Interpreting Your Report
Comments
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Djmammo thank you for the article. I’m still so confused, but I am trusting the radiologist with knowing what he’s looking at lol. Thank you so much for helpin
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Hi, djmammo.
You asked about my report in my thread. I now have the report and posted it there, but will post it here too.
Any insights are welcome.
Thanks.
"At 10 o'clock, about 10 cm from nipple.
Bi-Rads Category 4: Suspicious.
Cystic lesion with layering debris which is circumscribed and oval measuring 7x6x8 mm. Within the cystic there is an echogenic focus. There appears to be some color Doppler adjacent to or within the lesion. It does not definitely have the typical ring down artifact. A corresponding calcification is not definitely seen on the previous mammogram images. It may represent a mural nodule.
Slightly complex appearing cyst with debris and probable intramural nodule represents a suspicious abnormality. Ultrasound guided biopsy is recommended."
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Cysts come in three varieties: simple cysts that have only fluid no debris or solid parts; complicated cysts that have debris only; complex cysts that have solid parts that are stuck to the wall called a "mural nodule".
Looks like your radiologist correctly labeled that cyst as being complex. Any solid element seen in a cyst is suspicious and requires biopsy especially if it is shown to have a blood supply on Doppler imaging.
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Hello,I'm waiting for my biopsy scheduled for 9/14. In the meantime I was wondering if you could comment on my results. I've read the lack of internal vascularity is a positive, but the rest of the story ain't all that great.
Findings:
Computer-aided detection was used in the interpretation of this examination.
The breast parenchyma is heterogeneously dense, which may obscure small masses.
There is an irregular spiculated mass in the left breast lower inner aspect with associated coarse heterogeneous calcifications. The calcifications extend anteriorly from the mass with total extent of approximately 6.3 cm.
Targeted ultrasound performed by the technologist with attention to the mammographic findings. There is a 2.6 x 2.1 x 2.7 cm irregular hypoechoic mass at 7:00 6 cm from the nipple which correlates with mammography. Color Doppler shows no internal vascularity.
Sonographic evaluation of the left axilla reveals no abnormal lymph nodes.
IMPRESSION
IMPRESSION:
The mass in the left breast at 7:00 is highly suspicious for malignancy. An ultrasound-guided biopsy is recommended.
Suspicious calcifications extend anteriorly from the mass with total extent of approximately 6.3 cm.
Management options were discussed with the patient who has agreed to proceed with biopsy. Biopsy has been scheduled for 9/14/2018 at 2:00 PM. Please fax or co-sign the order for needle biopsy to 560-6613 in order for this exam to be completed.
BI-RADS 5: Highly suggestive of malignancy - Appropriate action should be taken.
Thank you for your time and input.
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There are enough criteria listed there that the lack of visualized vascularity would not dissuade them from making it a B5. I am going to assume after the biopsy they will do an MRI to see the area of tissue requiring removal which may include the area of calcification in addition to the mass. It will also show the axillary nodes on both sides as well as the other breast to see if there is anything else that needs a biopsy before proceding to lumpectomy.
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Hello djmammo
, I got a biopsy done (palpable lump) on wednesday 9-5 they told me they would call with results today (friday 9-7) but 5.30 now and no call. Now will be going into weekend, maybe a good thing that I don't know. TBH it goes out of my mind as I have plenty to occupy myself.
would be nice to get an opinion on this US report in the meantime, findings was BIRADS 4 suspicious - thanks and life is good regardless.
The breasts are extremely dense which limits evaluation and could obscure a lesion.
No dominant masses, areas of architectural distortion, or suspicious microcalcifications are seen
bilaterally.
Focused ultrasound of the upper inner right breast, 2:00 position 6 cm from the nipple, in the area
palpable concern, demonstrates a 1.4 x 0.7 x 1.0 cm oval complex solid and cystic lesion which
appears parallel to the chest wall. It has slightly ill-defined margins. There is no obvious
internal flow or shadowing. No other masses or adenopathy is seen.0 -
hi djmammo, I posted my US above, its been hard waiting for results as they were supposed to call me on Friday. I have a achy feeling in my chest area and a palpable lump. Just would like to know but will call them tomorrow if they don't call me first. thanks
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Thank you for your input, much appreciated.
