or masslike enhancement.
Left Breast: Distortion and scar tissue at 3:00, adjacent to the chest wall, 9-10 CM from the nipple, approximately 7 MM from skin surface. At this level, there is a 7 x 19 mm fluid collection, with slight nodular peripheral enhancement. Enhancement extends laterally along the chest wall. No extension to the axilla. No abnormal hypermetabolic or enlarged axillary lymph nodes.
IMPRESSION:
19 mm heterogeneous fluid collection at the postoperative site, 3:00 left breast extending along the chest wall as detailed above. Slight nodular enhancement. This is no assessed mammographically secondary to distortion of the breast.
Direct ultrasound at this level is recommended. If similar heterogeneous appearance is apprecipated on ultrasound, aspiration may be warranted.
BI-RADS Category 0
Do you think this is anything to worry about or just from my lumpectomy and radiation? I'm waiting to hear from my doctor and most likely get the recommended ultrasound. Thanks in advance.
Nancy
0 -
DJ Mammo,
Thanks for your reply. I hope to speak to my doctor tomorrow.
Nancy
0 -
I have a few questions about the language used in my ultrasound. It says:
"There is a 2.7 cm irregular solid mass in the left breast at 2 o'clock anterior depth. This irregular solid mass is hypoechoic. This correlates with mammography findings. Color flow imaging demonstrates that there is increased vascularity.
There also is a 2.4 cm solid mass in the left axillary tail. This correlates as palpated and with mammography findings. Additionally, there is a 2 mm dilated duct in the left breast at 12 o'clock middle depth. This dilated duct displays internal echoes.
In addition, there is a benign 4 mm lymph node in the left axillary tail. This lymph node displays fatty hilum, and is likely benign.
There is a benign-appearing lymph node in the left axilla measuring 15 mm. This displays normal fatty hilum"
My questions are:
1. What does increased vascularity mean?
2. What does it mean to have a dilated duct with internal echoes?
3. Is the prognosis worse when there are two masses?
I have a core needle biopsy scheduled on Wed. I am prepared for a cancer diagnosis but I really don't understand everything in this report.
Thank you so much for helping.
0 -
Proud_Patriot
What does increased vascularity mean?
On ultrasound you can identify blood flow within masses using the color flow Doppler function just like when they evaluate blood vessels with Doppler. Cancers produce a substance that makes blood vessels grow and this is evident on US with increased flow in the mass compared to the surrounding tissue. Benign masses have less blood flow in them.
What does it mean to have a dilated duct with internal echoes?
This is very a very non-specific finding. Most commonly it is just debris in the duct but could also be DCIS.
Is the prognosis worse when there are two masses?
Only if they are both cancers, that is, two primaries within the breast or one in the breast with the other representing an abnormal lymph node indicating spread of the disease.
0 -
Ok...I have been lurking here for the past month or so. I am now facing my second biopsy this year and I just wanted to get another take on an unexpected finding today. I went into the clinic today because I have been having bleeding from the nipple (more than one duct) since by previous MRI guided biopsy on 4/6/18 (benign results-fibroadenoma). I do already have an appt for follow up in 2 weeks with a breast surgeon to repeat the US and I guess determine the next steps. Have you ever seen pseudoaneurysms before on scan ( i know they mentioned this did not have the typical yin/yang appearance of a pseudoaneurysm)? Could it be some other type of arterial malformation or complication of the biopsy? Also, this cystic lesion is completely new since my biopsy (they could not find it on the 4/6 post biopsy scans), is it possible for something to form that quickly? Thank you in advance for any guidance!!
The following is the results of today ultrasound:
is seen for bloody discharge in the left breast immediately following a breast MRI performed on 4/6/2018. The blood is now brownish in color. The patient has no personal history of breast cancer. The patient has the following family history of breast cancer: sister, at age 41, breast cancer.
COMPARISON:
The present examination has been compared to prior imaging studies performed on 04/06/2018, on 08/25/2016, 01/30/2017, 08/30/2017, 03/23/2018 and 03/26/2018, and on 12/16/2014 and 01/12/2015.
