Interpreting Your Report
Comments
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Dear Mdwalkerr,
No apologies needed. You have come to the right place and you are very welcome here. We are sorry for what you are going through and the associated worry. Please let us know if there is anything we can do to be of help while you are sorting this out. Try to distract yourself as best you can while you wait for answers.Our member djmammo will be along to offer some thoughts on this. PM us if you need help. The Mods
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Hi Dj mammo: I had previously posted my mammo and US reports and you had given me some great advice and told me to post my MRI report after I got it. I’m having trouble finding that post just by scrolling back as it was back in October so apologies if this is the wrong place to post the MRI findings.
I’m pretty sure this is good news my frustration is that I am not being given a straight answer. This process has been going on for 4 months! Now the MRI basically seems to state the same thing the mammo and US did - probably fine but further testing needed just to be sure?? Your professional thoughts would be appreciated.
Right breast anteriorly there is a circumscribed ovoid, markedly T2 hyper intense focus that is likely a cyst; measures up to 2.4 cm; along its inferior aspect is a circumscribed T2 hyper intense 9mm focus, 2.5 cm from the nipple; this is intrinsically T1 hypo intense, and does internally enhance; enhancement critics are plateau type, not frankly aggressive.
In the right breast posterior medically at 3:00, there is relatively T2 hyper intense elongated structure corresponding to the mass seen on ultrasound, which has been palpable to the patient for just over a year. Benign enhancement characteristics.
Right breast fat posterior 9-10:00:00, there is a 10mm mass with mostly benign internal enhancement, but with a portion showing mildly concerning kinetics; most likely a lymph node; 2nd look ultrasound will be obtained.
Left breast: mid to posterior aspect at 2:00, there is a subcentimeter mildly T1 hypo intense to fat, hyper intense tissue, module showing favorable kinetics; may correspond with the 2:00 sub centimeter lesion seen on ultrasound previously.
In the left breast anteriorly, there is a ovoid, likely bean-shaped, subcentimeter focus with intrinsic T2 hyper intensity, and and no convincing enhancement. Likely corresponds to the 3:00 + 4 cm structure recently seen.
In the left breast posterior inferior aspect there is an ovoid solid nodule with non concerning enhancement kinetics.
Dynamic contrast evaluation otherwise demonstrates expected enhancement patterns throughout the breast parenchyma and adjacent soft tissues, without without rapid wash in and washout to suggest malignancy.
Recommend second look ultrasound for right breast fat posterior 9-10:00 structure.
Birads 0, further imaging needed
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amichelle,click on your username above your post and it will take you to a list of your posts.
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Hi Dj Mammo. Your posts here seem to be a huge help! Here are mine:
Screening Mammogram Report
FILMS COMPARED:
The present examination has been compared to prior imaging studies dated 05/08/2014 and 04/30/2014.
MAMMOGRAM FINDINGS:
Views obtained: Bilateral craniocaudal with tomosynthesis; bilateral mediolateral oblique with tomosynthesis.
The breasts are heterogeneously dense with 50% to 75% glandular tissue, which may obscure small masses. There is a new area of architectural distortion measuring 15 millimeters seen in the retroareolar region of the left breast.
In the right breast, no masses, significant calcifications or other abnormalities are seen.
IMPRESSION:
New area of architectural distortion in the left breast requires additional evaluation. An ultrasound is recommended.
BI-RADS category 0: Incomplete Study Need Additional Imaging Evaluation
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Ultrasound Report
HISTORY:
Patient is a 40 year old female and is seen for additional evaluation requested for prior study architectural distortion in the retroareolar region of the left breast. Patient has no personal history of breast cancer. Patient has a family history of breast cancer.
FILMS COMPARED:
The present examination has been compared to a prior imaging study dated 11/12/2018.
ULTRASOUND FINDINGS
High-resolution real-time ultrasound scanning was performed.
Finding 1: There is a simple cyst measuring 8 millimeters seen in the retroareolar region of the left breast.
Finding 2: There is an irregular hypoechoic lesion measuring 12 millimeters seen in the retroareolar region of the left breast. There is eccentric shadowing.
IMPRESSION:
Finding 1: Simple cyst in the retroraeolar region of the left breast is benign.
Finding 2: Hypoechoic lesion in the retroareolar region of the left breast is suspicious. Ultrasound guided biopsy is recommended.
BI-RADS Category 4: Suspicious Abnormality
------PATHOLOGY REPORT
GROSS DESCRIPTION
The specimen is labeled "left nipple" and consists of multiple fragments of yellow-brown needle core soft tissue measuring 1.4 x 0.7 x 0.2 cm in aggregate. All in one. The fixation time is approximately 10-1/2 hours.
MICROSCOPIC DESCRIPTION
Unless "gross only" is specified, the final diagnosis for each specimen is based on a microscopic examination of representative sections of the tissue.