Lynn
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Hi! I have a biopsy scheduled for Friday of this week. The not knowing is driving me crazy! I've convinced myself that the pathology report will show that I have a malignancy, but I'm wondering if anyone has seen a report such as this with benign biopsy results?
ed. Physician performed limited breast ultrasound iFINDINGS: MAMMOGRAM: There are scattered areas of fibroglandular tissue. There is redemonstration of architectural distortion in the upper inner, middle third right breast in the 1:00 position approximately 15 mm from the nipple on spot CC view. ULTRASOUND: Focused clinical breast exam over the area of concern demonstrates a firm palpable mass with limited mobility. Focused breast ultrasound over the area of concern in the 1:00 position 3 cm from the nipple demonstrates an irregular spiculated hypoechoic mass without posterior features associated with surrounding architectural distortion in internal vascularity measuring 1.1 x 0.6 x 1.1 cm. Additionally, there is a second smaller irregular hypoechoic mass with angular margins measuring 0.5 x 0.3 x 0.2 cm 0.5 cm lateral to the larger mass without definitive communication. The total span of these masses combined measures 2.1 cm. Focused ultrasound over the right axilla demonstrates numerous morphologically normal lymph nodes with a single morphologically abnormal lymph node with cortical thickening measuring up to 0.8 cm. IMPRESSION: 1. Suspicious spiculated right breast mass with architectural distortion. Recommend patient return for ultrasound-guided biopsy. 2. Morphologically abnormal right axillary lymph node. Recommend ultrasound guided biopsy. Patient is scheduled for ultrasound-guided right breast and right axillary lymph node biopsies on 9/14/2018 at 1:30 PM. The ordering provider was notified via Epic messenger. BI-RADS Final Assessment Category 5: Highly Suggestive of Malignancy Management
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I had a core needle biopsy last year - Fibroadenoma was conclusion.
This year I had an ultrasound followup fo my mammogram. Th results read “interval increased size of Right breast mass. Differential considerations include fibroadenoma and phyllodes tumor. Given the previous benign biopsy and high likelihood of no diagnostic biopsy, localization of the biopsy clip for surgical excision is recommended.”
Why is differential consideration mentioned?
Mass: heterogeneously hypocechoic circumscribed oval mass in parallel orientation measuring 4.5x0.9x2.3cm (previously 1.4x0.6x2.3
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"high likelihood of no diagnostic biopsy"
Is this the exact wording in the report? A differential was probably given this time because of the interval growth and in light of this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463252/
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If those findings were accurately described by the radiologist then B5 is a reasonable impression. This might represent a small malignancy with an even smaller satellite lesion accompanied by evidence of spread to a regional lymph node. Let us know what the biopsy shows.
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Am I reading this correctly, there is a cyst and maybe something else??
EXAM: DIGITAL DIAGNOSTIC LEFT CALLBACK MAMMOGRAM WITH TOMOSYNTHESIS AND BREAST ULTRASOUND
HISTORY: Follow-up tiny nodule in the posterior left mid outer breast at 3 o'clock.
TECHNIQUE: Digital mammographic images are reviewed. Low-dose full-field Digital Breast Tomosynthesis examination was performed with 2D and 3D acquisitions. Targeted left breast ultrasound was performed with special attention paid to the area(s) of concern.
COMPARISON: 9/4/2018
FINDINGS:
Mammogram:
Tissue Density: The breasts are heterogeneously dense, which may obscure small masses.
The tiny, benign-appearing nodule in the posterior left outer breast is stable. It is smooth bordered and benign-appearing. There are 2 such nodules noted on 3-D imaging in the left lower axillary tail each measuring less than 0.5 cm. Only one is visualized and a exaggerated craniocaudal view of the left outer breast. On 3-D imaging, this small, 0.3 cm nodular density is benign appearing.
Ultrasound: Ultrasound of the left outer breast extending into the left axillary tail to include the upper outer breast reveals a simple cyst at 3 o'clock 6 cm from the nipple measuring 0.6 x 0.2 x 0.5 cm. This may correspond to one of the nodules. They may both be small intramammary nodes, and are difficult to visualize.
Therefore six-month follow-up left breast mammogram and sonogram is recommended.
IMPRESSION:
There are 2, smooth bordered small nodular densities in the left x-ray tail with one simple cyst noted on sonography. As precaution, 6 month follow-up left breast mammogram and left breast sonogram of the upper outer breast extending into the axilla is recommended to ensure stability.
ASSESSMENT: BI-RADS Category 3: Probably benign.
FOLLOW-UP: Follow-up imaging evaluation in 6 months.0 -
Hi. I will be having a biopsy this next Monday. My report of my second mammogram this week says:
Magnification imaging of the right breast reveals clustered heterogeneous microcalcifications in the 12:00 right breast, 5 cm from the nipple over an area 7 x 8 x 6 mm in size. Further evaluation with stereotactic biopsy is recommended.
Impression: Suspicious microcalcifications in the 12:00 right breast, 5 cm from the nipple. Further evaluation with stereotactic biopsy is recommended.
The findings and recommendations were discussed with the patient. She was assisted with scheduling the biopsy appointment.
