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Interpreting Your Report

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  • renee_rn
    renee_rn Member Posts: 2
    edited November 2017
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    Birads was 0 - indeterminate. I have a diagnostic mammogram and ultrasound on Wednesday.

  • Scaredsilly1973
    Scaredsilly1973 Member Posts: 1
    edited November 2017
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    I have a biopsy scheduled for this Thursday. I’m worried as I have had some women tell me it’s very painful and others tell me it’s not so bad.

    I’m not sure what to expect in all this. The waiting in between tests is enough to drive anyone craxy

  • djmammo
    djmammo Member Posts: 1,003
    edited November 2017
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    Renee

    Agree with above. Could go either way but statistically it is likely overlapping area of dense tissue.

    You will need a few pictures with magnification an a little tighter compression followed by an ultrasound. Do they have “3D” Mammo where you go?

  • Eljay62
    Eljay62 Member Posts: 4
    edited November 2017
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    What do you make of this mammogram/ultrasound report.

    *There is partial fatty changes in both breasts.

    *There is a history of bilateral breast reduction surgery.

    *A well circumscribed lobulated soft tissue density lesion in the right breast lower outer quadrant 11mm diameter.

    *There is some asymmetrical density in the right breast laterally which is associated with microcalcifications, however on the magnification view there is one small group the microcalcifications that are showing some pleomorphic appearance within the asymmetrical density which are 2.8mm overall diameter. BIRAD 4/5.

    CONCLUSION

    *Asymmetrical density of fibro glandular tissue laterally in right breast which is associated with microcalcifications & there is a small group of pleomorphic microcalcifications within asymmetrical density. These are recomended for excision biopsy.

    *A well circumscribed 11mm diameter lobulated soft tissue density lesion in right breast lower outer quadrant ? Fibroadenoma.

    * Ultrasound showed the well circumscribed hypoechogenic lesion in right breast 8o'clock position 7cm from nipple with some vascular flow in the wall, seen on mammogram as a separate lesion. It has characteristics suggesting it may represent a fibroadenoma. Core biopsy of this lesion is recommended with ultrasound guidance.


    I have had the core biospy & am awaiting pathology results. I see a breast surgeon on 4th December to discuss what to do next as far as excision biopsy of microcalcification cluster.


  • djmammo
    djmammo Member Posts: 1,003
    edited November 2017
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    Eljay62

    The impression and recommendations match the description of findings in the body of the report with one exception. I would have recommended a stereotactic biopsy of the calcifications in light of the way they were described. It is far less invasive than an excisional biopsy, leaves no scar and yields a reliable tissue diagnosis in the right hands.

    Let us know the path report on your suspected FA.

  • Usher1127
    Usher1127 Member Posts: 2
    edited November 2017
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    Hi,

    I just received my ultrasound report and this is what it reads and i don't understand a word of it could you please help.

    In the area of the mammographic abnormality there is a 9 x 8 x 7 mm lobular mass that is not a simple cyst. there is no shadowing. This is about 5cm from the nipple at the 1:30 position. Adjacent to this about 5 cm from the nipple at the 1 o'clock position, is a small area measuring 4 x 1 x 4 mm has its long axis parallel to the skin. it is to small to definitely qualify as a cyst, but it's long axis orientation is a non aggressive features and there isno shadowing.

    it does look more Hypoechoic then the larger mass seen at the 1:30 position

    in the Axilla. there is a lymph node that is slightly asymmetric nodularity.

    BI-RADS 4b

  • djmammo
    djmammo Member Posts: 1,003
    edited November 2017
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    Usher1127

    If this is exactly what the report says, it is oddly worded and does not seem to draw any real conclusions.

    1) US was done in response to a mammo finding and not a lump you felt correct?

    2) 9 x 8 x 7 mm mass: (so less than 1/2 inch in greatest dimension). It says "lobular" but I will assume they meant "lobulated" which is a better prognostic feature than "irregular" or "spiculated".

    3) Not a simple cyst: so a complicated cyst or solid? Wording is not very clear/nonstandard descriptor

    4) Shadowing: In the overall scheme of things shadowing is a bad feature, so no shadowing is a good thing.

    5) Small area measuring 4 x 1 x 4 mm: An adjective is missing from this phrase after small and before area.

