Interpreting Your Report
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Does this mean they can't really see the mass clearly?
No. "Indistinct margins" is an actual finding, and a suspicious one
Can they know if it is fluid filled or not?
Yes. That is what US is best at.
3 weeks ago, the lump got really big and painful. Can cancer change sizes ?
It does not get smaller.
What else could it be?
When you go for the consult ask if it is originating in the skin, or the breast tissue. Ask if it could be a sebaceous cyst.
What subcategory in BIRADS 4 do you think this is?
I've never used the subcatagories. These are used to evaluate the radiologist's pre-biopsy diagnosis for the MQSA, not really meant for the patient to draw conclusions.
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Thanks djmammo, my fear is that the mass is cancerous. My physician was very optimistic and said not to worry much that the ultrasound would reveal more information. I'll be heading tlf or second round on Wednesday.
Thanks
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Hi djmammo,
My question is, when you have 2 tumors 2.1 cm apart and they are spiculated, do you believe that they will classify the tumor as one and then the size would be they whole of the 2 pulse the separation?
TISSUE DENSITY:
The breast is almost entirely fat.
FINDINGS:
Tomosynthesis: 3-D tomosynthesis was performed to further evaluate breast tissue.
Right breast:
There is a new mass in the upper outer quadrant at middle depth. On tomosynthesis, there may be
irregularity of the margins and spiculation.
Additional smaller mass is present in the upper inner quadrant towards the 12 o'clock position. On
tomosynthesis, there is also appearance of spiculation.
Left breast:
In the region of the triangular marker indicating the patient's reported palpable finding, there is
a mass in the 3 to 4:00 retroareolar region better visualized on tomosynthesis.
Performed By (Primary):
US BREAST BIL DIAGNOSTIC LIMITED - Bilateral: October 03, 2018 - Accession #: 5594714
FINDINGS:
Targeted bilateral breast ultrasound was performed by the sonographer and the radiologist.
Right breast ultrasound:
2 suspicious masses are noted:
R1: At the 1130 o'clock position 7 cm from the nipple, there is an irregular hypoechoic mass with
angular margins. Internal vascularity is demonstrated. The mass is antiparallel to the skin line
and measures 8 x 11 x 11 mm and likely corresponds to the new mass on mammography.
R2: At the 12 o'clock position 8 cm from the nipple, there is a second irregular hypoechoic mass
with angular margins. This mass likely corresponds to the second smaller mass on mammography and
measures 3 x 12 x 5 mm.
The distance between R1 and R2 masses is 2.1 cm.
On physical exam, there is subtle palpability of both masses.
Imaging in the right axilla 15 cm from the nipple demonstrates benign-appearing axillary lymph
nodes.PATHOLOGY RESULTS:
Result: Malignant, Invasive ductal carcinoma.
Estrogen Receptor: +. Progesterone Receptor: +. HER2/neu: -.
Biopsy results are concordant with imaging findings
US Breast Biopsy Additional Lesion RT - Right: October 10, 2018 - Accession #: 5597194
PROCEDURE DESCRIPTION:
Site B:PATHOLOGY RESULTS:
Result: Malignant, Invasive ductal carcinoma.
Estrogen Receptor: +. Progesterone Receptor: +. HER2/neu: -.
Biopsy results are concordant with imaging findingsThanks in advance. I had a subsequent core biopsy on both tumors, which revealed the R breast was IDC. They stated that staging and grading is done after surgery which is scheduled for 10-22.
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Dr mammogram - this is in reference to your post that divided the favorable and nonfavorable traits of radiologist reporting.
Last week I had a follow-up mammo plus U/S and they classified it as bi-rad 4b. My gut feeling says that everything is fine. What is bothering me is that the description of my lesion has all the favorable terms you mentioned - Oval, hypoechoic, wider than taller, and something else. It also mentioned that it's not vasculated. I also saw on the U/S the lesion and it was black with clear and crisp outline. To me- this sounds like it's benign. The radiologist recommends biopsy because the lesion is undetermined. If it has majority of benign characteristics, why am I being subjected to this? Last year I did have two biopsies done (core on left and ecxisoonal on right).eThe left was fibroadema and the right had the pappiliumar thing (that causes bloody discharge). The whole experience was a nightmare and I really don't want to go through this again. My surgeonmrecommended a mammogram guided biopsy which I'm waiting for an appointment t to be scheduled.
How can the radiologist report it as undetermined when it's obviously visible on the U/S showing a lot of benign traits?
Thank you
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Thank you Dj, I will ask after my lumpectomy tomorrow.
