Interpreting Your Report
Comments
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I narrowed my specialty to all things breast in 2003, up until then anything was fair game. Now it been too long to comment on anything that is not breast or breast related. I have retained a fair amount of knowledge and expertise on other matters in medicine, radiology in particular, but not enough to give the kind of advice people would have to rely on.
The last time I was familiar with the brachial plexus was med school and I forgot most of it after the exams. There was no way to image it until MRI came in around 1985. Years later the resolution improved enough to make it a routine exam but that was after I was out of training. I would venture a guess and say very few radiologists even today can read a brachial plexus MRI expertly outside of those with fellowship training specializing in musculoskeletal radiology (MSK).
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Thank you again Djmammo, we are all very thankful you are here!
Hopefully the one who read my Brachial plexus report had the correct expertise. Because I am having ongoing pain in that area (The other side from the ALND).
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how would I get my report? Do I call my doctor or the imaging facility? I have to go December 20 for a call back after a 3D mammogram and I'm hoping reading the report will ease my mind a bit
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Hello Djammo,
I am looking for some insight on a couple of reports I had done. Bone Scan and MRI. What I am wondering is, is this osteoarthritis? Is there bone islands pressing on the C6-C7 nerve? All they told me was rotator cuff, tendonitis, get a new line of work, sending me to a specialist for the shoulder, and come back if pain persists. Thank you in advance for just reading this post.
BONE SCAN:
"Mild linear anterior left upper lobe subpleural changes are less conspicuous today and more linear in appearance and most consistent with treatment-related change. Postsurgical change of the left breast including multiple surgical clips.
Increased radiotracer uptake at the bilateral shoulders, sternoclavicular joints, sternomanubrial joint, base of the cervical spine and SI joints which is unchanged from previous and most in keeping with degenerative change.
Increased radiotracer uptake at the sternomanubrial joint, the L5-S1, T11-12, T9-T10, T8-T9 and C6-C7 disc levels as well as the bilateral AC joints, sternoclavicular joints and SI joints most in keeping with degenerative change.
Multifocal uptake noted as described above in the skeleton, likely on a degenerative basis."
MRI - NECK:
The degenerative changes described below are superimposed on a congenitally narrow spinal canal.
C2-C3 - Mild left facet arthropathy
C3-C4 - Mild left and minimal right facet arthropathy
C4-C5 - Minimal diffuse disc osteophyte complex. Minimal bilateral facet arthropathy.
C5-C6 - Mild diffuse disc osteophyte complex. Mild bilateral facet arthropathy. Mild Spinal canal stenosis.
C6-C7 - Moderate disc height loss. Mild diffuse disc osteophyte complex. Mild left and minimal right facet arthropathy. Mild spinal canal stenosis. Mild left neural foraminal narrowing with the disc osteophyte complex and facet joint abutting the exiting nerve root.
C7-T1 - Unremarkable.
Other findings: T4-T5 there is incompletely imaged left-sided fact arthropathy which results in mild left neural foraminal narrowing wiht the facet changes abutting the exiting nerve root.
Opinion: Relatively mild multilevel degenerative changes are superimposed on a congenitally narrow spinal canal. This results in mild spinal canal stenosis at C5-C6 and C6-C7. There is also mild left neural foraminal narrowing at C6-C7 and T4-T5 due to degenerative changes which abut the exiting nerve roots at these levels.
MRI - SHOULDER:
Supraspinatus: At the anterior to mil insertional fibers of the supraspinatus there is a high-grade partial-thickness bursal surface tear which measures 0.8 cm AP with no significant tendinous retraction. Approximately 1 cm proximal to this there is a questionable intermediate grade partial-thickness articular surface tear seen focally measuring approximately 0.3x0.3 cm. There is a background of mild to moderate supraspinatus tendinosis.
Infraspinatus: No tears. Mild tendinosis.
Subscapularis: At the mid fibers there is an intermediate grade partial-thickness articular surface tear which measures approximately 2.0x0.1 (TR by CC). Background of mild tendinosis.
