Interpreting Your Report
Comments
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Please help ease my mind that my biopsy is just routine and will most likely result in benign findings. Report reads as follows:
Findings:
with supplemental imaging, the area of possible distortion in the upper central left breast does not definitely persist on tomosynthesis imaging. However, within region of previously questioned distortion there are amorphous calcifications within the superior, central and slightly medial left breast in a regional distribution spanning approximately 4-5 cm. Additional calcifications are also seen laterally.
Targeted ultrasound of the left breast at the upper inner and lower inner quadrants, there is no mass to correlate with the previously questioned distortion or the amorphous calcifications. At the 2:00 positions, 4 cm from the nipple in the left breast is a round, circumscribed, hypo echoic, 7x7x7 mm mass with posterior through transmission. Low-level internal echoes cannot be cleared. However, there is increased through-transmission, and this likely represents a complicated cyst incidentally found.
Recommendations:
Stereotactic guided biopsy of the amorphous calcifications in the upper central left breast, with targeting in the region of previously questioned distortion medially.
BI-RADS Category 4
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Thank you djmammo, shows my lack of knowledge, I thought this was the full report. I will definitely ask for a copy. Met with surgeon and they will remove papilloma (she was going to leave papilloma but I wanted it out)and part of the non mass area. She said tubular adenomas are never cancerous so ok to do 12 month follow up MRI. I am confused as to why a 12 month follow up is even needed on those if they are sure they are tubular adenomas and are sure they are never cancerous. Thoughts on that?
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Mamogram was birad 4 but mri and ultrasounds were birad 5. A core needle biopsy was benign. I am relieved but deep down feel that something missed with biopy, especialy after reading image report. I will repeat mamogram in 1 year but worry. This solid tumor was not there 1 yearago and is already 5 cm. What kind of benign tumor appears cancer on image could this be?
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Not sure. We often follow benign lumps just to monitor for change in size at which time we usually recommend they be removed.
We don't see many of those but here is a good article about them https://www.ncbi.nlm.nih.gov/pmc/articles/PMC58089...
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Hi all,
I have been reading this website for a few weeks as I seem to have failed all the mammo screens thus far and have to have a biopsy.
Having the information in this community is amazing, so thank you all for your sharing and information to people like me that are starting with zero knowledge.
My report leaves me with no sure estimate of what is going on, but I am hoping to get some feedback to put my head in a more sure place. I am a data person generally, but the unknowns of what is next or what the biopsy will show has thrown me into a tizzy.
@djmammo, can you help see anything in this to point me in a direction? My diagnostic report is below, which was after my yearly 3D mammo. The callback included an US and then the radiologists didn't like that so also had me do a 2nd 3D mammo on my left breast as they thought there was something else besides a cyst on my left breast, but she said she couldn't be sure because I had extremely dense breast.
I am 55 and have no history of BC in my family, only skin cancers.
RAD US BREAST UNILATERAL LIMITED, UNI LEFT ONLY 2D/3D DX OR AV MAMMO
EXAM 10/26/2018 3:28 PM
Signs and Symptoms/Comments: left breast inconclusive mammogram, oval mass lower inner quadrant
Comparison: Screening mammogram October 11, 2018, August 31, 2016, September 3, 2013,January 4, 2007, additional comparison made to left breast ultrasound performed December 16, 2005.
TECHNIQUE: Grayscale and color Doppler ultrasound was performed in the left breast lower inner quadrant. Spot compression synthetic 2-D/3-D CC and MLO views of the left breast were performed.
Left breast ultrasound findings: Targeted ultrasound was performed to the lower inner quadrant of the left breast which demonstrates a group of anechoic cysts at the 9 o'clock position 3 cm from the nipple measuring up to 0.7 x 0.3 x 0.9 cm which is not viewed with concern.