MICROSCOPIC DIAGNOSIS
Left nipple, core biopsy:
- Fibroadipose tissue with blood clot
- Negative for breast parenchyma and malignancy.
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Pathology report disappeared from online portal within an hour or two of me pulling a copy. Radiologist's report from the biopsy has not been posted to the portal and we're now 10 days out. He has ordered MRI and excisional biopsy. Doesn't seem to add up. Seems to be a sampling error? Have a request in to get all copies of films and reports, which I'll get on Monday. Is my anxiety warranted, or is the radiologist just being overly cautious? My results from genetic testing are due back next week, which we began the insurance approval process for well before my screening mammogram in November. (Paternal grandmother and all of her sisters that reached adulthood had breast cancer in their 40s. Their mother died at 45 of unknown causes.) Thank you for an insights you have!
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I don't know if this is an appropriate question for this section, but I hope it is. I've had two biopsies at different hospitals in the last two weeks and both radiologist had the same problem. When they grab my tumor it snaps back and they have to repeatedly try over and over for the samples. The radiologist today said that the tumor is very dense which made it difficult to grab. They think that I have ILC, but the first radiologist wasn't able to get large enough samples for the pathologist to use to complete the testing. Does tumor density have anything to do with the grade or aggressiveness of the cancer? Does the fact that it's dense have any significance? Mine was measured on ultrasound as 1.3 cm. Thanks
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thanks
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I had an ultrasound last week after a mammogram showing architectural distortion. The radiologist who did the US indicated it (the larger mass) was very likely cancer and the smaller one not. Is there anything you can point out in the report? I'm assuming the "spiculation" into soft tissue indicates it's invasive. They couldn't schedule me for the biopsies for 3 weeks, so it gives me a really long time to worry & wonder (including worrying and wondering if 3 weeks is too long to wait!) Thanks so much for any help!
IMPRESSION: 1.1 cm mass 6 o'clock right breast highly suspicious for malignancy. Second small mass at 9 o'clock appearing to be intraductal.
RECOMMENDATION: Biopsy Right breast mass at 6 o'clock. The small mass at 9 o'clock should also be sampled at the same time. Findings were discussed with the patient. Biopsy has been scheduled.
BI-RADS: 5Narrative
UNILATERAL RIGHT BREAST ULTRASOUND COMPLETE
INDICATION: Architectural distortion right breast 6 o'clock
COMPARISON: Mammography 12/5/2018, 11/29/2017
TECHNIQUE: Grayscale interrogation throughout all regions of the four breast quadrants, subareolar breast tissues and axilla of the RIGHT breast was performed. Doppler interrogation was performed as necessary.
FINDINGS: At the 6 o'clock region of the right breast 2 cm from the nipple there is a round mass measuring 1.1 x 0.6 x 1.1 cm. It is hypoechoic with spiculated margins and at real-time imaging spiculation extending into the soft tissue can be appreciated. The appearance is highly suspicious for malignancy. Multiple dilated ducts are seen in the subareolar region. At 2 o'clock there is a partially cystic area which I believe likely represents an ectatic thickened duct. In the 9 o'clock region 3 cm from the nipple there is either debris or mass within the duct which measures about 3 x 4 mm. Biopsy of this area is recommended as well.0 -
I think my report looks pretty good but I'm not sure due to the term "Hypoechoic.". Can you help me identify if this is pretty typical & not much too worry over? Also, if there is a possible cause of concern that I may not be aware of would be appreciated.
on dedicated ultrasound examination of the left breast a dilated duct is present in the retroareolar region with some low-level internal echoes without any vascularity. a 5 mm hypoechoic lesion with some internal echoes and with mildly increased through transmission is present at 1:00 position 4.7 cm which could represent a complicated cyst. A 5 mm anechoic lesion with septations is present at 12:00 position for centimeters from nipple which could represent a complicated cyst or a cluster of micro cysts. a 5 mm cyst is present at 11:00 position. A 9 mm cyst is present at 11 to 12 position. A 7 mm anechoic lesion with low-level internal echoes is present at 3:00 position likely a complicated cyst. A 6 mm anechoic lesion within crease through transmission and low-level internal echoes is present in the retroareolar region which could represent a complicated cyst.
..... follow up in 6 mos
(This was prompted from complaint of bloody discharge). Thank you in advance.
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Hi all I had an ultrasound and mammogram after finding a lump a couple months ago. My GP sent me to a BS for a consult because every person I saw said they could clearly feel it. She confirmed she felt it and it seemed bigger than the earlier notes said. She made a comment about it feeling lobular to her. She strongly recommended an excisional biopsy and urged to do it before xmas. My 30th birthday is on Sunday and I am supposed to travel after xmas to visit my family across the country. So the surgery is sceduled for Friday afternoon. My question is why push for surgery right before the holidays so hard when it isn't seen on imaging?
