Interpreting Your Report
Comments
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Here is something I posted a while back on calcifications.
There are many types of calcifications that can be found in the breast, most are benign. They need to be carefully evaluated if there is no mass associated wiht them. If there is, and ultrasound will give you the answer most times.
Calcifications are evaluated by size, shape, pattern, and distribution as well as stability between mammograms. Very small, new, irregular, branching calcs in one quadrant (without a mass) is pretty classic for DCIS. Calcs like these are biopsied to confirm they are DCIS (a non invasive "pre-cancer"), then a lumpectomy is performed to see if there are any areas of invasive cancer starting to develop.
Calcifications that are round and smooth are almost universally benign and are usually left alone even if they are very very small. There is also benign calcification associated with injuries, vascular disease, radiation, inflammatory conditions, foreign bodies and skin calcifications.
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thanks. I never saw any pictures of my mammogram so I don’t know how many I had or what they looked like. I don’t even know which breast they were in or both (I had both breasts done). And even my report only said “birads 2 benign microcalcifications”. My ultra sound was clear, nothing was ever found. This was 3 years ago. I’m going back to my OB tomorrow for a breast exam for pain once again. Still no lumps that I can find and the pain is subsiding now after a month but it’s still there and feels very localized. So obviously the micro calcifications that were fpund 3 years ago is setting off some alarm bells in my mind and has me freaking out. I’ll check out the link to the other info you posted. Thank you.
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I wanted to ask also, would a nasty case of mastitis 10 years prior be a cause of microcalcifications? I thought I read that but hat just seems crazy. I had a bad infection years ago. Same breast that has given me issues these past few years.
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The short answer is yes, calcifications can develop at a site of previous masitis.
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I recently had a mammogram and ultrasound. It shows a lobulated echogenic mass located at 1 oclock 4cm from nipple with vascularity and predominant echotexture. Birad 4 with recommendations for US guided biopsy. I also have 3 other masses which show as fibroidadenomas. I have history of fibroids so this was not unusual. I guess I'm more concerned as I've never needed further testing.
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I've been searching for “course pleomorphic calcifications", but find very little information. I can find references to “fine pleomorphic calcifications". Does course fall in the same non-favorable characteristic as fine when it pertains to pleomorphic calcifications? I currently have a new 5mm area of course pleomorphic calcifications in the upper outer quadrant of my right breast and have a stereotactic biopsy scheduled for 8/14.
My BiRad category was a 4.
I have a personal history of IDC and ADH, but both were in my left breast. I also have an extensive history of fibroadenomas in both breasts
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djmammo
Thank you for the reply. I get the need for biopsy, and it's scheduled for 8/14.
I'm just wanting to know if it's pleomorphic calcifications in general that are of concern for DCIS/IDC or if it's only “fine pleomorphic calcifications" that are of concern and not course.
Either way, I'm having the biopsy. I'm preparing for at a minimum ADH and at worse DCIS/IDC. I've had it before (other breast) and I can get though it again.
By the way, thank you for answering the questions the members here have! It's nice to have someone in the medical field on here to answer questions.
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"I'm just wanting to know if it's pleomorphic calcifications in general that are of concern for DCIS/IDC or if it's only "fine pleomorphic calcifications" that are of concern and not course."
Malignant calcifications can be fine or coarse. I have never used the terms fine vs coarse to distinguish between types of pleomorphic microcalcifications. I describe their pattern of distribution which is an important feature. Whether they are fine or coarse has never affected my decision to biopsy. If they are pleomorphic (calcifications of many different sizes and shapes) they get biopsied.
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djmammo
Thank you for the clarification! I appreciate it!
Tracy
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Hi -- I hope it's OK for me to post here. I had initially posted on the "diagnosed and waiting for test results" forum, but it was suggested I try posting over here.
I have already been diagnosed with invasive mammary carcinoma with ductal and lobular features (based on u/s guided core needle biopsy performed 7/16), and I am hoping for some help interpreting the results of my MRI from 7/30. My case was discussed by the board on 8/1 (breast surgeon, radiologist, radiation oncologist, and medical oncologist), and I met with all of them (except the radiologist) the same day to discuss next steps. The surgeon explained the MRI results to me -- and showed me some of the images -- but I did not read the full report until I got home.
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Reason for exam: 41 yo female with right breast cancer and extremely dense breast tissue -- MRI to assess.
Findings: Marked right and moderate left parenchymal enhancement.
