Interpreting Your Report
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momallthetime - thank you for your support. I think my husband will be calling Monday to politely make some suggestions about the patient care. I have dealt with this surgical hospital several times and this was the first time we have had this kind of treatment. I believe their mammography suite is a no man's land but you are right, there are other areas they could put a nurse's office. We will insist that my husband be with me after the biopsy as they will have to wrap my breasts because a skin condition makes it impossible to wear a bra and he will have to learn how to help support me in my care.
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What does irregular focal asymmetry mean and is it considered a mass
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The short answer is its not a "mass" per se. "Focal asymmetry" is a term we use when we see something that needs evaluation but does not conform to the definition of a mass on a mammogram. It may be later proven to be a mass on ultrasound but this is how it is reported on a mammogram.
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My anxiety level has been incredibly high since finding this lump. I am waiting biopsy now. Can I get some input on these findings? The radiologist said they do not classify the BI-RADS as 4a, b, c. I am being seen at a Naval Hospital and having some difficulty feeling confident with the level of care receiving. I have being doing a lot of my own research since I feel they are very vague with me and not using appropriate medical terms. I think they're trying to dumb it down for the patient but that is not helping me. It seems as if important wording is missing that should be included based off things I've read in this thread. Any help is appreciated.
MAMMOGRAPHY FINDINGS: There are scattered areas of fibroglandular density. Within the left upper outer breast is a lobular appearing focal asymmetry measuring 15 mm approximately 6-8 cm from the nipple. No masses, or regions of architectural distortion, suspicious calcifications or secondary signs of malignancy are identified on either side. A few prominent lymph nodes are noted in the left axilla.
ULTRASOUND FINDINGS: Targeted sonographic evaluation of the left breast, 1:00, 7 cm from the nipple demonstrates an irregularly margined hypoechoic, parallel mass with a large amount of internal flow and some edge shadowing. This measures 1.4 x 0.9 x 1.3 cm.
IMPRESSION: 1. Suspicious mass in the region of palpable concern in the left upper outer breast. 2. FDA/MQSA Assessment: BI-RADS Category 4 - Suspicious Finding - Biopsy Should Be Considered
I am very concerned about what a few prominent lymph nodes means.
Also, it looks like there are several unfavorable things mentioned in the ultrasound: irregularly margined, hypoechoic, large amount of internal flow, edge shadowing......but only one favorable thing mentioned: parallel.
Any thoughts?
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The report itself is pretty straightforward and uses mostly standard vocabulary. As far as completeness goes I only take issue with the lack of measurements given for the lymph nodes that were deemed "prominent", a term that is meaningless without a measurement of the length of the node, the thickness of the cortex in millimeters and the appearance of the fatty hilum.
"Irregularly margined, hypoechoic" are terms that can be associated with malignancy but not 100% of the time. "Parallel mass" means the long axis of the mass is parallel to the chest wall. It is sometimes expressed as "wider than tall". It means the mass is extending along the natural tissue planes rather than following the duct and destroying tissue in its path. This is a fairly reliable indicator of a benign mass. "Edge shadowing" isn't a thing. Due to the physics of US you can get pretty much anything to show edge shadowing if you hold the transducer the right way. The suspicious finding is referred to as "posterior shadowing" and it is a dark area behind the entire mass (not just the edge) where the sound beam is scattered and blocked by a cancer. Also benign masses have blood supplies too, thats how they grow.
The a,b, and c subdivisions of B4 is not for you, its for the MQSA's yearly quality evaluation of the radiologist. Its a measure of how sure the radiologist is that its cancer and that is compared to all their true and false positive and negative outcomes of callbacks and biopsies. I never used them myself having trained long before they were introduced. I never recommend a pt hand their hopes on a b and c designations. Its either going to be cancer or its not no matter what the letter is.
Let us know how the biopsy goes.
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i am so sorry to keep bothering you but I had my mri done with contrast and the clinic I go to never explains the report, I am told to come back in 6 months, my report says non mass like ductal like subsegmental enhancement in left breast measuring 1.3x1.3x1.4 cm, that is 7.5 cm deep to the nipple corresponding to the index focal asymmetry on mammography, what does this mean
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Thank you, djmammo. That does make me feel somewhat better. I will try to be more patient while waiting.