At the 6 o'clock position of the left breast 7 cm from the nipple there is a focal region of hypoechoic shadowing without a definite mass identified. It is unsure if this is the sonographic correlate to the mammographic finding. Therefore, additional mammographic views were subsequently performed. Left breast mammographic findings: The breasts are extremely dense, which lowers the sensitivity of mammography. The previously described mass in the lower left breast, slightly inner quadrant 5 o'clock to 6 o'clock position mid to posterior 3rd depth 6 cm from the nipple persists, but is obscured a dense region of fibroglandular tissue making characterization difficult.Left breast impression: BI-RADS 4: Suspicious.
Recommendation: Ultrasound-guided core needle biopsy is recommended to the indeterminant focal region of shadowing in the lower left breast 6 o'clock position 7 cm from the nipple. An appointment for ultrasound-guided biopsy will be scheduled prior to the patient's departure.
Overall assessment: BI-RADS 4: Suspicious.0 -
"Shadowing area on US without a mass" can go either way. Sometimes its artifact and can't be redemonstrated on the day of biopsy. Also I think its odd not to see a mass on US when a mass is present on mammo, and that they're not sure if these two findings correspond. Let us know how the biopsy goes.
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Thank you, I sent to you.
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Hello! First, this site is loaded with helpful information and somewhat overwhelming. I have no family history of breast cancer. I had breast reduction 22 years ago and on every subsequent screening mammo, there was a suspicious finding and had to have a diagnostic. I’ve been terrible because after several years of that, decided to skip the yearly. I found a small spot about a month ago. I was able to get a diagnostic mammo and ultrasound done yesterday. There is a small mass where I palpated one and I am now scheduled for a needle biopsy next week. Here’s my confusion:
I was able to pull up my report and there’s a couple of statements that are confusing.
Under findings, it says there is no dominant mass, suspicious finding or change from prior exam.
But then it goes on to say under ‘impression’ that on ultrasound, there is a small 4x4x3 mm Hypoechoic nodule without increase through transmission which correlates to palpable region of concern. Blood flow is suggested internally consistent with a solid nodule.
BIRADS 4B
So why does it say nothing suspicious? So confused
Thanks in advance
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DJMAMMO, Thank you.
I had my appointment for biopsy today so went in thinking there was a 20% chance of not-so-good news since I was in category Birad 4 and something was suspicous and showing shadowing of some sort.
Bottom line, once the doctor did a pre-biopsy ultrasound, she said she only saw extremely dense tissue. She played around with the frequency of the ultrasound, making it lower frequency, and the picture on the screen became much more clear to my untrained eyes. The shadowy "mass" faded away and the shapes on the screen looked more like what I imagine breast tissue would look like if zoomed in a lot. To confirm that what she was seeing was only extremely dense fibroglandular tissue, she looked at my other breast and it looked exactly the same.
So, my news today was good, no biopsy needed afterall. She told me I should have yearly 3D screenings and manual ultrasounds in order to see all the details of my extremely dense breasts. She really emphasized the extremely, as did the radiologists last week. They said that I was at risk for not being able to detect breast cancer, but it didn't necessarily mean I was at higher risk for developing breast cancer (and it does not run in my family either). So, I'll pass this on to my sisters and daughter as well. Genetics may make us dense, but modern technology can help us get detected if we should develop anything different from year to year.
I should note that I have not been good about getting mammos every year. I got a little lazy as I didn't have any worries and hadn't had any scary results like some of you. I didn't realize how they compare one year to the next so they can look at changes, so I will do better going forward in making sure I have yearly exams so the doctors are familiar with my super dense breasts.
Thanks all who contribute to this website. I learned a lot and admire those of you that have to deal with a different diagnosis.
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We kinda predicted that.
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The report says bilateral. The part about ultrasound specifies left. Tried to upload the page but it says not permitte
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ok...figured out how to post this:
Indication: Palpable abnormality 3 o'clock location left breast.
