Interpreting Your Report
Comments
-
djmammo, You are providing such a great service with all of this insight! I'd really appreciate your input on these results of my Mammo/ultrasound while I wait to get in for a follow-up (they did both breasts, but found nothing in left, so omitting references to that breast):
Findings:
1-Dense breast parenchyma is identified bilaterally
2-I do not see dominant masses, asymmertry or microcalcifications
3-Ultrasound of the right breast was performed and a hypoechoic nodule measuring 7mm in size is seen with flow
Impression:
1-Hypoechoic mass in the right breast
2-I would recommend MRI of the breast or marrow limits scan
3-BI-RADS 0
4-Category B
The lump is very easily felt without applying pressure and it developed over ~2 months (My gyno did a routine breast exam at the end of June and did not find any lumps). Because it developed quickly, and right after I moved to an area with a high cancer population, I may be more alarmed than I need to be, but I am resisting the urge to do too much research on the buzzwords for fear of convincing myself of the worst. Your input is greatly appreciated!
0 -
1) Can calcifications be felt? I ask because I can feel this particular nodule. It's hard and pointy.
Malignant calcifications are too small to feel. Large calcs from fat necrosis or inside a fibroadenoma can if they are large enough.
2.) Both radiologist said they cannot see anything on the mammo due to my dense breasts. Based on what you stated, they should have been able to see the calcifications on the mammo. Would that indicate that it is not calcification?
They mentioned calcification associated with the implants so I assume they see that on your mammo(s). To see that little nodule seen on US adjacent to it on the mammo, it would have to be seen in profile which would be a difficult proposition with the implant.
3.) My insurance is willing to pay for the MRI, but if it will be too small to pick up, what other options do I have to figure out what this is?
The MRI would be used to tell you if a cancer is present in either breast that is large enough to see. If the MRI is neg they will probably recommend a series of short term follow up US exams since thats what picked it up in the first place which is reasonable especially if ins will pay for the MRI. If a breast cancer is small enough not to be detected at all on an MRI, IMO its not an immediate threat so it can and should be followed with imaging.
4.) I don't recall them checking for internal blood flow on the second US. I also have copies of the photos and they didn't save any.
Might be tough to demonstrate flow in something that small (4mm x1mm).
Aside from having a third ultrasound how would I find out if it was complex or complicated cyst?
The MRI will tell you what you need to know about the cyst. If you don't have the MRI performed, ask the radiologist who read the US whether s/he thinks it needs to be biopsied.
0 -
Thanks very much djammo. Not sure I know how to quote...lol
My follow up mammo and ultrasound provide the following:
BI-RADS 3 Complicated (complex?) cluster of cysts, follow in 6 months.
So, although I feel better, should I feel better?
Thanks!
Lori
0 -
Its not a follow up to see if its a cancer, its a follow up to prove its benign.
We are taught to use B3/6mo only when we see no suspicious features that would require a biopsy. We use it only when we feel its safe to wait 6 months to prove our position that its benign.
I guess it comes down to faith in your provider.
0 -
Looking for an honest educated opinion on mri results. Biopsy scheduled for 10/22. Hate waiting, would rather know now as I am already thinking it is not good. Thanks for any help.
Rt breast there is mild background enhancement. Within the retroareolar breast there is a t1 hypointense heterogeneous linear non mass enhancement measuring 34 x 7 x 11mm (Ap x trv x si) with mixed enhancement kinetics including washout. This extends towards nipple with associated nipple enhancement and retraction. This finding is suspicious. MRI guided biopsy is recommended for definitive diagnosis. Again seen 4mm mass within upper outer breast and a 4 mm mass within the 12:00 position at the fat fibroglandular interface. Previously evaluated on u/a with complicated cysts identified as possible correlates. Although likely benign biobsy is recommended to exclude multicentric disease, given the presence of new suspicious linear non mass enhancement. Birads 4
Brenda
0 -
Good Evening, DJMammo!
My Stereotactic biopsy got cancelled as they discovered that the microcalcifications being posterior and on the upper outer quadrant was not ideal. I will be getting a wire guided excisional biopsy instead. Crossing my fingers for a quick recovery!