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thank you! It doesn’t say if the parallel or non parallel or the taller than wide or viceversa. It’s 11 x 7 x 12. I don’t understand order of measurements. And it doesn’t talk about shape. What would Be your conclusion about the parallel / non parallel and shape of this measurements
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No way to know unless they label the dimensions as L X W X H.
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Can you read this???
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Here is what was typed on my report. Thank you for trying to help me understand this as to me, it sounds like it all should be benign. But I’m not smart like you radiology people. Lol
Mammogram: there is a 1.6 cm oval Isodense mass in the inferior lateral right breast, middle depth, corresponding with both the asymmetry visualized on the prior mammogram as well as the patient’s palpable abnormality. This lesion is well visualized on the true lateral view, as well as the compressed MLO and CC views.
Ultrasound: A gently lobulated, solid, Hypoechoic, wider than tall mass is present at the 7 o’clock position of the right breast, measuring 1.3 x 0.9 x 1.5 cm. No definitive internal vascularity is evident within this lesion.
Conclusion: indeterminate solid mass at the 7 o’clock position of the right breast. Additional characterization with tissue sampling is recommended. This lesion would be amenable to percutaneous sampling under ultrasound guidance or wire localization prior to surgical excision.
Bi-rads assessment: category 4b suspicious abnormality- biopsy should be considered
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In general, anything new and solid is suspicious, and for me my degree of suspicion increases with patient's age. The choice would be biopsy now vs. watch it with a follow up every 6 months for 2 years. My preference was to biopsy it and if it comes back benign, I feel safe following up at 6mo and 1 year. Here is the reason why I biopsy them.
I had a case where I was sure a small mass was a benign fibroadenoma but since she worked in my department I made the decision to biopsy it just in case I was wrong. It turned out to be an unusual cancer that can mimic a fibroadenoma.
Discuss the next step with your doctors.
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Regarding Birads 4B: "Specialists divide BI-RADS category 4 into three sub-categories A, B, and C. In terms of the positive predictive value for breast cancer, a category bi-rads 4A mammogram is quite low at 13%, and category bi-rads 4B also moderately low at about 36%. But, when we see a mammogram with a classification of bi-rads 4C, the positive predictive value of breast cancer jumps up to around 79%. So, this means that category 4C indicates a high risk for breast cancer." from https://breast-cancer.ca/bi-rads/
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I finally got my ultrasound report. He mentioned possible fibroadenoma on the left which he's watching. I assume the right is the cysts his nurse mentioned. I got Birad of 3. I’m 36 with no history. By my report, would it be fine to wait the six months as recommended? I didn't get to speak directly to the radiologist but this topic did help! Thank you
Ultrasound report
Ultrasound right upper outer quadrant 4 cm from nipple demonstrates circumscribed oval anechoic mass measuring 5 x 2 x 4 mm (suspect cyst). Circumscribed oval Patel hypoechoic mass 10.00 3 cm from nipple measuring 1.2 x 1.1 x 0.3 cm
Left 11-12 o'clock 3 cm from the nipple demonstrates a circumscribed oval parrallel hypoechoic mass measuring 3.6 x .1 x 2.9 cm
Left 11-12 o'clock 4 cm from the nipple demonstrates a circumscribed oval parallel hypoechoic mass measuring 0.8 x 0.5 x 0.7 cm
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Hi DJMammo,
I got the path results from my ultrasound guided needle biopsy today. It came back positive for DCIS. They took three samples.
My excisional biopsy on Monday has been changed to a lumpectomy, and radiation to follow.
Because of my gene (RAD51D), and heavy family history, we will also be talking about a bmx this week.
Part of me wants to forgo the lumpectomy and go straight to mx, but perhaps having that area taken out in the meantime will give some piece of mind.
Just thought I would follow up as I have seen you like to learn the results following diagnostics.
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Thanks for the update !
Reagarding BMX without prior lumpectomy: There may be information to be gained by examining the lumpectomy specimen that would influence your subsequent surgery(s). In my experience, surgeons and oncologists want to know as much as they can about a cancer before a treatment plan is finalized. You might ask them if that is the case if you are presented with the choice.
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In general, if you trust the rad reading your studies I see no reason not to follow their recommendations.
(The "impression" is missing from the report you transcribed)
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H,I finally got my mammo results after a month.....in my letter it stated that there was 1 founding, dense breast....now my doctor just called me saying that that is a small density abnormality on my left side.......on my left side is where I can see/ feel a dent type of something(almost like when u take off sock and there's a line ) going for a ultrasound on the 31st I'm going crazy tho
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That’s great advice. I will do that.