BI-RADS 4B: Suspicious abnormality- intermediate suspicion for malignancyFrom what I have read online I feel that clustered and heterogeneous are more suspicious but my doctor emailed and said "The chances of benign are good." I am hoping of course, that this is true. Can you give me any info on clustered and heterogeneous. They didn't say if the heterogeneous were coarse or fine.
Thank you so much!
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djmammo
high likelihood of nondiagnostic biopsy
Is the exact wording
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This has been a great resource. I just received the results from the ultrasound and I am seeing that all of the findings point towards the less favorable diagnosis. I’m 32 with a palpable mass. It’s completely painless, but I get an intense itch in that area. The findings stated that the ultrasound shows a hypoechoic irregular mass with indistinct and angular margins. It also shows posterior acoustic enhancements. I heard the radiologist mention taller than wide when he reviewed the images, however, that was not written in the report. Additionally, he found an axillary lymph node with a cortical bulge.
He did not mark the Bi-rads 4 with an a,b, or c, so it’s hard to tell what’s really going on. Is it fairly common for the doctor to not use the Bi-Rads 4 sub categories? The patient care nurse told me that he would have let me know if the findings were high risk (Bi-rads 5, I guess). I have a biopsy tomorrow and I can’t wait to get it over with so I can find out what’s going on. I’m hoping for the best, but I’m also trying to mentally prepare myself if things don’t go the way I’d like.0 -
Hi I am hoping you can help settle my nerves a little bit. I had a Mammogram 3D tomosynthesis one year ago followed by a breast US. The impression is as follows. Mammogram findings: there are scattered fibroglandular densities, there are bilateral retro-pectoral saline implants. There is a stable focal asymmetry. This mammogram was done on sept 25th 2017. It is compared to my mammogram I had before my implants on 7/28/2017. These were the findings in the left breast. Right breast so no suspicious findings.
I also had an ultrasound to the area around 3 o'clock on my left breast near my nipple. Reason for US is small palpable lump. It 's hard for me to tell if its moveable. It moves around when I try to pinch it with my fingers. Anyhow, my US findings say subareolar nodule seen in the lateral subareloar location measuring 3mm. No abnormality seen in the uppler outer quandrant in the area of long-term stable focal asymtery. There is no evidence of axillary adenopaty. No abnormality seen in area of axillary pain.
Clinical follow up recommended for low suspicion left nipple and axillary pain.
Hypoechoic nodule in the periareloar region of left breast is probably benign. Sonographic f/u recommended in 6 months. Bi-rads category 3 Lifetime cancer risk says 8.5%.
I am 40 years old, have had 3 children, one when I was 18, breastfeed a little bit, I didn't produce much milk. My maternal grandmother was diagnosed with IDC at 81 years old and my dad's sister was diagnosed with bc at 42. I am not sure of what type she had but it was hormone related. Due to the risk, I opted for Breast MRI was was came back negative. Therefore, I didn't go back for my 6 month US which should have been in March. MRI said f/u with mammo in a year. I had put of my appt due to craziness going on in my life, rescheduled my appt and then dr had to cancel an appt and here were almost 6 months later from my f/u
Am I over reacting, I am going in for my mammo and US which is now one year to the date on sept 25th 2018 and I keep getting a lot of anxiety that I should have went to my f/u a few months ago.
Another question... if DCIS is found and not treated immediately does anyone know how long it takes to turn into IDC?
Keep beating myself up and poking and prodding the lump, nipples and breast is extremely sore from doing this but I am having a ton of anxiety. Please help
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I am so worried. I went in yesterday for a mammogram and ultrasound, and after finding microcalcifications and a slightly enlarged lymph node, I was sent for biopsies. Below are my ultrasound results. The word “metastatic” has me terrified. Can you help to calm my nerves as I wait for biopsy results
In the right breast upper, inner quadrant, there are extensive pleomorphic microcalcifications which involve the breast from the subareolar region to the posterior depth over approximately 7 x 4.6 x 5 cm. The appearance is highly suspicious for malignancy and biopsy is recommended.
In the left breast at approximately 11 o'clock, mid depth, there is a small group of heterogeneously coarse microcalcifications. Stereotactic biopsy (x1) is recommended.
A few scattered punctate calcifications are seen in the left breast, medially.
ULTRASOUND FINDINGS: Targeted right breast ultrasound was performed and gray scale/color flow images were reviewed.
In the upper, inner quadrant of the right breast, in the region of palpable lump, there is heterogeneously echogenic breast tissue with scattered small cysts. Multiple clustered echogenic foci are seen in the region of the palpable lump around 2 o'clock consistent with suspicious microcalcifications seen in the mammogram. A slightly dilated duct with low level internal echoes is seen in the subareolar region. No definite suspicious mass is demonstrated.