    6) Its long axis parallel to the skin: This is a feature common to benign masses

    7) It is too small to definitely qualify as a cyst: I think they mean its so small it is difficult for them to tell if its a cyst or a tiny solid nodule on their US machine.

    8) it does look more hypoechoic then the larger mass: it looks darker/blacker on the screen than the other mass. Cysts are completely pure solid black on US like an 8 ball (without the number on it) but still too small it seems.

    9) in the axilla there is a lymph node that is slightly asymmetric nodularity: This is very poorly worded. The description of a lymph node on US should include its size in three dimensions, shape, its surface contour, the thickness of the cortex, and the status of the fatty hilum (center) as well as presence and degree of internal blood flow. The phrase they used does not tell me whether they though it was normal or abnormal.

    10) Birads 4b: It is considered abnormal but not as suspicious as Birads 5 but more suspicious than 4a. I personally never used the subscript letters B4

    11) You did not list the recommendations but I will guess they want to biopsy what they saw. Is this from a breast center or from a community hospital xray department?

  • Eljay62
    Eljay62 Member Posts: 4
    edited November 2017
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    I will get the path report at 9.30am Sydney Aus time, once I do I will let you know what it says.

    Not too concerned about the ? FA more worried about the pleomorphic calcification cluster.

    My 3D mammogram has now been compared to the Breast Screen government program films I had in May & although they say the ? FA was present then, the pleomorphic microcalcification cluster was not. Do FA show on basic mammography?

  • Eljay62
    Eljay62 Member Posts: 4
    edited November 2017
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    Pathology Report

    *The core biopsy of breast tissue shows a fibro epithelial lesion in which there is columnar cell change, usual ductal hyperplasia, adenosis & calcified secretions. The features are consistent with a complex fibroadenoma. There is no evidence of atypia or malignancy.

    *Diagnosis: Features consistent with Complex Fibroadenoma

    My gp has suggested montoring yearly instead of every 2nd year.

    Is it correct that a complex fibroadenoma increases my risk of breast cancer slightly?

  • djmammo
    djmammo Member Posts: 1,003
    edited November 2017
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    Eljay62

    I personally have never heard it increases your risk. They can be seen on mammo unless they are very small and surrounded by very dense tissue. They cannot hide from ultrasound.

    Sounds like those calcifications are next. Good luck.


  • Cutie1112
    Cutie1112 Member Posts: 1
    edited November 2017
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    1st u/s scan:
    Ill-defined hypoechoic lesion at 12 o'clock 2cm fm nipple measuring 0.6x 1.4x 1.3cm.
    Another lesion more well-defined at 10 o'clock 4cm from nipple measuring 0.9x1.5x 1.3cm, wide receiver than taller, with posteriors shadowing and no intralesional color dropped within.
    A biopsy was done, at 3 attempts with 2 good samples, results: no maglinancy evidence found.
    2nd scan after 3months:
    well defined hypoechoic lesion seen at
    - 12 o'clock 1cm from nipple: 0.6x1.4x 1.5 cm
    -10 o'clock 4cm from nipple: 0.8 x 1.4x 1.5cm
    No posterior shadowing or enhancement. no intralesional color dropped within.no calcification.
    A few subcentimeters axillary lymph nodes with preserved fatty hilum bilaterally.
    Question:
    1. should I believe the biopsy results it is benign and should not worry about it?
    2. My doctor asked me to removed the lump. Is it necessary if biopsy said they are benign?
    3. What is axillary lymph nodes with preserved fatty hilum. Should I be worry it?

    Need advice please


  • djmammo
    djmammo Member Posts: 1,003
    edited November 2017
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    Cutie

    1. should I believe the biopsy results it is benign and should not worry about it?

    If the radiologist states correct site was biopsied and the pathologist indicates that the samples were adequate for analysis, then yes.

    When the rad who does the biopsy gets the path report they generate a report indicating whether or not they agree with the path findings and issue a report with a recommendation. Ask for that report.

    2. My doctor asked me to removed the lump. Is it necessary if biopsy said they are benign?

    Did they tell you it should be removed or did they ask you if you wanted it removed?


    3. What is axillary lymph nodes with preserved fatty hilum. Should I be worry it?

    That is a description of a normal lymph node. We don't worry about the normal ones.

