Interpreting Your Report

Tangler

djmammo-

I had my mammogram, they found several lumps in both breasts with the largest being 15 mm X 12 mm.  They called my old films and compared and none of the lumps were there before.  So now, I am scheduled for an Ultra Sound.  Can you please help me under the following "US Breast Bilateral with HCT US1" means?  I understand "US" is ultra sound, "breast bilateral" is of both breasts, what I don't understand is what does the "with HCT US1" mean?  My ultrasound is scheduled for next Wednesday, 11 Jul.

FLO_66

djmammo-

Help please with interpreting my MRI w+w/o Contrast . Reads as follows:

Clinical History: Elevated Tyrer-Cuzick score of 27%.

Right Breast: Within the right breast, in the area previously identified as having calcifications at mammography there is regional enhancement which is mild but diffuse involving an area measuring at least 3.4 x 1.7 cm in size. Along the interior margin of this area of clumped enhancement, there is an 11-mm well-circumscribed nodule which demonstrated plateau kinetics. This nodule is hidden behind dense breast tissue on mammography. It is not readily apparent. No other area of suspicious enhancement or nodularity is identified within the right breast.

Impression: Suspicious

There is an enhancing nodule within the right breast with associated clumps surrounding enhancement. This is in the region of milk of calcium identified at mammography but the overall pattern of enhancement looks abnormal.

Recommendations: Targeted biopsy of the enhancing well-circumscribed 11-mm nodule is suggested. Sonography of this area could be performed to try to identify this nodule. If the nodule is not visible at ultrasound, MRI-guided biopsy would be necessary.

I would appreciate your insight/interpretation as I'm feeling lost. Family history of breast cancer, sister and maternal aunt. Thank you in advance.

Cathy1975

Djmammo,

I posted my results.. but I guess it got looked over. I had my biopsies done last Tuesday and will get my results back this Tuesday. Any info would be greatly appreciated.

I recently had a mammogram and ultrasound my results are: heterogeneously dense breast tissue 9:00 position irregular hypoechic 5×9.5mm solid mass without internal vascularity and no shadowing. Consider u/s guided biopsy.
12:00 position a Stellate solid lesion with mild internal vascularity 5×7.5mm no suspicious shadowing. U/S guided biopsy should be considered.
Bi-Rads category is 4: suspicious abnormalities
What are my chances of cancer?
I do have a family history of breast cancer, lung cancer, stomach cancer and colon cancer. I'm disabled. I was ran over by an SUV in 2005 so I don't get much exercise

djmammo

Tangler

what does the "with HCT US1" mean?

Its not anything I recognize. It may be the initials of the US tech and the ultrasound room number.

djmammo

FLO_66

None of the terms used to describe the nodule put it clearly in either the benign or malignant category.

The term "milk of calcium" describes a kind of clearly benign calcification. An 11mm nodule should be visible on US for the purposes of further evaluation and for biopsy.

djmammo

Cathy1975

The terms used for describing the findings are those used for suspicious lesions: irregular, hypoechoic, stellate. With those features, if it were cancer, I would have thought there would be internal vascularity and shadowing but the report indicates those were not seen. The findings are a bit contradictory. Let us know what the biopsy shows.

Cathy1975

djmammo,

Thank you for the reply. I will get my results back Tues at the Dr. It shows mild internal vascularity and no shadowing ?

Tangler

djmammo,

Thanks for the rely.  I will wait and see on Wednesday what is happening.  If I have more questions, I will post them here!

Cathy1975

djmammo. I sent you a pm... Thank you in advance

FLO_66

djmammo

I sent you a pm.

Thanks in advance.

Cathy1975

djmammo,

Thanks for all your help. I'll get my results today and I will let you know the findings.

Cathy1975

Got my results... Fibroadenoma!!! Thank God. Thank all of you for your kind words and b9 vibes. I'm having surgery June 23rd. To remove them. Dr said we should remove it cause there's a 5% chance if left alone it could become cancer.

Mrsbaker

Hello,

I'd appreciate insight you can offer. I had a screening mammogram last month, called back for a diagnostic and ultrasound. Results of screening mammogram are as follows: There has been no change in the left breast from previous mammogram from 2016. The breasts are fatty and glandular. There is increase in calcifications in the 12:00 retroareolar area of the right breast associated with focal asymmetries. Magnification views right breast and ultrasound right breast suggested.