I’m wondering what could be possibly happening with microcalcifications that are grouping (as compared to previous mammo) and Pleomorphic in shape in that area. It’s pretty high up, and I’m on the thin side, so not a lot of tissue going on there. Just seems like an odd place for funny business, or so I am hoping!
Any input from you...or others reading this?
Thanks, all!
0 -
I am a 42 year old woman with a strong family history of breast cancer. I was recommended to start alternating MRIs and mammograms every 6 months. I had my first MRI two weeks ago and had 3 areas biopsied last week as a result. I received my biopsy results today, and while I am thrilled everything came back benign, I'm still concerned that the MRI report doesn't match the pathology results. Are fibroadenomas ever spiculated and non-circumscribed? I am posting the two reports below. I'd appreciate any additional clarification that you can provide.
MRI:
RIGHT BREAST:
Right breast posterior one third aspect upper-outer quadrant at approximately the 11:00 position
there is an oval not circumscribed spiculated appearing enhancing mass measuring approximately 0.8 x
0.9 cm. This demonstrates slow initial uptake with persistent enhancement kinetics. This measures
approximately 1.8 cm from the skin laterally and measures 0.8 cm from the pectoralis muscle. This is
demonstrated on axial postcontrast image 85/180, and sagittal subtraction image 208/281.
Additionally, within the right breasts middle one third aspect just lateral to the posterior nipple
line at approximately the8-9:00 position there is a reniform-shaped circumscribed enhancing mass
with central nonenhancing component suggestive of fatty cleft however without T2 hyperintense signal
changes. This measures approximately 0.4 x 0.4 centimeters. Laterally, this measures 1.6 cm from the
skin, and this measures 3.4 cm anterior to the pectoralis muscle. This is demonstrated on axial
postcontrast enhanced image 114, and sagittal subtraction image 214.
No other suspicious enhancement of the right breast. No skin thickening, no nipple retraction.
Benign cysts are scattered throughout the right breast.
LEFT BREAST:
Left breast anterior one third aspect upper inner quadrant at approximately the 11:00 position there
is a 0.4 cm focus of enhancement demonstrating slow initial uptake, and persistent enhancement
kinetics. The closest margin to the skin is approximately 1.2 cm along the anterior margin. This is
approximately 3.8 cm anterior to the pectoralis muscle. This is demonstrated on postcontrast axial
image 91, and subtraction sagittal image 75.
No other suspicious enhancement within the left breast.
Pathology:
Final pathology of fibroadenoma in the right breast at 11:00 is concordant with imaging findings.
Final pathology of nodular adenosis in the right breast at 9:00 is concordant with imaging findings.
Final pathology of dense stromal fibrosis, columnar cell hyperplasia and usual ductal hyperplasia in
the left breast at 1 cm is concordant with imaging findings.
Recommend follow-up diagnostic mammogram in May 2019 and bilateral breast MRI in one year as well as
0 -
Tbkk4
Here is an excerpt from this fine BrCa site: https://breast-cancer.ca/mag-lex/
"A non-mass-like contrast enhanced distribution of a breast MRI is described as 'ductal' when it appears in a linear or linear branching which follows one or more ducts. ... Ductal contrast enhancement is thought to have a positive predictive value for breast cancer ranging from about 26% to 59%."
0 -
EA76
They said all the path findings were concordant, thats the word we want associated with all biopsy results. If they are satisfied that all the correct areas were biopsied (by comparing pre and post biopsy images, the placement of the biopsy markers, etc) you might want to ask them if they described all their findings in the proper sequence/ locations within the breast on that report if you think they don't correspond, and to amend the report if a discrepancy is found.
0 -
I had mammogram for a follow up for a fibroadenoma they found fine powerlike micro calcifications some i said fibroadenoma but mostly out it was birads 4 and 4b moderate suspicion for malignancy, had my wire biopsy yesterday and the fibroadenoma removed should I be concerned I go a week from today for my re
0 -
I think there are some typos in your post but I will try to answer what I think you are asking.