  • Eljay62
    Eljay62 Member Posts: 4
    edited December 2017
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    I have seen the breast surgeon on Monday. She seemd a little concerned in regards to the complex fibroadenoma & wants to keep an eye on it with 6 monthly ultrasounds. She thinks microcalcifications are either early DCIU or fat necrosis from breast reduction. I came away doubting the 2nd possibility as my reduction was 14 years ago plus it has never been seen on mammo before May this year. I am booked for stereotactic biopsy next Wednesday & should have pathology results back before Christmas.

  • luvpinkcmc
    luvpinkcmc Member Posts: 2
    edited December 2017
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    djmammo,

    Hoping you can help with my report, biopsy is scheduled on the 18th and the unknown has made me a nervous wreck, I am 42 yrs old.


    Mammogram report: (3D/2D with cad study)

    Clinical: Palpable lumps inferior bilateral breast by history

    Both breasts are extremely dense, which lowers the sensitivity of mammography.

    Examination indicates a biopsy marker in the right breast.

    There is a 7mm round mass with an obscured margin in the right breast at 11 o'clock anterior depth. This correlates to the area of reported pain and with ultrasound findings. No other significant masses, calcifications, or other findings are seen in either breast.

    Suspicious of Malignancy

    The 7 mm round mass in the right breast is at a low suspicion for malignancy. An ultrasound guided biopsy is recommended. There is no abnormality seen in either breast to correspond with the area of clinical concern in the lower aspect, however, clinical followup is recommended.

    Letter sent: Abnormal/Biopsy BIRAD 4-5


    Ultrasound report: (US breast bilateral limited)

    Clinical: Bilateral palpable lumps inferiorly. Pain right upper outer.

    Color flow and real-time ultrasound of the right breast and real-time ultrasound of the left breast were performed. Gray scale images of the real-time examination were reviewed.

    There is a 0.6 cm x 0.5 cm oval mass with an angular margin in the right breast at 11 o'clock anterior depth 1 cm from the nipple. This oval mass is hypoechoic with internal echos. This correlates to the reported pain and with mammography findings. Color flow imaging demonstrates that there is no vascularity present.

    Impression: Suspicious of Malignancy-Follow Up Recommended

    The 0.6 cm x 0.5 cm oval mass in the right breast is at a low suspicion for malignancy. An ultrasound guided biopsy is recommended. There is no abnormality seen in either breast to correspond with the area of clinical concern in the lower aspect, however, clinical followup is recommended.

    Letter sent: Abnormal/Biopsy BIRAD 4-5


    The above information is verbatim from my report, sorry it is so long. Part of what confuses me is the Abnormal/Biopsy BIRAD of 4-5 but then there's a sentence that says there is no abnormality seen in either breast to correspond with the area of clinical concern in the lower aspect........ Should I be concerned?

    Thanks in advance for any insight!

  • djmammo
    djmammo Member Posts: 1,003
    edited December 2017
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    Luvpink

    If verbatim, the report is a little confusing, but perhaps what they are concerned about is something you are not currently feeling ? Unclear at minimum.

    The finding they want to biopsy is very small and they feel it is low suspicion which is good but they do not seem familiar with proper Birads assignment. There is no "Birads 4-5", there is 4a, 4b, 4c to convey their level of suspicion or 5 if they are convinced it is cancer from the imaging. Either one gets you a biopsy.

    Did you have a prior mammogram? Did they compare new and old studies?

  • luvpinkcmc
    luvpinkcmc Member Posts: 2
    edited December 2017
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    Thanks for responding djmammo! At the bottom it says Birads 4a, I missed that, so that corresponds with the low suspicion, right? But it does still say Birad 4-5 under the heading "Letter sent", which has me freaked out because my mom had a birad 5. I don't understand why he would put that.

    I did have previous mammograms that they compared, one in May 2013 and March 2014. In 2013 the mammogram showed an area of asymmetric density in the right breast, I was called back for more imaging and deemed all was ok but they wanted to see me in 6 months. I went back in March of 2014 and nothing had changed and I received a benign report that said come back in a year. I waited almost 4 years to get another mammogram :( not very smart on my part. I have a sister and mother with breast cancer.

    I initially thought this sentence "There is no abnormality seen in either breast to correspond with the area of clinical concern in the lower aspect, however, clinical follow up is recommended" was referring to my doctors concern of "palpable lumps inferior bilateral breasts" Could that be what its referring to? I don't feel any lumps and when she examined me she didn't say she felt anything either. All I've had is a burning from within pain on the right side.