Findings from my diagnostic:

INDICATION: Increased calcifications and focal asymmetry right retroareolar.

FINDINGS: The mammogram views demonstrate resolution and dispersal of the asymmetries into normal-appearing fibroglandular tissue. A group of pleomorphic microcalcifications at the 12:00 position have a suspicious morphology. Ultrasound at the 12-12:30 position shows several small cystic structures with enhanced posterior through transmission. Echogenic foci may represent the back walls of cysts, or microcalcifications. No solid lesion.

IMPRESSION: Group of microcalcifications with suspicious morphology at the 12:00 position of the right breast are recommended for stereotactic biopsy. BI-RADS 4A

I've been reading up on microcalcifications. Pleomorphic doesn't look good, correct? But 4A is hopeful?

What about the cystic structures? What does enhanced posterior through transmission mean? And Echogenic foci?

Thank you so much!

Edited to add: I’m 42. No history of breast cancer in family. Had a benign complex cyst (core biopsy) in this breast 7 years ago.

djmammo

Mrsbaker

Pleomorphic means the calcs have a variety of shapes and sizes. We would rather see small smooth round calcifications that all look alike.

Important features of calcifications are their arrangement/pattern, distribution within the breast and how large an area is involved, none of which is mentioned. Also it seems from the report they were present in 2016 and they have increased in number(?). I have to assume whoever read the 2016 study felt these were benign so if you have had exams dated prior to 2016 they should all be reviewed and compared to see the behavior of these calcifications over time if they have been present on additional older studies. It is encouraging to see that over a two year period no solid mass has developed in the area of the calcifications.

Simple cysts are benign and "enhanced posterior through transmission" is one sign of a benign cyst. It relates to the physics of sound traveling faster through a liquid than a solid. This also produces a sharp curvilinear echo from the back wall of the cyst making it look very well defined, which is another benign feature.

Echogenic foci in this case are likely the tiny scattered white dots on the images representing the reflection of the sound waves from the calcifications or from the back walls of the cysts which I feel must be very small if they are similar to the echos from the calcs.

Let us know what the biopsy shows.

Mrsbaker

Thank you so much for answering my questions. My biopsy is Monday and I will post results. For what it's worth I've had all my mammograms at the same hospital since my original/baseline for that complex cyst 7 years ago. I had yearly ones for a few years following that cyst, then moved to every two years. I do remember them mentioning calcifications way back then, but they were not concerned at the time.

The pleomorphic worries me. I've read stories where they have come back benign. And I'm trying to take some comfort in the 4a, but still preparing for the worst. The waiting is so hard.

What else could cause pleomorphic calcifications?

kareli

Hello! Have been lurking for a while. I am BRCA2 positive, 51 year old female, no kids. Mom survived breast cancer and died of uterine cancer 23 years after BC.

Have had normal mammograms for years at same imaging place. Had last mammogram this March. It was normal. But dense tissue.

Due to recent discovery I am BRCA2 Carrier was sent for MRI on June 19th. MRI results state:

Heterogeneous fibroglandular tissue bilaterally with mild background enhancement.

In the right inferior outer quadrant, 7 o'clock, approx 5.5 cm from the nipple, there is a linear area of nonmass enhancement, measuring 0.5-0.6 cm with predominantly plateau enhancement pattern on the CAD stream and mild progressive enhancement. On the corresponding T2 weighted images, there is a small focus of bright T2 signal within the area suggestive of a small component of cyst in this region. Otherwise, there is mild background enhancement with small scattered enhancing foci. No size significant axillary or internal mammary chain adenopathy.

Second look ultrasound was recommended. If negative, follow up MRI in 6 months to ensure stability.

Left breast had no suspicious areas of enhancement.

Any thoughts from the experts on how worried to be? I have second look u/s on July 29. LONG wait.

Thanks in advance. Great forum. 😊

EDITED TO ADD: BIRADS 0

Hanna2013

Hi all especially MelissaDallas and momallthetime,

I thought a lot about you suggest me, then talked with my gyn and he indicated me a MRI. Of course I googled and read MRI are very sensitive and rises a lot of false positives...and of course I got scared.

Btw, I couldn't live without knowing, so I went and had the MRI done. The procedure was very simple and to be sincere stay laying down for a couple of minutes was pretty easy for me, a mom that never have an opportunity to lay down in the middle of the day 😂.