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hi DJ Mammo- hoping you can help me out with my report: I am 37, lactating and have grandma and great grandma with history of BC.
Bi-rads category 4a. Small, oval benign appearing nodule left 2:30 axis. Superficial in location.
Bilateral axillary regions negative for adenopathy. Breast tissue is homogenous background echotexture-fibroglandular.
On left side at 2:30 axis, small solid hypoechoic nodule in area of palpable concern. Measures 7 x 4 x 7. Minimal internal vascularity. Has sonographic appearance of fibroadenoma or lactating adenoma.
Would you agree with this? Also, they’ve suggested a Core needle biopsy. My OB has suggested speaking with a surgeon as they may just opt to remove it....I really don’t want to go through the bx if it’s just going to be removed anyways?! Would love your opinion. THANK YOU
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An update, they were able to biopsy by guided ultrasound using the MRI report last week. I received the results today. The left side is cancer free, benign changes. The right however is showing invasive Grade 2 probable stage one. I amglad it is not worse but had hoped for grade 1 like previously. So I will need a mastectomy. I am hoping it isn't in the lymph nodes, as they hadn't shown up on the ultrasound. So glad I will be able to get on with treatment. Though I do wonder if I should consider a bilateral.
Thanks for your help at a time I was really struggling with the protracted wait.
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Can you please explain report to me. Concerned about persistence of irregular asymmetry and not sure what is meant by ill defined posterior shadowing. Thank you for your time.
Radiology Report from Diagnostic LT, US Breast Limited LT
Findings: A left ML view as well as spot compression CC and MLO views were obtained. There is persistence of the irregular asymmetry on the spot compression views. This is located within the central left breast. Overlying benign-appearing microcalcifications are present. No definite architectural distortion is identified.
Sonographic evaluation of the entire left breast demonstrates scattered mildly prominent fluid-filled ducts. No well defined solid mass or architectural distortion is identified. There are scattered areas of extremely echogenic dense breast parenchyma with ill-defined posterior shadowing. It is unclear of these areas of dense breast parenchyma correspond to the mammographic findings.
Impression: Persistent irregular asymmetry left breast. Extremely echogenic dense breast parenchyma is noted on ultrasound without a well defined mass
Recommend: MRI with contrast
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Hello Djmammo...I hope you can help me understand my reports ......
ultra-Breast/-LT
IMPRESSION:
1.left 1:00 architectural distortion with possible sub-centimeter sonograohic correlate at left 1 o'clock Ultrasound guided biopsy of the sonagraphic correlate is recommended.
2.No suspicious left axillary adenopathy.
ACR BIRADS 4 (SUSPICIOUS ABNORMALITY)
RPTAT:UU.
CLINICAL INFORMATION:Left upper outer architectural distortion on the screening mammogram.
TECHNIQUE:Left breast spot mammographic views are completed using digital mammography.Targeted left breast ultrasound is performed.
CIMPARSION:screening mammogram from May 9th 2018
FINDINGS:Mammogram: There are scattered fubroglandular tissues.There is a persistent architectural distortion in the left outer upper quadrant.
BREAST UTRASOUND:The targeted leftupper outer breast is remarkable for a 7mm irregular shadowing mass at left 1oclock 5cm from nipple. This is a probable correlate for the mammographic finding. There is no suspicious left axillary adenopathy.
Well there it is ...so nervous thank you for helping me understand all this ..
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Advice? From 2015-2017, I had the following cancers: breast, uterine, thyroid, and a sarcoma on my spine-back. I feel good now. Had my 6 month breastscreening. Birad 3. The radiologist said wait till next screening in November. What do u all think? Same side as before.
Thx
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Its a brief report but fairly to the point. Arch distortion on the mammo plus a shadowing mass on the US is a pretty suspicious and fairly classic. The good news is its small, only measures 7mm on the US. This was a good pick-up on your screening exam by the radiologist.
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Thank you Djmammo so much...I have my biopsy on Monday ....I am very nervous about the biopsy but it has to be done...thank you again for taking the time to help me....
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Djmammo, would a Brachial Plexus MRI find cancer in the axilla if it were there or can an MRI sometimes miss cancer? Thank you.