Opinion: Partial-thickness of the supraspinatus and subscapularis. Background of rotator cuff tendinosis.
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Thanks.
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Djmammo,
Would you mind looking at this report? I see both favorable and less favorable verbiage. I am 47 with normal annual mammograms since age 40. I was adopted so have no information regarding family history. Biopsy is scheduled for the 18th.
Thank you for taking the time to offer your most valuable expertise.
EXAM:
Diagnostic mammogram left breast with conventional and tomosynthesis imaging
Left breast limited ultrasound
CLINICAL HISTORY:
New asymmetric density screening mammogram,,
COMPARISON:
11/16/2018 11/15/2017
FINDINGS:
Mammograms: An exaggerated left breast CC lateral conventional and tomosynthesis mammogram was obtained and a combination conventional and tomo left MLO spot compression image of the upper breast was obtained. There is a 1.1 cm mildly lobulated predominantly circumscribed nodule in the left breast 2 o'clock at 7 cm. There is surrounding relatively heterogeneously dense breast parenchyma. No spiculation or associated calcification.
Left breast ultrasound: Targeted left breast ultrasound demonstrates a 1.2 x 1.1 x 0.9 cm hypoechoic lesion in the area of concern 2 o'clock radial at 7 cm. It is tri lobulated relatively well circumscribed and wider than tall with minimal vascular flow demonstrated within. Enhanced through transmission noted.
IMPRESSION:
Suspicious lesion in the left breast 2 o'clock 7 cm from the nipple. Differential includes breast neoplasm, fibroadenoma, enlarged intramammary lymph node. Recommend ultrasound-guided core biopsy.
Breast navigator has been notified and will be notifying the referring physician. The above recommendations were discussed in detail with the patient.
CL4: BI-RADS CATEGORY 4 - SUSPICIOUS ABNORMALITY; BIOPSY SHOULD BE CONSIDERED
Note:
Assessment:C4
Recommend:S0 -
Hi am worried sick and utterly confused by my latest ultrasound, mostly because my breast specialist and radiologist have differing opinions on next steps. P.S Have been following up every 6 months since 2015.
Findings
Multiple nodules seen within both breasts.
Largest is a lobulared complicated cyst around 10:00 of right breast 26.3 by 9.7 by 17.5mm. Between 12 and 1 o’clock on the left is a well defined solid nodule 12.3 by 9.4 by 11.7mm.
Impression
Solid lesion at the superior aspect of left breast shown marginal change since the 10thFeb 2017 US scans but was not noted in the earlier study 28th Mar 2016. Further evaluation should be considered to establish histology (birads 4).
Remaining lesions may represent complicated cysts or solid lesions and prob benign (birads 3).
My breast doctor feels that the change is within her threshold (increase in size) and reccomends a 6 month follow up. But it has been adjusted to a 3 month follow up after reading the radiology report. I am confused by whose opinion is favorable and may seek a second opinion. Why would the doctor and radiologist have differering views on this- this is really confusing for the patient. Any thoughts
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Thank you Djmammo! I will let you know the results.
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Here is the official list of acceptable terms used in US to describe masses from the latest Birads Lexicon. They are listed in order in each column from less worrisome to more worrisome.
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Here is the official list of acceptable terms used in mammography to describe masses from the latest Birads Lexicon. They are listed in order in each column from least worrisome to most worrisome.
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I was called back today after a routine mammogram yesterday. I am 43 and have had routine mammograms since age 35. It says I have heterogeneously dense breast tissue, which I've always been told. I have another mammogram and ultrasound scheduled for Tuesday, but am seeking better understanding of these results. The words in my report ("focus", "ill-defined") don't match exactly what I've read here but I think sound more like the unfavorable than the favorable. And I'm worried it's bad that there are both of these things, not just one.
There is a focus of microcalcifications anteriorly, 9:00 right breast. These are indeterminate for possible malignancy.