Depending on how old a fibroadenoma is, they can develop calcifications and still be benign. I don't recall seeing a patient's excisional biopsy of a core-biopsy diagnosed fibroadenoma ever come back as a cancer. If the original biopsy did not show any areas of atypical cells then it should come back benign. Let us know what the final surgical pathology shows and what their recommendations are.
0 -
Hello again,
I went for another ultrasound last week as my BS wanted to make sure that my microcalcifications and the palpable lump were/were not in the same area, since she has to do a wire guided excisional biopsy.
She called me today to tell me that this time the US noted a 1.2 cm lesion with calcifications, and they are not able to confirm if it is in the same spot.
She asked me if I wanted to postpone surgery (on the 29th) so that she can do a biopsy on the lump and then see how to proceed. I said why not just take out both the area with micros and this lump? She said it could change the plan of attack.
She’s booking the biopsy and with the hope we will get results back in time for surgery date. I’m complicating things with a vacation for the next week, and a conference in early November.
I’m ok with postponing but I’m wondering if that’s the best idea? If my first US in Sept didn’t show what they see as of last week, is that concerning, time wise? Am I best to do a biopsy and wait and see, or should I just forge through with the idea of removing the lump alongside the micro biopsy. Keeping in mind they are already doing an excisional because the micros are in a spot they can’t access with stereotactic needle.
What’s a lesion vs a cyst? Is it more or less concerning?
Thanks everyone
0 -
What's a lesion vs a cyst? Is it more or less concerning?
A "lesion" is a general term that has been used to convey "something that shouldn't be there", even if it looks benign. I personally reserve it for something that I feel is "abnormal looking and should not be there". A cyst is a specific diagnosis.
0 -
Hi DJ
TGIF, I am a 52.5 year old women with no family history of BC (except a paternal aunt who was diagnosed at my age and later passed with brain cancer at 55, however I have been told that isn't close enough to count). I am wondering if I should pursue the stereotactic biopsy for the below finding in my left breast. As in, should I wait the 6 months for the follow-up? The report is below, I would appreciate any insight you could provide.
PERTINENT SYMPTOMS/CLINICAL HISTORY: SCREENING Z12.31
PROCEDURE: Bl SCR TOMO+CONV LT DX MAM+CAD
BREAST PARENCHYMAL PATTERN: (Type Ill) The breast tissue is heterogeneously dense, which could obscure detection of small masses (approximately 51-75% glandular).
COMPARISON: 10/05/17, 9/29/16TECHNIQUE: Digital tomosynthesis and C-View bilateral screening mammogram was initially performed.
FINDINGS: Densities there are bilateral coarsely calcified axillary and axillary tail lymph nodes, unchanged.
RIGHT BREAST: Screening mammographic views of the right breast demonstrate no discrete mass, suspicious microcalcifications, or architectural distortion to suggest the development of malignancy.
LEFT BREAST: Screening mammographic views of the left breast demonstrate a cluster of calcifications in the inner posterior left breast. There is also a focal asymmetry in the inner left breast. The rest of the breast parenchyma demonstrates no discrete mass, suspicious microcalcifications, or architectural distortion to suggest the development M malignancy. There is a large well circumscribed density in the upper breast, unchanged and consistent with a cyst.
DIAGNOSTIC MAMMOGRAM: Spot magnification view of the left breast was performed as a followup to the screening portion of the study, demonstrating a cluster of indeterminate calcifications in the area of initial concern. Spot compression tomosynthesis view of the left breast was performed as a followup to the screening portion of the study, demonstrating multiple well circumscribed densities in the visualized parenchyma, likely cysts or other benign etiology.
IMPRESSION: A cluster of indeterminate calcifications in the left breast for which further evaluation with stereotactic biopsy is recommended. Multiple well-circumscribed parenchymal densities, likely cysts or other benign etiology, given their appearance and multiplicity. This finding could be reassessed at a six-month follow-up mammogram to the above recommended stereotactic biopsy.