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When you say "cancer in the axilla" do you mean in the lymph nodes from breast cancer or a primary tumor involving the brachial plexus?
Can an MRI "sometimes miss cancer" ? In order for an MRI to detect a cancer these minimal requirements must be met:
1) the cancer has to be in the field of view (in the location being scanned)
2) the cancer has to be big enough to see
3) the imaging sequence used must be one that renders that particular cancer visible
4) IV contrast must be administered if the cancer sought is known to enhance with contrast
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Thank you Djmammo. I did mean both. I have swollen nodes and pain radiating from the axilla but not tender to the touch. After four negative ultrasounds, I had a Brachial Plexus MRI without contrast. It was grueling, about nine five min and one ten min scans. Nothing was found. How big is big enough? What should I do now? Wait? It’s been worsening over three years, more nodes, more pain, but pain is subtle.. Not on my bc side. Could it be due to no nodes (alnd) on the other side? Lymphatic Congestion? The pain is also in my shoulder and down my arm to my wrist like a constriction feeling of something.
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I have had normal mammograms for the past 10 years. Did my annual mammogram on 5/30, and was expecting the same, but got a call the next day from my doctor's office indicating that i needed to do additional mammo and ultra-sound based on what the radiologist saw (Screening Mammo: BI-RADS 0 Dense - Incomplete Assessment). I did the follow up Diagnostic Mammo and US on 6/04, and the report shows BI-RADS 4, Suspicious Abnormality, biopsy recommended. I can't get the biopsy scheduled for another week, and appointment with the breast specialist two weeks from now. I am worried and don't think i can wait that long to get more educated about my report. My report shows 3 findings that are suspicious and need biopsy, and a 4th finding about lymph nodes with MRI recommended. The BI-RADS shows 4, but as i understand it, the probability for cancer is >3% to <95%. That is a big range, and is driving me crazy. The report doesn't show 4a, 4b, or 4c. djmammo, I am hoping you can help some lights on interpreting my report as follows. The verbiage is like foreign language to me. What do they mean? Are they indicative of cancer? Or more benign that i don't need to worry about?
(1) Cluster of pleomorphic calcifications in the left breast at the 4:00 position. The findings are suspicious
(2) There is a 1.3 x 0.8 x 1.3 cm heterogeneous masslike structure in the right breast at the 11:00 position. The borders are partially circumscribed, partially indistinct. No internal color Doppler flow. No posterior acoustic enhancement or posterior acoustic shadowing. The findings are suspicious
(3) There is a 1.8 x 0.8 x 1.2 cm heterogeneous mass in the right breast at the 11:30 position. The margins are partially circumscribe and partially indistinct. No posterior acoustic enhancement or posterior acoustic shadowing. The findings are suspicious
(4) 3 possible lymph nodes in the right breast (1.1 x 0.5 x 0.8 cm at the 10:00 position 10 cm from nipple, 1.0 x 0.4 x 0.9 cm at the 11:30 position 8 cm from nipple, 0.9 x 0.4 x 0.7 cm at the 11:30 position 7cm from nipple) that the report shows MRI is recommended. However, when the radiologist talked to me after the diagnostic mammo & US and told me about the need for biopsy, he didn't mention the need for MRI at all. I am puzzled as to why he didn't mention that.
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ElsaJ: The biopsy is standard of care to base a diagnosis and then (if necessary) treatment on. It's terrible to wait to have a biopsy, and then it's usually 1-2 days more waiting for its results. Take a close friend or partner with you to the biopsy, if that's at all possible, and if you feel extremely nervous and need some support. Stay tenacious on asking them to work in a biopsy as soon as possible, to alleviate this anxiety. Be sure to ask for clarification about the question about an MRI, either with your breast screening center, that radiologist, a breast cancer specialist, or your primary care provider. If you do have cancer, you've been smart to get in to this annual mammogram. Early diagnosis = early treatment = best outcome. I send you warm support.
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HikingLady,
Thanks for the words of support. I appreciate it. I will post an update after my biopsy
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djmammo,
Just an update. My results did come back as fibroadenoma. Thank you for your expertise while waiting. I am very relieved.