Right breast: There is diffuse asymmetric parenchymal enhancement and edema with asymmetric skin thickening, particularly along the medial breast, worrisome for diffuse infiltrating malignancy. At least 3 pathologically enlarged level I axillary lymph nodes, several with morphology suggesting extracapsular extension of disease. Largest lymph node measures 2.7x1.6cm. Subcentimeter level II and II axillary lymph nodes without clear fatty hila, equivocal for malignant involvement. No internal mammary adenopathy.
[I pretty well understand the first part -- I already knew it was invasive carcinoma, and the description sounds consistent with my own perception that my right breast is quite swollen and feels very firm. The description of the level I axillary lymph nodes sounds bad! And I think the description of the level II and III nodes indicates that they are suspicious.]
Left breast: Solid 0.9x0.8cm mass in the upper inner quadrant near 11:00, about 3cm from the nipple. Mass is circumscribed with oval configuration, shows primarily plateau enhancement. Scattered simple cysts. No suspicious axillary or internal mammary lymph nodes.
[The finding on the left breast is new -- nothing was seen on the mammogram 7/5, and nothing was palpable in subsequent clinical breast exams on 7/16 and 8/1. This description doesn't sound alarming to me, although I am not sure what the plateau enhancement means. I know it means that took up the contrast and that the intensity stayed level--but I don't know whether that is suggestive of something concerning?]
Impression:
1. Right breast shows diffuse abnormal parenchymal enhancement associated with parenchymal, skin and nipple areolar complex edema, highly worrisome for inflammatory breast cancer. Pathologic right level I axillary adenopathy with small indeterminate morphology level II and II axillary lymph nodes.
["highly worrisome for inflammatory breast cancer" is concerning to me -- but since the area was biopsied and came back as mixed ductal/lobular, and the board reviewed all of the imaging and pathology reports together, is it reasonable to assume that they concluded it was not IBC? I would think the pathology trumps the imaging? And since they have recommended mastectomy on the right, it's all coming out anyway, and we'll certainly know for sure then...]
2. Solid 0.9cm left breast mass near 11:00, indeterminate.
Recommendation:
1. Limited left breast ultrasound... If not identified by ultrasound, would suggest MRI guided biopsy.
2. Consider right axillary lymph node biopsy to confirm nodal involvement. Given presumed nodal metastatic disease, would also consider PET/CT to assess for distant metastatic disease.
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I have the PET scan and additional ultrasound scheduled for next week.
Thanks in advance!!!
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TC
Your assessment of the report is good. The impression and recommendation are pretty straigtforwardly expressed.
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thank you, djmammo!
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Hi, I'm wondering has anyone else had this same report.
0.75 cm x 1.15 cm deeper than wide hypoechoic spiculated mass with shadowing @ 9 o'clock, 10 cm from the nipple on ultrasound. Had MRI that stated 0.9 cm.
Had biopsy today.
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Hi djmammo - finally got my initial u/s and mammo report back... see my previous post for the biopsy report.
Breast density: extremely dense
BIRADS 4
Both mammogram or tomo mammogram came back clear and showed nothing.
U/S findings: At 12 o'clock, there is a small focus of irregular shadowing and architectural distortion measuring 3 x 3 x 4 mm.
Small focus of spiculation at 12 o'clock.
Pathology results are fibroglandular breast tissue with no evidence of malignancy. These results are benign and concordant.
6 month follow-up with repeat left breast targeted ultrasound to the 12 o'clock position is recommended to ensure stability.
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Are you surprised to hear they think this is concordant? I'm trying to wait the 6 months with the least amount of worry as possible!
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“12mm irregularly shaped mass with spiculated margins....non-parallel, hypoechoic mass with angular margins with shadowing... no evidence of other calcifications"
Had mammo and 3D mammo and ultrasound yesterday.Core biopsy next week. Birads 4. Breast have scattered areas of fibroglandular density.
Help....I'm nervous. No family history
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Over 70% of women who are diagnosed each year have no family history. That line from your report contains all the buzzwords usually associated with an abnormal biopsy outcome assuming it was interpreted properly. The good news is, all things being equal, abnormalities measuring less than 14mm have the better prognosis.
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It's been a week since my diagnostic mammogram and u/s and I finally got the results in my MyChart account. The radiologist said that it seemed to be on the benign side but I needed a biopsy to make 100% sure. I was hoping that my report would clarify whether I was considered 4a, b, or c but it only says 4.