Bl-RAD CODE: 4-SUSPICIOUS ABNORMALITY-CONSIDER BIOPSY
0 -
They are recommending a biopsy for the calcifications. The 6 month followup recommendations are for the findings they feel are benign cysts on mammogram. Was an ultrasound done? Did you have a prior US showing cysts?
There is no specific description of the calcifications so it would be difficult to hazard a guess on the outcome of a biopsy but since the calcifications are new, and are indeterminate (that is, not clearly benign) a stereo biopsy is a reasonable recommendation.
I am curious about the bilateral lymph node calcification. This indicates there is something else in your past medical history unrelated to the breasts, if indeed they are calcifications. Was this finding ever discussed with you?
0 -
Thank DJ for the insight.
I was told that the lymph node calcifications were from my tattoos. I have full back, both side ribs tattooed and shoulder caps as well. That is all they said in regards to the lymph node calcs - nothing else has been said about them since. I have had previous US on both breasts about 4-5 years ago but haven't had an US since 2015 on the L breast but did have a FNA for a cyst in 2015 on the L. Historically I am very cyst prone in both breasts with 2 ducts removed in the R breast in 2011 due to ductal ectasia/nipple discharge.
I did ask about a US after this mammo and the nurse navigator said they wouldn't do an US because the calcifications wouldn't show up on the US (that density only shows up on US). I am clueless about that statement typically before when I have had diagnostic mammo an US was always included.
0 -
CasM
Tattoos make more sense as calcification in the nodes on both sides is unusual, seen in things like TB or lymphoma after radiation treatment.
What they are seeing are the metallic pigments from the ink in the nodes having been taken up by the lymphatics and transported to the nodes, not calcifications.
0 -
The results of my mammogram were as follows: The tissue of both breasts is predominantly fatty. There is possible architectural distortion in the left breast at 12:00 anterior depth (best seen on left MLO tomosynthesis view). No other significant masses, calcifications, or other findings are seen in either breast.
IMPRESSION: ACR BI-RADS CATEGORY 0: INCOMPLETE: NEED ADDITIONAL IMAGING EVALUATION. The possible architectural distortion in the left breast is indeterminate. Spot compression and lateromedial views as well as additional views with possible ultrasound are recommended.
Today I went and had a diagnostic mammogram and ultrasound. I could see the screen on the ultrasound. There were a lot of white areas. The black areas were what they were taking pictures of. The radiologist said that there was something solid and they needed to do a needle core biopsy. That is scheduled for a week from now. Basically they said we are no closer to knowing anything that we were after the first mammogram. I am pretty concerned. Any feedback would certainly be appreciated.
0 -
"Basically they said we are no closer to knowing anything that we were after the first mammogram"
Did they phrase it just that way when they told you?
0 -
Djmammo... if your mammo report describes "no associated microcalcifications" around suspicious area... but then pathology report says "microcalcifications identified" does that matter?
0 -
Two different size calcifications. The term microcalcifications means different things to radiologists and pathologists. Rads use this to describe tiny suspicious calcs that are visible to the naked eye. Pathologists use that term to describe calcifications that are several orders of magnitude smaller, not visible on mammogram but visible in tissue under a microscope. They dont have the same significance.
0 -
DJMammo-
I have a question stemming from a comment you made (I've copied and pasted it)- Oct 11, 2018 04:45AM djmammo wrote:
What's a lesion vs a cyst? Is it more or less concerning?
A "lesion" is a general term that has been used to convey "something that shouldn't be there", even if it looks benign. I personally reserve it for something that I feel is "abnormal looking and should not be there". A cyst is a specific diagnosis.
My pathology report reads features suggestive of a fibroadenoma or fibroadenoma-like lesion.
Could this mean they aren't sure that it's a fibroadenoma? And you stated you reserve "legion" as "abnormal looking and should not be there", should I request this be evaluated further?
0 -
DJ
Thanks for the clarifications on the inks in the lymph nodes. I had the biopsy but haven't received the pathology yet. The radiologist completed a report for the biopsy and this is what it said. Does this mean that it appears B9? Thanks for any info provided. I am so glad you are part of this community.