Comparison:11/25/2011, 24 to 1010
Findings:
Standard bilateral digital images were obtained as well as left MLO tomosynthesis views.
There is no dominant mass, suspicious finding, or change from prior exam noted in either the right or left breast. Changes from prior breast
reduction are stable.
Left breast ultrasound was performed to evaluate the palpable area of concern.
At the 3 o'clock location 9 cm from the nipple is a hypoechoic nodule measuring 4 x 4 x 3 mm without increase through transmission which corresponds to the palpable region of concern. Blood flow is suggested internally consistent with a solid nodule.
Impression:
Small solid hypoechoic nodule of the left breast corresponding to the palpable area of concern, for which biopsy is recommended.
BI-RADS 4- Suspicious finding, biopsy should be considered
Breast Density: B - There are scattered areas of fibroglandular density.
Recommendation: Ultrasound-guided core biopsy for hypoechoic nodule 3 o'clock location of the left breast
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I see now. The US finding is not seen on the mammogram so the conclusion of the mammo portion of the report is "...no dominant mass, suspicious finding...". The overall impression and Birads are based on the US finding. Let us know how the biopsy goes.
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Thank you for all you do for this community!
I'm having an excisional biopsy on Tuesday November 6th, due to discordant benign results. I understand the purpose of this procedure, and I'm completely on board. I was just wondering if you could help me interpret the language of my ultrasound and pathology. If it's possible, it would be nice to know what my odds are going in.
My initial ultrasound says this under impression:
There is a shadowing nodule or density in the left breast at 6:00 for which biopsy is suggested. BI-RADS Category 4.
My ultrasound report from the core needle biopsy says this under findings:
Left 6:00 N6 taller than wide lesion that has some shadowing and some vascularity that measures 6x7x5mm.
The pathology report from the core biopsy says under diagnosis:
Benign breast tissue with ectatic duct and dense nodular stromal fibrosis. No sign of atypia. Biopsy recommended based on discordancy.
One of my issues is with the vagueness of the language. I'm not sure what 'some' means in the context of shadowing and vascularity. I wish that the initial ultrasound was a little more specific as to A, B, or C for the BI-RADS score. One positive factor is that there were no calcifications found.
Pertinent stats: 37 years old, nullipara, never breastfed. The left breast hurt quite a bit when the transducer was pressing on the area.
Thank you in advance! You are an angel!
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Not actually that vague a report, remember the body of the report is not worded for patients but for other radiologists, with the conclusion and recommendations directed at the ordering physician.
The a,b and c designations with B4 is also not for you but for evaluating the radiologist's positive predictive value by the MQSA. The information is used in their yearly report on our performance. No other imaging modality is this closely studied and regulated like breast imaging.
In addition to cancers, areas of focal stromal fibrosis can cause shadowing on ultrasound, especially if it is nodular. If the marker was seen in the correct spot on the post biopsy imaging I will assume this is what will be found on the excisional biopsy but you have to be sure so that nothing is missed. Let us know the results when you get them.
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Thank you! I will definitely report back.
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Hello,
I'm wondering if you could give me some insight on my ultrasound and mammogram reports. I am 50 years old and have had mammograms for 10 years without issue. This year I got a call back and went for another mammogram and the doctor wanted an ultrasound as well. The doctor told me there were two concerning areas which needed to have a biopsy. She said the areas of concern could be cancer or a radial scar and a biopsy was needed. I went to the biopsy last week and am still waiting for results. The doctor said that the areas are concerning. Can you give me more insight? Can you explain "adjacent vascularity"? Are these architectural distortions commonly found in radial scars or cancer? She asked if I've ever had breast surgery to explain a possible radial scar (no).