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Hi Djmammo,
I am writting from Brazil.
I am 35 years old and still Breastfeeding my 3y old daughter.
No cases of BC in my immediate family.
I had a routine ultrasound performed last December. My report says:
"At 8'o clock there's an oval mass measuring 5x5x4mm. It's parallel to the skin, hipoechoegenic, with well circumscribed margins and has no posterior enhancement. Birads3".
The radiologist who performed my usg told me to not worry and that was like a lipoma. My gyn reassured me that it was pretty normal and maybe an old galactocele. He told me that in most cases this type of nodule resolves by itself when I wean.
Fast foward to June, I must go for my 6 month follow up ultrasound. It was scheduled to today (june, 12th),but when I went I started to freak out and imagine that my lump would have grown, that I would need a biopsy and that I would found out something very scary and, this way, no able to raise my daughter. So I left without doing the test.
Back to my Home, I realized that i really need to have this ultrasound test done, but the idea is scaring me to death!
Based on my last report, What are your considerations? Am I overreacting?
Many thanks for reading and helping me!
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Hi Djmammo,
I am writting from Brazil.
I am 35 years old and still Breastfeeding my 3y old daughter.
No cases of BC in my immediate family.
I had a routine ultrasound performed last December. My report says:
"At 8'o clock there's an oval mass measuring 5x5x4mm. It's parallel to the skin, hipoechoegenic, with well circumscribed margins and has no posterior enhancement. Birads3".
The radiologist who performed my usg told me to not worry and that was like a lipoma. My gyn reassured me that it was pretty normal and maybe an old galactocele. He told me that in most cases this type of nodule resolves by itself when I wean.
Fast foward to June, I must go for my 6 month follow up ultrasound. It was scheduled to today (june, 12th),but when I went I started to freak out and imagine that my lump would have grown, that I would need a biopsy and that I would found out something very scary and, this way, no able to raise my daughter. So I left without doing the test.
Back to my Home, I realized that i really need to have this ultrasound test done, but the idea is scaring me to death!
Based on my last report, What are your considerations? I’m overreacting?
Many thanks for reading and helping me!
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Based on your report it is almost certainly benign. Go get your ultrasound. Sticking your head in the sand doesn't help anything, and unknowns are always scarier than reality
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Hanna2013 we are all scared. All of the time, for different reasons. You have the little one, that should be a push for you. No excuses. Not to take care of it, and if there is something then it grows then it really becomes an issue. Do the US. You mentioned US but not mammogram. And in the States, MRI is also done when it's not clear on US. I don't know how the system is there. It's socialized medicine, then for sure they will be cheap on your account. But at least, get that test done, if it's nothing to worry about then you are in good shape. If it's something to look into, then you will be in good shape too, because you'd be dealing with something in the early stage.
Let us know. You are not alone. I even think you'd sleep better, otherwise you will keep thinking, what if...Boa sorte.
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djmammo-
Thanks for being here! You are so nice to help explain things to those of us who need it. I have a question for you. My previous MRI said diffuse pattern of parenchymal enhancement within normal limits. Just wondering if you think that means mild? Or ?
Thanks!!
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djmammo, I was wondering if you could help me to understand my report a little more? Background: I’m 35, noted a palpable lump on my right breast. I did have a core biopsy and am currently awaiting those results.
FINDINGS: The breast tissue is heterogeneously dense, which can obscure the detection of small masses. Bilateral benign calcifications. Skin marker indicates area of palpable abnormality in the upper-outer quadrant right breast, middle depth. In the upper-outer quadrant right breast, middle depth there is architectural distortion, and obscured mass and associated fine pleomorphic calcifications. Multiple additional bilateral circumscribed masses are present.
Subsequent targeted right breast ultrasound demonstrates an irregular hypoechoic mass with posterior acoustic shadowing. The mass measures 2.0 x 0.8 x 1.1 cm. There is an adjacent 5 mm hypoechoic irregular mass, likely a satellite lesion. This is within 1 cm of the dominant irregular mass.
IMPRESSION: BI-RADS 5 highly suspicious for malignancy
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Could use some help with location and meaning of report
Small group of calcifications posteriorly on the right, inferiorly and just slightly laterally
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