I got my results today and the MRI came back as a birads 2, only some cysts were found (very small, the biggest is 7mm) what is a huge relief!!

Thanks a lot for this amazing community and just to let more people know about a birads 3 that turn out a birads 2 after 6months follow up.

Obrigada

djmammo

kareli

A very common and very non-specific finding, and very "reader dependent" in my opinion. The followup US is the important study now.

Katie913

Hi I am 32. I had a follow up ultrasound a few days ago and I'm unsure what this means? Does this mean there are 2 masses one ok and one not? Or is this saying the one mass has changed to not so good.

OMPARISON: Right breast ultrasound 12/22/2017, bilateral diagnostic mammogram 12/22/2017

INDICATION FOR EXAMINATION: 32-year-old female presenting for ultrasound evaluation of a palpable right breast lump. This was evaluated in December 2017, and has not clinically changed. In addition, on the prior outside diagnostic ultrasound, an oval hypoechoic mass was seen at the 12:00 subareolar position, for which six-month sonographic follow-up was recommended.

TECHNIQUE: Real-time grayscale images were obtained. The entire breast was scanned, including all four quadrants and axillary regions.

FINDINGS: At the 12:00 position 3 cm from the nipple, corresponding with the patient's palpable lump, there is an oval hypoechoic mass with indistinct posterior margins and internal vascularity measuring 5 x 4 x 5 mm. This was not seen on the prior exam. Ultrasound-guided biopsy is recommended. At the 12:00 subareolar position, there is redemonstration of an oval circumscribed hypoechoic mass with parallel orientation measuring 7 x 2 x 6 mm. This is amenable to continued ultrasound follow-up.

ASSESSMENT:
BI-RADS CATEGORY (4) suspicious. Biopsy should be considered.

RECOMMENDATIONS:
Right Ultrasound-guided breast biopsy of the hypoechoic mass at the 12:00 position 3 cm from the nipple.
Right Follow-up diagnostic breast ultrasound in 6 months for continued follow-up of the hypoechoic mass at the 12:00 subareolar position.

kareli

thanks so much for the reply. It’s very appreciated.

djmammo

Katie913

There are two. One was seen before and again a short term followup is recommended for it.

There is a second one now not previously seen. It is smaller than the first one. One or two features of it are a little suspicious, primarily the indistinct posterior border but it is described as oval which is seen more in benign masses than in cancers but this finding is not 100% in that regard.

The biopsy is a good idea just to make sure. Let us know how it goes.

FLO_66

djmammo

Thanks for the pm. The saga continues. I went for the ultrasound today, just to be told I was at the wrong location. I asked to see the patient advocate and was directed different ladies who listened to the run a round I was being given, apologized profusely, and made things happen.

Today I had the ultrasound, followed by a face-to-face with the radiologist. He confirmed I have two masses (Not one as claimed before) and wanted to do the biopsy today. He took 3 biopsies from two masses and promised to personally call me as soon the results were available, probably Monday or Tuesday of next week.

Katie913

Thank you so much! My biopsy is July 25. I will update as soon as I get some results! Thank you again

Mrsbaker

I got my results. (Biopsy was for increased pleomorphic microcalcifications).From the pathology report:

- Non-proliferative breast tissue with:

Sclerosing adenosis

Columnar cell change

Fibrocystic change with apocrine metaplasia

- Microcalcifications are noted associated with benign epithelium

-Negative for epithelial atypia or carcinoma

Does anyone know if any of these increase my risk? Breast specialist recommended a mammogram next year, then after that returning to every other year (my usual routine).

Katus28

Hi DJmammo

My MRI showed an oval 8mm mass with associated architectural distortion, concerning for neoplastic pathology. Type 3 enhancement.

Mammogram showed spiculated mass with architectural distortion, as did ultrasound which also mentioned Hypoechoic.

Core biopsy was rendered inconclusive as it showed scraping adenoids but not in line with radiological findings. I have a wide local excision where they removed a 5cm by 5cm area, awaiting results.

What does all this mean? The terminology really confuses me

mrsamysully

If someone could explain any further about my core biopsy results I would so appreciate it!