    I agree the report is confusing, it doesn't seem like it offers enough of a description but then again I could be wrong about that also.

  • Monique72
    Monique72 Member Posts: 1
    edited January 2018
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    I can’t understand why I was given only a Birads 4 (with no a, b, or c) and not a 5 with this description:

    “...palpable...approximately 12 o’clock, 3cm from nipple....irregular, non-parallel solid mass...2 x 1.1 x 1.1cm. The most suspicious component, with more posterior acoustic shadowing and spiculated margins, is in the superior aspect of this and measures 1.2 x 1.0 x 0.7cm”

    This does not sound like a 4 to me, more likely a 5, because it fits EVERY description for cancer that I’ve read.

    I had the biopsy today. My mother died of breast cancer at 65 and my sister had it at age 35. She had IDC with node involvement. She is 50 now & all clear. I am 45. Both sister and mother dealt with poor screening & inadequate care due to being poor and living in a poor area of the country.

    I had two mammograms this past year some 9 months apart, both showed no abnormality. Only the ultrasound and palpation show that there is a problem.

    I’m irritated that the hospital sends a letter with these necessary details to my primary care doc, but treats me like I’m an idiot by telling me next to nothing.

    My health insurance sucks, I’ve had a month’s worth of runaround before I could have the biopsy authorization. I’m beyond disgusted. The billing department called me before anyone involved in my care has. In fact, no one involved in my care has contacted me at all. I feel like a number, and a presumed poor dumb number at that, which truly sucks

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2018
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    Monique72 et al

    As long as it is biopsied the Birads # 4 vs. 5 really doesn't matter. These number are tracked by the MQSA and used to evaluate the radiologist reading the studies. Its a way of keeping score and insuring quality readings. In the beginning they really weren't intended for patients' review.

    As many radiologists were using their own nomenclature for findings and results back in the day, it was felt there should be one common denominator that any referring doctor could understand no matter who was reading it and it was decided that numbers should be used. Later, strict adherence to a particular vocabulary was introduced and together with the numbers make up the Breast Imaging Reporting and Data System. A lay letter was then proposed and its distribution to patients made law as a sort of bottom line summary of the patient's mammogram report. Back before the internet, patients were not familiar with the wording of x-ray reports and the lay letter was deemed the solution. Now that patients have access to their reports on line, and Google, there is a tremendous interest in the report itself. It's turned out to be a double edged sword.

    Let us know what the path report says when its available.


  • djmammo
    djmammo Member Posts: 1,003
    edited January 2018
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    I'm sure I have posted this elsewhere but here it is again the BIRADS 5th Edition quick reference card you can print out and glue to some cardboard (that's what I did). It lists the acceptable breast imaging terminology for all modalities and their definitions, the meaning of the Birads #'s for both density and diagnosis. If your breast imaging center uses these terms exclusively, thats a good sign.

    Click here to download

  • momto3sons
    momto3sons Member Posts: 68
    edited January 2018
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    Hi djmammo! Can you help shed some light on my report? This is the main part of the summary from the radiologist (there was more in there about several cysts, but those are noted as most likely benign):

    IMPRESSION: SUSPICIOUS OF MALIGNANCY, ULTRASOUND

    PROBABLY BENIGN

    The architectural distortion in the right breast at

    11-12 o'clock posterior depth is suspicious of

    malignancy. A surgical consult is recommended. There

    is no US correlate and no h/o prior biopsy. This has a

    suspicious appearance on mlo tomo views. Surgical

    consult regarding physical exam findings recommended.

    Needle loc would be preferable to stereotactic biopsy

    and breast MR would be recommended for evaluation of

    this area as well

    letter sent: BIRADS 4/5 Exam

    MAMMOGRAPHY BI-RADS: 4 Ultrasound BI-RADS: 3

    Breast Tissue Density: C - The breasts are

    heterogeneously dense, which may obscure small masses


    I did have an appointment with a surgeon, but she couldn't feel anything in the area where they noted the architectural distortion. She's ordered an MRI, but we have to see if insurance will cover it.

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2018
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    momto3sons

    US is extremely good at showing spiculated masses that are often the cause of architectural distortion on a mammogram so thats in your favor provided they scanned the correct portion of the breast. Did they give a size to the area of interest?

    If a mammo shows arch dist, and nothing is seen on US, this may be a radial scar which is always removed but is not a cancer. This, among other things is what they will be looking for on the MRI.