The right CC view demonstrates a possible 8mm ill-defined mass, inner aspect of the right breast, seen on 2D, and the CD cc image 26/50. This is indeterminate for possible malignancy.
Impression: We will ask the patient to return for repeat 3D imaging of the possible 8 mm mass, inner aspect of the right breast, with targeted ultrasound. Also, we will perform magnification views for the right breast 9:00 focus of microcalcifications.
I appreciate any input.
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slc9a, I can tell you that from what I've learned in my recent experience, there are plenty of benign conditions that are ill-defined. I'm not familiar with the focus part. I had biopsy this week and results coming on the 13th. It's literally just a sucky waiting game. Positive thoughts for both of us.
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Hi Djmammo:
Today I received my results on two punch skin biopsies that showed no signs of cancer. My surgeon wants to do one more punch biopsy to be closer to 100% sure that things are good. Is this the "industry standard?" I had IDC in 2003.
Below are my diagnostic mammogram and ultrasound results from earlier this week.
Mammogram Results
FINDINGS: There are scattered areas of fibroglandular density.
There is significant skin thickening and trabecular thickening most pronounced in the lower inner left breast in the same area as the prior lumpectomy.
No additional suspicious masses, calcifications, or other findings are identified in the breast.
IMPRESSION: 1. There is significant trabecular thickening and skin thickening most pronounced in the lower inner left breast. This is suspicious for inflammatory breast cancer.
2. Recommend targeted ultrasound of the lower inner left breast to further evaluate. Also recommend targeted ultrasound of the left axilla.
BI-RADS: 0 : Incomplete-Needs additional imaging evaluation.
RECOMMENDATION: U : Ultrasound, left.
DENSITY: B : There are scattered areas of fibroglandular densityUltrasound Results
CLINICAL HISTORY: Further evaluation of the trabecular and skin thickening predominantly in the lower inner left breast.
FINDINGS: Targeted ultrasound was performed of the left breast at the area of the mammographic abnormality at 6:00 to 9:00. Representative images were submitted for evaluation. Within this location, there is marked skin thickening, measuring up to at least 6 mm. Otherwise, there is no focal sonographic abnormality to target for ultrasound-guided biopsy.
Targeted ultrasound was also performed of the left axilla. There are no morphologically abnormal left axillary lymph nodes.
IMPRESSION: 1. In the lower inner left breast, there is marked skin thickening measuring at least up to 6 mm. 2. There is otherwise no focal sonographic abnormality to target for an ultrasound-guided biopsy. 3. Findings on imaging are suspicious for an inflammatory breast cancer. Recommend a skin punch biopsy as soon as possible. 4. These findings and recommendations were extensively discussed with the patient at the time of her exam.
BI-RADS: 5 : Highly suggestive of malignancy-appropriate action should be taken.
RECOMMENDATION: B : Biopsy should be considered, skin punch biopsy should be performed as soon as possible0 -
Skin biopsy is the "standard of care" for diagnosing IBC, but how many sample are taken I suppose is up to the surgeon or dermatologist doing the biopsy. I could guess that with a rad report coming down that hard on their impression, who ever is doing the biopsy is put on the spot to be 200% sure. And if its not IBC you still want to know why your skin is reacting/behaving that way and to what.
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Focus = "a small area of "
The report does not come up to the standard set in the Birads Lexicon. The calcifications and the small mass are incompletely described. For both findings we need to know if they are new since prior study. For the calcs we'd want to know size, number, pattern and distribution. For the mass we need to know the margins, the internal echogenicity, shadowing or no shadowing, internal blood flow. I should be able to picture these findings after reading a report. All this person told us is how they feel about them. Not enough information here for you to panic yet. Let's see what the diagnostic studies show first.
I would give this report a C- if I were grading it.
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djmammo and JenCanDoThis
I appreciate you taking time to reply. Friday afternoon is a terrible time to get this news and I’m having a hard time thinking about anything else.