Anyway thoughts on the words, what I may have, and what they may find during the biopsy tomorrow will be appreciated. I know nothing expect the biopsy is 100% but I would like to have some idea before my results appointment next Tuesday.
Wording from mammogram and u/s
IMPRESSION: Solid mass left upper outer quadrant, possibly a fibroadenoma but not entirely typical
FINDINGS: The breast tissue is heterogeneously dense, which may obscure small masses. There is mass in the upper outer quadrant, mid depth, equal density, mildly lobulated.
Ultrasound demonstrates a solid mass, upper outer quadrant, 8 cm from the nipple, 17.6 x 6.5 x 11.5 mm. It is hypoechoic, with parallel orientation. Margins may be slightly irregular.
Axilla: No abnormal lymph nodes.0 -
This was posted to your question earlier today. There is nothing I can add to improve upon it.
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I had forgotten I posted this here. It timed out on my phone and then I posted it elsewhere - but yes her answer was very helpful. Thank you.
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Hi, I am new to this site and really appreciate all the insight from everyone. I am 43 and just recently had my 4th mammogram. The first 3 were clear, no follow up. This one showed some irregularity in my right breast. Went in for follow-up, then U/S, then core needle biopsy. The results included a lot of stuff, but this I think is the most troubling.
Breast tissue with extensive atypical ductal hyperplasia (ADH) bordering
on ductal carcinoma in situ
(DCIS), flat epithelial atypia (FEA), part of an intraductal
micropapilloma with focal ADH (measuring up
0.15 cm in greatest dimension), columnar cell change, fibroadenomatous
change, pseudoangiomatous
stromal hyperplasia (PASH), and microcysts.I am scheduled for lumpectomy in early September. Trying to remain calm and stay busy, but I continue to worry. Has anyone had results that show extensive ADH, but not quite DCIS? Is it likely that it’s DCIS? Should I be worried about my age and the fact that his popped up so quickly?
Thank you
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Hi Djmammo thanks so much for being here! I'm a little stumped by a recent ultrasound that was done because I have changes to my MX scars and we want to rule out a recurrence or skin mets. It's in my signature, but quick background: 2014 LX for DCIS in right breast, no radiation or chemo, wide margins. Follow up mammo at 6 months showed numerous new growths in right breast, and biopsy showed Atypia in a new papilloma. Faced with another excisional, I chose BMX. I had tested positive for the BARD1 gene mutation (recent study shows it's associated with increased incidence of TN bc), my mother and her sister both died of bc. Left MX was to be prophylatic, but numerous pre-cancerous changes were found in the left breast pathology post BMX, including LCIS. Reconstruction with gel implants, never any fat grafting or natural tissue used. I've had nice faded flat scars since 2015.
Four weeks ago I got a mosquito-bite like hive on my right MX scar; it has remained constant despite cortisone cream and benedryl. Some other changes on both scars made me concerned. I was seen and an ultrasound ordered. Right breast was normal but left showed this:
"IMPRESSION: PROBABLY BENIGN - FOLLOW UP RECOMMENDED
"Three hyperechoic, well-circumscribed masses in the central breast are probably benign. The largest is 5mm. Differential includes lipomas. A follow-up ultrasound in 6 months is recommended to demonstrate stability."
I understand all of those words, and I understand why those results would normally be considered nothing to worry about. HOWEVER, here are my questions/concerns:
1. Breast lipomas are generally singular, right? There are three masses.
2. Breast lipomas are generally isoechoic, or partially hyperechoic, right? Mine are hyperechoic.
3. Lipomas in general are found in areas of high adipose tissue. I have skin and pec muscle there, with an implant -- hardly any fat. Breasts usually have a lot of fat, so finding a glob of fat wouldn't normally be suspicious. But I don't have breasts. So why would there be three gobs of fat where there is no breast tissue or much fat?
4. There was nothing there three years ago, and now there are three masses?
5. I've had all kinds of things in my former breasts, but I never had a lipoma.
6. This wasn't a screening ultrasound; I was there because there are suspicious happenings.
I don't particularly trust this radiologist -- not done at a dedicated breast center, and a few other reasons I won't bother with here (my insurance changed so I'm not with the same place I had my previous treatment)
With all of the above, would you have ordered a biopsy? Three month follow up? Same recommendation?
thank you!
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I had a diagnostic mammogram after nipple changes in right breast and left nipple turning black. It found an “irregular density” in right breast and I had to have a spot compression mammogram. I got those results today.
can someone help me understand my results?