    The insurance company goes by your history and the wording of the request. I usually recommend "suspicious mammographic finding without ultrasound correlate" for the reason for the MRI. If there is a cancer there, the MRI should see it.


  • momto3sons
    momto3sons Member Posts: 68
    edited January 2018
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    They didn't give a size to the area of interest, unfortunately. I could definitely see the spot on the mammogram when the doctor reviewed them with me, but she didn't mention any size either.

    The doctor and her nurse tried to word it the best way to get insurance to cover it, and with my family history of BC and other cancers (plus the density issue) will help push it through.

    Thanks for the follow up!

  • jennaaz
    jennaaz Member Posts: 1
    edited January 2018
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    DJmammo: I found out on 12/20 that I a mass was found in left side at 2:00 position thru diagnostic mammo & u/s, core biopsy ordered and is scheduled for tomorrow. I just read the report yesterday and am looking for some insight.

    Birad 4c - Findings of moderate concern but not classic for malignancy

    Findings: A hypoechoic, parallel, not circumscribed mass is noted measuring 2.2 cm. The margins are indistinct with angular margins also noted. No abnormal axillary nodes are identified.

    Breast Composition: C heterogeneously dense

    I'm 44 y/o, no immediate family history of bc

    Thank you!

  • moderators
    moderators Posts: 8,091
    edited January 2018
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    Dear jennazz,

    Welcome to the community. We are sorry about these breast changes and hope that you find the information that you are looking for. The Mods

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2018
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    momto3sons

    Good. Let us know the results of the MRI

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2018
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    jennaaz

    Not all of those descriptors are worrisome but in general and for safety's sake, if a mass does not fit the strict definition of benign on imaging it will usually get biopsied. There are some fibroadenomas that can look odd, and that 'parallel' adjective leans toward that. Benign masses if not spherical, will have their long axis parallel to the chest wall, while suspicious masses usually perpendicular to the chest wall which is a fairly reliable rule of thumb based on the structure of the breast.

  • MayDayMelK
    MayDayMelK Member Posts: 25
    edited January 2018
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    I have a random question about mammograms. Does the radiologist take into consideration the hormonal status of a woman when they view a report? Or just view the age? Because I wasn't asked any questions about my menstrual cycle/etc and I have been in surgical menopause for 7 years. I was given a BIRAD of 3 and read that due to scattered density and focal asymmetry that generally they'll request more of a workup if you're in menopause versus what a natural/normal hormonal 32 year old would be recommended. The ultrasound they did with the mammogram couldn't view anything solid or cystic. Right now I'm just waiting to go back to the doctor.

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2018
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    MayDayMelK

    I never paid much attention to hormonal status unless I saw a difference in the appearance of the breast when compared to the prior mammogram.

    Any mammographic changes re: hormones are usually related to onset of hormone therapy or pregnancy.

  • Wathom
    Wathom Member Posts: 4
    edited January 2018
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    I have my biopsy tomorrow. In the last 10 days, I've had an MRI, ultrasound and a mammogram. I am a biards 4c - Suspicious Abnomality, High suspicion for malignancy. They found 3 areas in my left breast and 1 in my right. I am 48 but I had Hodgkin's Lymphoma 18.5 yrs ago and was treated with chemo and chest radiation. i know I am at a high risk for bc because of the prior chest radiation.

    I am trying to be an optimistic realist. I am assuming it's cancer (yeah, not too optimistc, but hey!) but I just want to know one way or the other. My ultrasound report uses words like

    "hypoechoic, indistincly marginated lesion"

    "hypoechoic, irregular mass measuring 1.4 x 0.6 x 0.7 cm with internal vascularity. Calcifications are identified"

    "spiculated mass measuring 1.5 x 1.3 x 1.2 cm with posterior acoustic shadowing"

    I guess what I'd really like to know is what is the chance of this being benign? I'm making myself crazy thinking about it. Any insight would be greatly appreciated. Thank you!





  • MayDayMelK
    MayDayMelK Member Posts: 25
    edited January 2018
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    Thanks for the reply! I have not had any prior imaging. I did read an article about trying to steer clear of using Birads 3 in menopausal women due to the lack of hormonal shifts and fibrocystic changes. I won't pretend to understand it! I guess I just don't want my age to lead to being dismissed. Thanks again!