I hope you get good results JenCanDoThis
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I'm so frustrated! I can't get in for further testing until 12/31. I pray this turns out okay. Otherwise I will have gone over a month and a half without answers and mental anguish, as well no treatment.
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Hello djmammo,
I appreciate any input. I found a suspicious lump on a self exam and went to have it checked. They did a mammogram and ultrasound and I am awaiting MRI and biopsy.
Breasts are heterogeneously dense which may obscure small masses. No suspicious cluster of microcalcifications.
In the area of palpable abnormality in the upper quadrant right breast is asymmetric somewhat spiculated density measuring 2.18 x 2.16 cm. On spot compression views this asymmetric mass density is persistent. No underlying cluster of microcalcifications. Left breast is unremarkable.
No Architecture distortions. BIRADS Catagory incomplete: additional imaging needed.
Bilateral ultrasound performed.
In the right breast at the 9:00 position 2cm from the nipple at the area of the lump are multiple hypeochoic nonvascular nonspecific structures measuring 0.8 and 0.6 cm. This finding is in the are palpable abnormality and corresponds to the findings noted on recent mammogram. This could represent intramammory lymph node. However, other etiology are not excluded.
There is an irregular shaped prominent node in the right axilla measuring 1.63 x 1.5 cm
Left breast is free of any cysts, masses or abnormal nodes.
BIRAD incomplete- additional images needed
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"multiple hypoechoic nonvascular nonspecific structures"
Well, I am glad you are having the MRI as I can't make head or tail of those two reports.They are filled with non-standard terms arranged in vague sentences. They also left out a number of features of the findings that would have helped us to figure out what they were talking about. Let us know what the MRI shows.
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Update after additional mammo and ultrasound:
Mammo:
There is a grouped punctate calcification in the right breast at 9:00. Focal asymmetry in the inner part of the right breast does not persist in additional views.
Ultrasound:
A targeted high resolution right breast ultrasound was performed. No suspicious finding is seen.
Impression: Right breast 9:00 grouped punctate calcifications are probably benign.
Overall BI-RADS category: 3- Probably Benign
When the radiologist spoke to me after, I asked about the number of calcifications and he said 4. I'm supposed to get another mammo in 6 mos. instead of 12 mos.
I think this is pretty good news, but I wonder if anything further should be done at this time? Is waiting/watching 6 mos. a good idea?
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djmammo
Thanks again for taking the time to reply. I wouldn't have even known to ask how many microcalcifications without having learned info here. There is just a part of me that thinks if I have these 4 microcalcifications let's just get them out! I understand there are protocols; I just hope not to have regrets about not doing more sooner.
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Of course there is nothing wrong with biopsying/removing them and being sure but understand that in 6 months if there are a few more calcs even if abnormal, the odds of that affecting your prognosis are vanishingly small.
If a 6 mo f/u is recommended and you want a biopsy your ins may not cover it. Also if it comes back completely benign the rad that agreed to do the biopsy will have a false-positive in his next MQSA report, meaning he made an error in judgement.
Also if you Google "mammography over diagnosis" you will see articles blaming radiologists for recommending and performing too many unnecessary biopsies the problem being that if a cancer is found that is very low grade and would never have threatened the patient's health in their lifetime, then it would be considered "over diagnosis" (an alt term for false positive) and unnecessary and forces the surgeon to remove a non threatening cancer.
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This new concept makes me nuts. Should I ignore findings I know are abnormal? That I know are small cancers? I thought that was the value of mammography. And how do we know they are low grade without the biopsy? Ugh.
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I may have posted in the wrong topic earlier - but my diagnostic mammo was labled BI RADS 3, but still worries me as I have not had a mammo in 5 years (I'm in my late 40s) so they had nothing to compare it to. This finding is new compared to my older mammo - my radiologist gave me option of waiting 6 months for another mammo or biopsy - I'm choosing biopsy. Maybe I'm crazy but I'm worried. Any thoughts?