Ultra sound:
There is 0.5 cm x 0.3 cm x 1 cm irregular mass with an indistinct margin in the right breast at 9 o'clock posterior depth 7 cm from the nipple. This irregular mass is hypoechoic with posterior acoustic shadowing. Color flow imaging demonstrates that there is an adjacent vascularity. This is very subtle on ultrasound and is better seen on tomosynthesis mammography. There also is 1 cm x 0.8 cm x 0.5 cm irregular mass with an indistinct margin in the right breast at 9 o'clock middle depth 7 cm from the nipple. This irregular mass is hypoechoic with posterior acoustic shadowing. This correlates with mammography findings. Color flow imaging demonstrates that there is an adjacent vascularity. This is better seen by 3D mammography. letter sent: BI-RADS 4/5 Ultrasound BI-RADS: 4b Suspicious abnormality - intermediate suspicion of malignancy
Mammogram: Tomosynthesis views show multiple bilateral low-density circumscribed masses which are fluctuating in size and known cysts and benign. There are scattered milk of calcium calcifications bilaterally. There is 1.4 cm x 1.2 cm x 0.8 cm irregular architectural distortion in the right breast at 10 o'clock posterior depth 8 cm from the nipple. There also is possible 1.4 cm x 1.4 cm x 1.2 cm architectural distortion in the right breast at 9 o'clock anterior depth 4 cm from the nipple. IMPRESSION: SUSPICIOUS OF MALIGNANCY
The 1.4 cm x 1.2 cm x 0.8 cm irregular architectural distortion in the right breast at 10 o'clock posterior depth has a differential diagnosis of carcinoma or a radial scar and is at a moderate suspicion for malignancy. The possible 1.4 cm x 1.4 cm x 1.2 cm architectural distortion in the right breast at 9 o'clock anterior depth has a differential diagnosis of carcinoma or a radial scar and is at a moderate suspicion for malignancy. BI-RADS: 4c Suspicious abnormality - moderate concern but not classic
Thanks for any insight. I"m a nervous wreck waiting for biopsy results. I'm hoping for the best but want to be prepared for news that is otherwise. Thanks so much!
Shellgirl
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Hello! I want to thank you for all you have done for us to help us better understand our reports.
I had an ultrasound guided biopsy done last week and this was the findings that came out of it. I also had an excisional biopsy done this previous Friday and am waiting on the results of that. The excisional biopsy was for the Atypical Ductal Hyperplasia removal.
Can you give me a summary in layman's language as to what the below results mean? I think I understand one part that the lump is fibroadema.
Sections demonstrate breast parenchyma. The parenchyma reveals significant adenosis left a mild stromal proliferation in a pericanicular pattern. The findings seen here are most consistent with a fibroepithelial lesion, and more specifically a fibroadema. Focally, an area of atypical ductal hyperplasia is identified and is characterized by punched-out lumens with mildly atypical nuclei. There is no evidence of invasive disease within the sections examined.
Thank you
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Can you explain "adjacent vascularity"?
On ultrasound they saw blood flow in a vessel near the mass. It is much more significant of the blood flow is seen in the mass itself.
Are these architectural distortions commonly found in radial scars or cancer?
Those two are included in the differential diagnosis of architectural distortion. The third would be a surgical scar from a prior procedure.
She asked if I've ever had breast surgery to explain a possible radial scar (no).
A radial scar is different from a surgical scar. Click on this link: https://breast-cancer.ca/radscrs/
As far as which one this might be, in my experience, I have rarely been able to demonstrate a well defined shadowing mass on US in cases of radial scar.
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This is the pathology report. It is a communication between physicians. As with other medical reports, it uses very specific language and no attempt is made to make it "patient friendly". Unlike mammograms, there is no law or regulation requiring them to issue a "patient lay letter" with a summary of the findings.
This paragraph from the path report indicates they found what they feel is a fibroadenoma, and they see the ADH that was initially identified on the core biopsy. They did not see any cancer in the sample which is good news.