In the meantime, this was just posted in our local newspaper. Quite interesting!
https://www.theprogress.com/news/b-c-oncologist-changing-the-face-of-breast-cancer-treatment/
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Hi DJ
Thought I would share my pathology report from my stereotactic biopsy - CALCIFICATIONS PRESENT IN ATYPICAL PROLIFERATIVE Fl8ROCYSTIC CHANGES INCLUDING ATYPICAL LOBULAR HYPERPLASIA, MILD TO MODERATE ALSO COLUMNAR CELL HYPERPLASIA WITHOUT ATYPIA AND STROMAL FIBROSIS.
I have an appt. with a breast surgeon on 10/29 to see where we go from here. What I have been reading maybe a excision biopsy? Would I get a MRI before this procedure or should I ask for one?
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Anything showing atypia is always removed and examined to make sure there are no cells that have progressed beyond atypia to something more insidious.
MRI is routine after finding a malignancy. I don't know that it is universally performed for ALH (also called lobular neoplasia) but I believe that it might classify you as "high risk" which should allow ins to pay for subsequent screening MRI's. It would be helpful preoperatively to screen for a small occult tumor but as far as I know there are no specific findings for ALH or ADH like there is for IDC so you may wind up with additional biopsies.
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DJMAMMO, yes, that's how they worded it.
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Hi DJ
Thanks for the link and also the insight. It is much appreciated. I have resolved my mind that I will probably be getting a excision so I won't be surprised if the breast surgeon decides to go that route.
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Hi,
I was wondering if you could help interpret my U/S report.
Findings: In mammogram, there is asymmetric parenchymal density in the left breast posterior laterally; this area was not convincingly seen previously; likely represents parenchyma; this is not the area of the palpable lump.
The right breast medial lump is not visible on mammogram.
On ultrasound in the right breast, the palpable lump is visible as an elongated planar hypoechoic structure at 3:00 + 12cm, measuring up to 1.8 x 0.4 x 2.7 cm; there is what may be hilar blood flow, and this could be a lymph node; no aggressive features; non tender on physical examination.
In the left breast on physical examination, the patient’s small, slightly Mobile relatively superficial nodule at 3:00 to 4cm is identified as a small hypoechoic ovoid focus; there may be hilar blood flow, and this could be a lymph node; there may be some lobulation however. In the left breast at 2:00, 9cm from the nipple, there is a questioned area of vague noncircumscribed shadowing hypoechogenicity measured at up to about 6 mm; this is most likely normal dense breast tissue, but will also be followed.
Bi-rads 3
The radiologist that did it asked me if i wanted a biopsy or if i wanted to wait 3 months and rescan. I said if he said it’s ok to wait - i was fine waiting. However, back to my Ob and he said No waiting and sent me to breast surgeon. I finally see the surgeon and he said he wants an mri. It’s been 3 months. I’m just so frustrated.
I’m 43. No family history.
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Hi djmammo, my biopsy results came in as follows: " A. Right breast Central MRI guided core biopsy for non Mass enhancement: benign breast tissue with sclerosing adenosis, fibroadenomatoid nodule, usual ductal hyperplasia, duct ectasia and microcysts. Focal stromal histiocytic reaction with rare foreign body giant cells present suggestive of a ruptured cyst or duct ,however , no cyst lining present B. Right breast upper outer mri-guided core biopsy for Mass: Benign breast tissue with cyst showing apocrine metaplasia, adenosis and a fibroepithelial lesion with features most consistent with a tubular adenoma. small papilloma also present. Impression: given the extent of the retroareolar abnormality excision is recommended to exclude a small intraductal malignant process causing the inflamatory changes found at biopsy. Results of site B are concordant with the same mass targeted showing benign pathology therefore the additional morphologically similar mass not biopsied should be followed un with month MRI to confirm stability. Surgical consultation as recommended by pathology for the incidental papilloma." Hoping I can get your opinion on this. *had posted in wrong area so reposting and have since met with surgeon yesterday. They will call me Tuesday to schedule surgery. Not sure how confident I was in what they thought she be rechecked versus what I thought so would still love any input from anyone with similar experience and also djmammo. * thanks to you all💖
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It sounds like they saw two small intramammary lymph nodes that dont worry them.
The third finding on the left at 2:00 is the one I would be interested in seeing on MRI. Is this what they offered the biopsy for, or was the biopsy for all three findings?
3 months is half the normal "short term followup" waiting time, standard is 6 months which is long enough to see some change if its going to, and short enough not to affect prognosis if abnormal. A report of "no change at 3 months" is not really that reassuring unless their routine is two exams in a 6 month period.
Post your MRI report when you can.
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This looks like the radiologist's "path addendum" to the biopsy report and not the actual report from the pathologist. There is a lot going on there but from this I am not sure why the suspect "small intraductal malignant process causing the inflammatory changes found at biopsy". Do you have the original path report ?
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Djmammo
thank you SO much.
Will do!!
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