There are scattered fibroglandular elements in the left breast that
could obscure a lesion on mammography.
Tomosynthesis 3D imaging of the breast was also performed.
Current study was also evaluated with a Computer Aided Detection
(CAD) system.
There are coarse round calcifications in a grouped distribution
measuring up to 8 mm in the left breast at 10 o'clock anterior depth.
These are seen in additional views. Rim calcification is identified
adjacent to the grouped calcifications.
IMPRESSION: PROBABLY BENIGN
The grouped coarse and round calcifications in the left breast are
probably benign. Follow-up left diagnostic mammogram and a possible
ultrasound (if needed) in 6 months is recommended to demonstrate
stability. These findings and recommendations were discussed with the
patient.
Followup Recommended BiRad 3
Mammogram BI-RADS: 3 Probably benign0 -
Course and round are benign adjectives for calcifications. The size of each one would be interesting to know.
Rim calcification is also a benign feature but it is not clear what finding has the rim calcification.
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Looking for some input - I have done a lot of reading but thought I would put this out there to see what others might make of this report from my test on Wednesday. Thank you for any input you can provide.
HISTORY: FOR EVALUATION OF RIGHT BREAST MICROCALCIFICATIONS. COMPARISON: 2017 AND 2012 STUDY. TECHNIQUE: UNILATERAL RIGHT 90 DEGREE ML 2-D DIGITAL MAMMOGRAPHY. MAGNIFICATION VIEWS ARE OBTAINED IN 3 PROJECTIONS. COMPUTER AIDED DETECTION WAS USED.
BREAST DENSITY: EXTREMELY DENSE.
FINDINGS: RIGHT MAMMOGRAM: A GROUP OF MICROCALCIFICATIONS IS NOTED IN THE OUTER MID POSTERIOR BREAST. THIS MICROCALCIFICATION ARE SLIGHTLY VARIABLE. THEY WERE NOT PRESENT ON THE PRIOR STUDY OF 2012. NO ASSOCIATED MASS EFFECT IS SEEN. IN ADDITION TO THIS, A FEW SCATTERED PUNCTATE CALCIFICATIONS ARE NOTED.
CONCLUSIONS: AN INDETERMINATE GROUP OF MICROCALCIFICATIONS IS NOTED IN THE OUTER MID POSTERIOR BREAST WHICH WAS NOT PRESENT ON THE PRIOR STUDY OF 2012.
RECOMMENDATIONS: STEREOTACTIC BIOPSY OF THE RIGHT BREAST IS RECOMMENDED.
BIRADS 4: SUSPICIOUS ABNORMALITY; BIOPSY SHOULD BE CONSIDERED.
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hello,
I sincerely apologize if I am doing this wrong. I am completely new to this website, but I have done a lot of reading in the past 24 hours on here. I am 23 years old. I have had breast pain in my right breast for weeks. Upon breast examination, my doctor felt two “cysts” and because of my pain, she wanted me to have an ultrasound. The ultrasound tech and radiologist could not find the cysts... but they noticed that my right axilla lymph node was “odd”. The radiologist even jumped back when she saw it. No one would tell me what they saw. In the end, she told me she wanted to see what the lymph node was going to do, and asked me to come back in three months. Not even 20 minutes after leaving, the radiologist called and told me it’s recommended that I have a FNA biopsy. The next day, I went back to the radiologists to pick up my report from the front office. Just wondering if someone could help me understand what some of the things I list below on my ultrasound report mean? My biopsy isn’t until next Friday, and I am meeting with my gyno tomorrow to go over the report.. but this is eating at me. I already had a cancer scare and had to have half of my thyroid removed early this year
Findings: in the right axilla there is a lymph node measuring 1.4 x 1.2 x 0.6 cm with a localized Hypoechoic enlarged area that measures 4-5mm. This could represent a focal area of cortical thickening.
Assessment: BI RADS 4: suspicious findings.
Has anyone else ever had a similar report? Lots of anxiety. I’m sorry.
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