LEFT BREAST ULTRASOUND FINDINGS:
High-resolution real-time ultrasound scanning was performed.
There is a complex cystic and solid mass measuring 15 x 18 x 12 mm seen in the left breast at 3 o'clock located 1-2 centimeters from the nipple. The lesion appears primarily cystic with some internal debris. In addition, there is a 4 mm hyperechoic solid masslike mural nodular compenent within the deep aspect (non-mobile) of the cyst. Blood flow is identified within this hyperechoic nodular portion that demonstrates an arterial waveform with doppler evaluation. However, there is no evidence of to and fro flow or feeding vessels.
IMPRESSION:
Complex cystic structure in the left breast at 3:00 near the nipple with a smaller internal nodular component containing arterial blood flow in a patient with a recent MRI guided biopsy in this location. In review of the breast MRI from 3/23/2018, no enhancing masses are identified in this region and no significant hematoma is seen after the biopsy procedure. It is possible that this represents a late forming hematoma from the biopsy procedure with the hyperechoic vascular component representing some type of atypical pseudoanuerysm (although usually feeding vessels are seen). Alternatively, this could represent an intracystic mass (i.e. papilloma). Given the concern that this could represent a vascular complication, percutaneous biopsy was not recommended. The patient is being set up for a surgical consult within the next 2 weeks at which time a followup ultrasound will be performed. The BIRADS given at this time reflect the uncertainty of whether this could represent an underlying mass. A surgical consult is recommended.
This exam underwent intradepartmental review prior to the final recommendation being made. The results and recommendations of this study were discussed with the patient at the time of her visit.
BI-RADS Category 4: SUSPICIOUS ABNORMALITY
0 -
djmammo, you are offering a wonderful service to the scared and confused people here. I'm wondering if you can clear up something for me. I don't have a copy of my report but I do have notes I made while it was read to me over the phone. I'm 38 with fibrocystic breasts.
Extremely dense breasts, difficulty in reading mammo. No discreet abnormality. Typically benigncalcification previously seen.
7x4x2mm simple appearing cyst at 3 o'clock in the left breast, previously seen on u/s.
A 6x4x2mm slightly hypoechoic, irregular, ill-defined area of concern was found at in the palpable area on ultrasound. (I didn't get the depth or distance from center but the lump is roughly 1 1/2" from the nipple at 2:30 in my right breast.) No vascularity. Possibly tissue variation. BI-RADS 4A, biopsy recommended. (Biopsy was done Friday and I am nervously awaiting results.)
I'm confused. The radiologist showed me that the spot was visible from one angle but looks like normal fat from another. He said he doesn't even know if it's a mass. Is that the reasoning for 4a despite irregular and ill-defined margins? The lump, on palpating, felt like it disappeared between my ribs when pressure was applied from certain angles (with finger tips, couldn't locate it well with flat fingers) and was easier to feel in a reclining position. Is that something that can obscure malignancy? Also, are those dimensions considered taller than wide? No specific orientation term was mentioned.
I hesitated to post in this thread but am trying to make sense of it. The radiologist stated he thinks it's most likely benign for lack of classic cancer characteristics, but aren't irregular and ill-defined considered highly predictive for risk of malignancy?
I likely won't have the results until Tuesday or Wednesday, so any light you can shed on the seemingly conflicting report would be appreciated. Thank you!
Edited to add: Received benign result of fibrocystic changes today but will leave my post in case you'd like to comment for anyone else who runs into a similar situation.