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djmammo,
I have 3 biopsies scheduled, for Monday 11/19. From my research I am feeling quite concerned because of some words in my report (heterogenous mass, and grouped heterogenous calcifications). I have lost family members to breast cancer (sister, 2 maternal cousins, 1 maternal aunts 1 paternal aunt). Can you confirm that those are indeed concerning descriptions? I can handle the diagnosis but am the type that likes to be very well informed to be able to ask educated questions.
FINDINGS:
MAMMOGRAM
The breasts are heterogeneously dense, which may obscure small masses.
Mass left lower inner quadrant persists on additional views.
Heterogenous calcifications right upper outer quadrant 9-10 o'clock, 6-7
cm from the nipple (2 groups).
A left breast ultrasound will be performed.
ULTRASOUND
Ultrasound is performed in the area of mammographic concern left breast at
6 o'clock 4 cm from the nipple demonstrating a 16 x 4 x 9 mm tubular
heterogenous mass.
ASSESSMENT: 4 - Suspicious
RECOMMENDATION:
1) Biopsy US - Left breast.
2) Biopsy - Stereotactic of right breast calcifications (2 sites)0 -
In my opinion the report is incomplete, the findings are inadequately described. It does not mention any of the important attributes of these findings to make a guess at what they are thinking. Heterogenous is a fairly neutral term overall so don't let that one word bother you.
When I taught radiology residents, I would tell them to describe the findings so that a colleague would be able to draw the findings on a piece of paper sitting across the room and have them look the same. There is very little detail in this report.
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djmammo
Thank you so much for your prompt reply! I am now feeling more optimistic about my upcoming biopsies.
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Hi,
I've been trying to do my own research (no not Dr. Google, scientific articles!) but coming up empty so I thought I would post here.
Just got my USS report. I will preface by saying that I am in Australia and have not revieved a BIRADS score. I'm also not really concerned about malignancy as the report states 'benign appearing' on most of the lesions, just wanting to understand the findings better. Also age is most definitely on my side at 27. My GP just didn't really have much knowledge on the topic.
Also the sonographer at the scan thought that they would suggest biopsy of the palpable lump at the 7 o'clock position as it demonstarted vascularity on the USS. This is not in the report.
USS Right:
At 11 o'clock 6cm from the nipple 2 benign appearing hypoechoic lesions noted. They measure 13x13x5mm and 10x7x3mm.
Fibrocystic change and 4:30 position.
At 7 o'clock 1cm from the nipple corresponding to a lump there is a well defined heteroechoic lesion at 14x13x6mm.
At 9 o'clock 5cm from the nipple there is a benign appearing hypoechoic lesion at 7x6x3mm.
At 10 o'clock 7cm from the nipple there is a benign appearing hypoechoic lesion at 5x5x4mm.
At 10:30 position 7cm from the nipple there is a benign appearing hypoechoic lesion at 6x4x8mm.
At 10:30 position 5cm from the nipple there is a benign appearing hypoechoic focus 5x6x3mm ?entrapped fat ?fibroadenoma.
A 6, 12 and 24 month scan has been suggested.
Thanks for any input!
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The descriptions of the findings are incomplete. There is no mention of margins/borders, shadowing/through transmission, or even whether they are cystic or solid which is the most basic finding to report.
That last line "? entrapped fat ? fibroadenoma". Does that refer just to the last finding or all of them? Not difficult to distinguish those two entities really. Since only follow up is recommended this would be a B3 report.
Personally, I don't like using the word "lesion" (which to me has a negative connotation) in the same sentence as "benign appearing".
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Thanks for that.
That was all the descriptors that were used in the report. The only things I left out were the two small cysts they found on the left breast. So I'm assuming these 'lesions' on the right are solid as they didn't specifically outline them as cysts.
The ? entrapped fat ? fibroadenoma was in reference to just that last finding. The end impression does however say multiple benign appearing hypoechoic lesions ? fibroadenoma.
What then what the heteroechoic lesion be consistant of? Another fibroadenoma, just 'different' in appearance?
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