In the right axilla, there is a slightly enlarged lymph node with thickened cortex which measures 1.7 x 1.6 x 0.9 cm. The appearance is non specific however, metastatic involvement cannot be excluded. Ultrasound biopsy is recommended.0 -
Is the report worded exactly as you have posted it? Its a little confusing.
What I get from this is that there are two very small nodules and they are both seen on mammo, but only one seen on US and they said its a cyst. Since only one is seen in 2 views on the mammo, we can only predict where that one is located in the breast and I assume thats where they did the US. The other could be anywhere in that half of the breast.
They only see one at US and its called a simple cyst. Not sure why, at that point, that they postulate that these could be two small lymph nodes.
For me the key is finding the other nodule and evaluating it. The entire breast may need to be scanned to find it.
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Most grouped calcifications are not cancer. They can be completely benign or they can run the gamut from ADH to high grade DCIS. Predictability depends on particulars of their configuration. We are most suspicious if they are branching in their distribution (like the ducts) and vary is size and shape (pleomorphic). I dont know if the reader in your case used the term heterogenous instead of pleomorphic. I personally only use the term heterogeneous for the appearance of the breast tissue and masses, not calcifications. Let us know that the biopsy shows.
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djmammo, yes that is the exact report copied and pasted. Should I wait for the 6 month repeat mammo and US or request something sooner? Thank you!
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Breast imaging reports deal in what is likely and what is unlikely in light of what we see. Only the biopsy will tell you what is going on.
That being said if there is no mass seen on any imaging it could be the case that this is only DCIS and not an invasive cancer at this time. If it is pure DCIS the likelihood of metastatic disease to the lymph node drops considerably. This is not to say there wont be microscopic evidence of invasive disease demonstrated somewhere down the line on the lumpectomy specimen or sentinel node dissection, but it is less likely without a mass. Let us know that the biopsy shows.
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That's what I had assumed. I reserve that phrase for biopsies where I feel I completely missed the target, for example there is a clearly suspicious mass present and the path report says "normal breast tissue" and I will recommend a repeat biopsy or an excision for diagnosis.
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djmammo, Guess since they already did a diagnostic mammo and us, I will just have to trust their judgement and go back in 6 months. Thank you for your input.
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hank you. I’ll hold onto that hope.
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Hi! I’ve been scanning this thread and apparently my radiologist doesn’t use the exact terms that others do. I have met with him and he does seem knowledgeable. I just think that he is sugar coating a tad bit. So I’m curious what the interpretation of this report sounds like to someone else. This is both the spot compression and ultrasound report. They had it lumped together. I was to have a biopsy tomorrow but they called and had to postpone until Monday. The main concern he has is the lobular mass. He stated he felt that 50/50 were the odds of malignancy. I guess I’m just looking for a blunt unbiased opinion
FINDINGS: DIAGNOSTIC CATEGORY 4--SUSPICIOUS- TISSUE DIAGNOSIS: BIOPSY SHOULD BE PERFORMED IN THE ABSENCE OF CLINICAL CONTRAINDICATION. LEFT BREAST: Spot magnification views demonstrate persistence of a lobular mass within the lower lower-outer quadrant, mid breast. Ultrasound evaluation demonstrates an 8 x 5 x 5 mm hypoechoic geographic shaped area with mild posterior shadowing; mass versus complex cyst at the 4 o'clock position, 5 cm from the nipple. Small amount of internal blood flow. Additional hypoechoic lesions are also noted the 3 o'clock positions, the largest is 11 x 6 x 3 mm favoring benign etiology. Ultrasound-guided biopsy of the 4 o'clock hypoechoic shadowing lesion is recommended. 6 month followup evaluation of the remaining lesions is recommended unless the biopsied lesion is positive for neoplasm, then MRI of the breast should be performed to exclude satellite lesions. The findings, recommendations, and alternatives were discussed with the patient. The radiology department nurse is working with the patient to schedule biopsy. RECOMMENDATIONS: ULTRASOUND-GUIDED CORE BIOPSY: LEFT BREAST. PLEASE NOTE: A NORMAL MAMMOGRAM DOES NOT EXCLUDE THE POSSIBILITY OF BREAST CANCER. A CLINICALLY SUSPICIOUS PALPABLE LUMP SHOULD BE BIOPSIED.
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Ductogram reveal something "irregularity" in the duct. Its any possible be other than cancer? It was pre operative duct staining. Symptom dark yellow discharge, mri normal ducts
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Some of the wording is odd.
Most things that shadow deserve a biopsy as that is one feature of a breast cancer, but some benign things shadow as well so no help there. Some benign things also show a blood supply. And yes if positive an MRI will be performed to get a look at both breasts at once and to see the nodes under both arms. Let us know what the biopsy shows.
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