0 -
@djmammo I am waiting on my ultrasound assisted core needle biopsy that I had 4 days ago, any input while waiting is greatly appreciated. I am almost 37 with no immediate family history of BC. I went in for a lump that I had an ultrasound on 2.5 yrs ago (nothing came up back then), but started to bother me for the last 5 months or so. I had a diagnostic mammo then ultrasound, then the biopsy. The reports say:
-Mammogram report says: Irregular-shaped, significant decreased density,spiculated parenchymal density measuring 1.8x1.4x1.6cm at left 2 o'clock, no associated clustered calcification, there are spiculated margins
-Ultrasound report says irregular-shaped hypoechoic mass
-ACR BIRADS 4B
PS: I did have breast augmentation about 3 years ago and I am wondering if that could have caused this?
Thank you!
0 -
djmammo, I’m going in for my biopsy tomorrow and was hoping for your feedback on my u/s report.
Background: 44 years old, screening mammogram showed focal asymmetry that developed since my last screening mammogram; 3D diagnostic mammogram showed same. Followed 3D mammogram w/immediate ultrasound. My mother had breast cancer at age 44.
u/s Findings: There is a .5x.5x.4 cm irregular mass in the right breast at 12 o’clock middle depth 5 cm from the nipple. This irregular mass is hypoechoic. This correlates with mammography findings. Color flow imaging demonstrates that there is no vascularity present. No abnormalities seen in right nodal basin.
BI-RADS 4/5
BI-RADS 4b intermediate suspicion of malignancy
(The radiologist came in and repeated the ultrasound. She said it looks suspicious for cancer, said that if it is, it’s probably been caught early, should consider genetics testing.)
If this mass isn’t cancer, what else could it be? Thank you
0 -
Good news! Had excision biopsy a week ago. Came back benign. Specifically, “it” was identified as a “Nodular Stromal Sclerosis.” I’m attaching the path report.
Could you explain what this is and if it has any meaning for the future? Thanks!
0 -
can you tell me is 0.7 x 0.5 cm is big. I was just informed I have to enhancing masses one on each breast they are the same size axilla is remarkable I am having a biopsy next week and very petrified I got a Bi rad 4.
0 -
Noratara, are you sure axilla wasn't "unremarkable"? Remarkable isn't a finding. A specific description ofa lymph node would be given.
0 -
re: Nodular stromal sclerosis
I am not a pathologist but I assume this is similar to "focal stromal fibrosis" which is an area of benign tissue that will cause shadowing on US similar to a cancer but without a well defined mass on imaging. Did you have vague shadowing on your US, then a benign biopsy which they felt was discordant which lead to your excision?
0 -
djmammo -
“re: Nodular stromal sclerosis
Did you have vague shadowing on your US, then a benign biopsy which they felt was discordant which lead to your excision?”
There was shadowing. The core biopsy came back begnign and was discordant, so we did the excision biopsy. This came back benign. Great news, but my BS said the modular stromal sclerosis was an overgrowth of cells. I’m wondering if, this could be a risk for a future overgrowth that turns out to be cancer? “Overgrowth” of anything potentially can’t be a good thing even though benign now? Thanks
0 -
Yes unremarkable. Ty
0 -
Someone suggested you may be of help!
I am 37. Last year I felt a lump in my left breast. I had a mammogram and ultrasound, likely a Fibroadenoma, but biopsy was recommended. I have breast implants, so they tried biopsy but could not safely get to it without risking the implant. They aborted the biopsy and decided follow up was safe.
Now it's one year later and I had my diagnostic mammogram. That mass has grown a bit, but they still think likely a Fibroadenoma. They want to biopsy anyway due to increase in size.
they also found a new mass on the mammogram. Ultrasound was done and it is irregular, 0.7x0.3x0.8cm. Hypoechoic withAdjacent hypervascularity.
I am scheduled for biopsies of both sites for Monday. They said Somethig about needing surgical excision anyway, but I missed it (anxious at that point- she started questioning fin it was possible ANYONE in my family's Hans breast ca)..
so- any words of wisdom? Is the adjacent Hypervascular good or bad? I know irregular is bad.
Thanks!!
0 -
I have seen this term "adjacent hypervascularity" a few times here, that is a term I have not heard before. "Internal vascularity" is the finding I find can be worrisome. Let us know what the biopsy shows.
0