"IMPRESSION: Stereotactic biopsy of calcifications within the upper inner left breast.
Benign pathology results would be considered concordant"
0 -
DJmammo, I had a Brachial Plexus MRI and I would like to know if that imaging includes specificallythe armpit area as that is where my problem is. Thanks in advance for your reply.
0 -
Djmammo Appreciate your help! Biopsy Monday and will be hoping I am in the good percent. Love that you are helping us "anxiously waiting"interpret results. So frustrating to wait and I would always rather know possibilities up front and have time to process every possible outcome. Thank you
0 -
Thanks for your info Djmammo!! You're such a blessing to us all! ☺
0 -
CLINICAL HISTORY: Palpable area or concern in the right breast for four months. Patient reports nipples have always inverted intermittently, however the right nipple has been fixed for the past four months.
BREAST DENSITY: The breasts are heterogeneously dense, which may obscure small masses.
DIGITAL MAMMOGRAPHY FINDINGS: Right breast: There is an approximately a 14 mm mass in the subareolar/periareolar right breast at 9:00 in the region of the palpable marker.
RIGHT BREAST ULTRASOUND FINDINGS: Directed ultrasound was performed in the region of concern in the subareola right breast. At the palpable sight of concern in the subareolar/periareolar right breast at 9:00 in close proximity to the inverted nipple there is approximately 11 x 7 x 12 mm hypoechonic mass with indistinct margins which appears to be at least partially within the dermis. Findings correspond to the mammogram and are indeterminate. No abnormal appearing lymph nodes are identified in the right axila.
IMPRESSION: BI-RADS category 4-Suspicious Abnormality.
RECOMMENDATION: Biopsy should be considered. Recommend surgical consult for the mass in the subareolar/periareolar right breast (in close proximity to the inverted nipple).
Does this mean they can't really see the mass clearly? Or they do? Can they know if it is fluid filled or not? I asked but she only said she thought so. What are your thoughts djmammo? I'm going for a consult on Tues. Thanks!
Also, 3 weeks ago, the lump got really big and painful. You could even see it. That's why I got it checked. Is this a good sign? Can cancer change sizes or is this most probably something else? What else could it be? What subcategory in BIRADS 4 do you think this is?
Thanks again
0 -
Looking for help, I’m worry
REASON FOR EXAM: SCREENING, ASYMPTOMATIC.
SCREENING MAMMOGRAM: OCTOBER 18, 2018 - CHECK IN #: 5533615
BILATERAL CC AND MLO VIEW(S) WERE TAKEN.
TECHNOLOGIST: MARTHA L. ROCHA, RT(M)
NO PRIOR STUDIES AVAILABLE FOR COMPARISON.
THERE ARE SCATTERED FIBROGLANDULAR DENSITIES (AVERAGE).
BILATERAL BREASTS:
BENIGN APPEARING CALCIFICATIONS ARE PRESENT BILATERALLY.
THERE IS NO RADIOGRAPHIC EVIDENCE OF MALIGNANCY IN THE RIGHT
BREAST.
THERE IS A PARTIALLY OBSCURED 0.8 CM MASS IN THE LEFT
RETROAREOLAR REGION.
ACR BI-RADS® ASSESSMENTS: INCOMPLETE (BIRADS 0), NEEDS ADDITIONAL
EVALUATION
RECOMMENDATION
OBTAIN PRIOR STUDY FOR COMPARISON.
SPECIAL VIEW MAMMOGRAM OF THE LEFT BREAST IF PRIOR EXAMS ARE
UNAVAILABLE
ULTRASOUND OF BOTH BREASTS.
THIS CASE WAS ALSO EVALUATED USING CAD (COMPUTER-AIDED DETECTION)
ANY PALPABLE FINDING SHOULD BE EVALUATED INDEPENDENTLY OF THIS
REPORT.^RISK VALUE(S):^TYRER-CUZICK 10 YEAR: 2.224%, TYRER-CUZICK LIFETIME: 9.219%, ^MYRIAD TABLE: 1.5%, GAIL 5 YEAR: 0.6%, NCI LIFETIME: 7.7%0