I'm 39, presenting with sharp pain in left breast, sometimes into arm pit. Paternal grandmother passed away from MBC, also had an aunt on that side of the family that had BC before age 40. Had u/s initially, then mammo, then tomo?? mammo, finally biopsy.

Asked for the pathology report because Dr's receptionist just called to say it was benign fibroglandular tissue and that was it! They want another u/s in 6 months. Am I in the clear??

A. LEFT BREAST, NEEDLE BIOPSY 12:00: Each block is examined with 6 levels and SMMHC/CK8/18 immunostains. Sections from the core biopsies demonstrate fibroglandular breast tissue with stromal sclerosis. In section A2 there is crush artifact around the glandular component of the breast tissue, hence difficult to assess this area and some detached ductal epithelium. There is no overt cytologic atypia or mitotic figures. The SMMHC/CK8/18 immunostains show benign ducts with myoepithelial cells around them and some focal groups of cells interpreted as detached epithelial cells.

Although there is no evidence of in situ or invasive carcinoma in the sections examined, correlation with clinical and radiological findings is necessary and repeat biopsy is to be considered, if clinically indicated.

Final Diagnosis:
- FIBROGLANDULAR BREAST TISSUE WITH NO EVIDENCE OF MALIGNANCY, SEE DESCRIPTION

moderators

Dear mersamysully,

Welcome to the community. We are sorry that these breast changes and the accompanying worry brought you here. Perhaps you could make an appointment with your physician and bring the report with you and have your doctor explain it to you, including what it means and the reasons for the 6 month follow up. Most medical reports require explanation on the part of a medical expert. Sometimes when results are benign it is possible that you receive them from a receptionist but it sounds like you could benefit from a better explanation of the results for your own knowledge and peace of mine.

The Mods

djmammo

mrsamysully

As a rule, when a path report becomes available the radiologist who did the biopsy will issue a report indicating whether the path report agrees with their impression of the imaging. You can ask for a copy of that report and/or sit down and review it with the radiologist.

For example if the rad thought it looked like a cancer and the path report comes back normal breast tissue that is a "discordant" result and additional procedures such as re-biopsy or surgical excision etc may be recommended.

If you cannot get the post-biopsy radiology report can you post the last mammo and US reports done before the biopsy?

mrsamysully

Hi djmammo,

Thanks so much for the response!

I didn't know the radiologist would be writing up something separate. From the top of this report it sounds like they were concerned it could have been cancer?

Clinical Information:
Previous history of cancer: no
Is there clinical concern for cancer: yes
3mm nodule at 12 O'clock with shadowing and distortion
Cancer vs small area of dense parenchyma
2 cores, 0.9 and 0.8 cm

I've requested the initial mammogram and ultrasound but not sure if I'll get it or not. I'm in Canada so things are different up here! My family Dr isn't the greatest with telling me how it is. I went in for ultrasound initially, then they had me do a mammo/special mammo immediately after. When I heard I had to have a biopsy done my family Dr said it was due to "architectural distortion - 3mm x 3mm x 4mm", and didn't even say if it would be needle or core!

Is there a chance something could have been missed with the "crush artifact" situation? They took 3 samples and only 2 are mentioned.

The only information I was given over the phone for results was that the biopsy was benign and they want to do another ultrasound in 6 months. It was a little surprising considering the speed and concern they did everything else with!

They must think it's safe to wait 6 months, but it would be good to know whether I can truly relax or not.

Thank you so much for offering your expertise in this way - it's a huge help!

Erinashley19

djmammo- can you elaborate on microcalcifications? What they are? As I understand it there is a difference between calcifications and Microcalcifications. One seems to be an indication of cancer or at a least warning sign of cancer to come. (At least that’s my impression). I had a mammogram 3 years ago that showed “benign microcalcifications”. At the time I had no idea what that was. Nothing was ever explained to me about what they are. I was told I was all good and sent home. Since being here I’ve read more and more about how micro calcifications are NOT a good thing!! Now I’m extremely concerned.

Is it possible for them to ever resolve/disappear on their own? How high is the percentage of benign micro calcifications to turn into cancer? Is it almost always a sure thing at some point?

I’ve never seen a picture of my first mammogram so I’m not even sure what they looked like. I never had a biopsy. Radiologist didn’t take long to review the mammo before telling me it was clear. I was 33 at the time and had the appointment for pain and swelling. Mammogram and US were both clear with the except of the microcalcs.