HISTORY: Focal asymmetry within the anterior upper right breast visualized on MLO production.
FINDINGS: The breast tissue is heterogeneously dense limiting sensitivity mammography. The density partially dissipates on MLO spot compression views there appears represent summation artifact on the 90 degree lateral views. There are no suspicious groupings of microcalcifications or axillary lymphadenopathy. No skin thickening or nipple retraction.
IMPRESSION: Asymmetry partially dissipates on MLO spot compression views and is more compatible with summation artifact on the 90 degree lateral views. Recommend a six month follow up right breast mammogram to stability of these findings.
Bi-Rads category #3- probably benign findings and recommend follow up right breast mammogram to re-evaluate
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The path report you posted lists almost all of the borderline-almost-neoplastic features there are that require removal to continue the search for evidence of outright malignancy. It may or may not be present but no way to really know until after the surgery. You may have an MRI before the surgery for the purposes of planning the surgery and/or looking for a mammographically occult cancer.
The area of the prior biopsy will be excised and sent to pathology and evaluated for the presence of cancer cells. If the margins of the tissue is found to be positive for cancer or any of the above listed entities there may be a re-excision to find a clear margin. There will then be a discussion amongst your docs re: what the next step will be depending upon what is found.
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Should I assume you gathered your information on the US appearance of lipomas from the internet? Things that are "generally" and "usually" sometime aren't...and thats where years of training and practice come in, for those rare exceptions for which Google cannot prepare you.
If these are new and you do not trust your current imaging professionals by all means show your studies to someone else. Or better yet have an MRI which should be able to solve this problem in less than 6 months. Having already had DCIS one hopes insurance will cover it. Its really the best way to evaluate post mastectomy/reconstructed breasts.
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Summation artifact is the appearance of a mass-like density caused by overlapping areas tissue within the breast. Not the best example, but picture holding up a page of text to a light source. If printed on one side you can easily read the text. If you hold up several pages the text on one page overlaps the text on another, obscuring the words. If however you shift the papers a bit you can read the lines on one through the spaces between paragraphs. If you compress the breast it shifts the tissue around so you can displace one dense area away from another and be able to "read the text" in that area. Thats what the report says they think is going on with your mammogram. It is not unreasonable to get a check up in 6 months just to be on the safe side. That being said if there is a palpable lump in the area of this finding an US should be performed.
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DJMammo You didn't answer my question. As for your snide remark about Google, I actually read the radiology textbook listings on breast lipomas, along with some clinical studies. You are correct, I do not have years of training and practice in radiology, which was why I was asking you. I am in an HMO (Kaiser) without a dedicated breast center, and the radiologist did not instill confidence in me for reasons other than his reading of my images. I am trying to arrange a repeat ultrasound at another facility, but this is difficult.
I have stayed alive -- not just from bc -- by being an educated patient. Nine major procedures, including a spinal angiogram with embolization of an acquired arteriovenous fistula in my spinal cord, have meant that I have to ask questions in order to stay on top of my health. Asking questions shouldn't be met with "You don't have years of training and practice." I never said I did.
Yes, those masses are new, which I explained in my post. Getting a breast MRI ordered at Kaiser is not on the table at the moment. While you didn't answer my questions (which were pretty simple -- would you have ordered a biopsy or had a different recommendation based on my history), you aren't required to -- you aren't even required to be on this site. However, I thought this thread was for questions about imaging and I checked eagerly for your answer, only to be met with a sarcastic response ("for those rare exceptions for which Google cannot prepare you"). That was not only arrogant, it was unkind. I'm just trying to stay alive here.
I will seek help elsewhere. As you were.
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Breast cancer is "generally" hypoechoic and "usually" vascular, but in my experience, not always. Your radiologist's opinion is that they are likely lipomas. If your research on Google has lead you to disagree with their report then by all means have them removed and you will no longer have to wonder what they are. This also eliminates the possibility of an MRI or biopsy path being misread.
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Hi DJMAMMO, hope it is ok to post a question here. I have already posted in waiting for test results. I have never really been on a forum before so excuse me if I make an error. I got my mammo and US results, and I am wondering what it means when it says ill defined blackwall. The sentence reads targeted ultrasound of the palpable mass in the 1'oclock position demonstrates an irregular hypoechoic solid mass with ill defined blackwall. I have a BIRAD scrore of 5, so I realize that is not a good sign but I just want to understand the report best I can. Thank you for your time.
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