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Hey Courtney,
I'm not an expert but my understanding is that lobular cancer is often missed on imaging. That plus how young you are might have pushed the urgency also. If it were cancer, which hopefully it's not!, getting the ball rolling asap to start getting test results and planning next steps does seem prudent.
Hopefully it's just a good doctor being cautious! I hope the procedure goes easily and you're able to enjoy your birthday and travels!
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Sounds like they just want to be sure that one thing is a benign lymph node by US. :-)
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It seems odd the path report says the nipple was biopsied which is not what you had biopsied is it? Plus, no breast tissue. Make sure your name and hospital numbers match on all reports you get.
There is always a report generated by the rad who did the bx when the path report is issued. This report states whether or not the path is concordant with what was biopsied or discordant. You need to read that report to know what is going on. The MRI should tell you what needs to be done next.
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I am not sure what those docs mean by what they said. That doesn't sound like any problem I have ever had with a biopsy.
Sometimes the densest tissue is the breast's reaction to the presence of a tumor (desmoplastic reaction) and some believe that a large amount of this reactive tissue means the tumor is growing slowly giving the breast time to produce this reaction but not sure if there are any definitive articles on the subject.
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Hypoechoic and spiculated are often enough to make a call of "highly suspicious" although I would have mentioned + or - shadowing and + or - internal blood flow too.
The duct may contain debris or a papilloma but they will biopsy that too so you will know either way.
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I am surprised nothing was seen on US if it feels so worrisome to a breast surgeon on palpation.
Did the surgeon say it felt "lobular" or that it felt "lobulated"? One refers to cell type and the other refers to the edge/border of the mass which can sometimes be felt on exam.
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Thank you for your response Djmammo. Those were my thoughts exactly. Though she seemed most concerned about the noticable growth over the last 3 weeks. I am sure she said it felt lobular to her. She said it more to herself than me. Not that I am complaining that she is taking me seriously. I'm just a bit confused on the urgency from the BS when no one else seemed too concerned due my age (I turn 30 on sunday). Any ways thanks our your opinion.
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Djammo, out of curiosity, how long (minute wise) should a whole breast US take? More then 5-6 mins? On average of course.
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Hand held US? Too many variables to hazard a guess. Screening or diagnositic? One breast or 2? Size of breast, breast tissue to fat ratio, experience of the US tech, and if there are any findings it takes time to measure and label them in 3 dimensions.
Automated whole breast ultrasound? Usually used for screening whole breast US. This blurb is from a breast center website: "The procedure will take approximately 15 minutes from prep to image creation, with each scan lasting only 40 seconds". These are read/interpreted by the radiologist at a later time usually batch read with the others done that day. Images can be processed and viewed in any plane.
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Yes hand held, one breast. It was with a diagnostic mammo, so I guess diagnostic. I was just curious. Thanks
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djmammo,
Had my second look ultrasound today and now headed for a biopsy. The radiologist said because there was internal vascularity. I’ll have to wait a few days to get the report but I was curious are there other things that would have a reason to have blood flow?
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Benign fibroadenomas have a blood supply as well as papillomas.
Here is an excerpt from this article on US of benign breast lesions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558101/
"...the literature has revealed a substantial overlap of aspects in the vascularity of benign and malignant lesions. The hypothesis that more vascularization means a higher probability that the lesion is malignant is absolutely not valid (for example, also benign papillary lesions are highly vascularized)"
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Not sure how to start this, but I can't find any information similar to my situation. Family history, my mother is a breast cancer survivor. I just had a diagnostic mammogram around April 2019 for a lump under right arm followed be an ultrasound immediately after. It was determined that due to some previous fluid that it was a hematoma, results from mammogram came back good. This week I just went for a stress test for my heart and the report from nuclear medicine came back stating that I had an increased radiotracer uptake in my left axillary area in two places. I was referred for an ultrasound. I was in the ultrasound appointment at a different facility yesterday for less than 5 minutes and the technician told me the lymph nodes were too deep and nothing showed up on the ultrasound. I am a heavier person, is this normal? Now what are my options? I am stuck thinking about this over the holidays and have not seen an official release of the report yet. Is it normal for none of your lymph nodes to show up on an ultrasound?
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There are a few reasons lymph nodes can take up nuclear tracer, and not all are bad. Can you post the report of that study? We'll start with that and at some point in time you should be able to access your breast imaging report through a patient portal.
There are three levels of lymph nodes. Level one, most superficial are usually visible on US exam whether they are normal size or enlarged. Level 2 are deeper and are not visualized on all people. Level 3 is not routinely imaged due to their depth/position. If necessary a CT scan is excellent at visualizing all the areas in the chest/upper body where lymph nodes live. Diagram below is the right shoulder/axilla as seen from the front.
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This is all of the information I have been given in the report posted online:
2 small areas of extraneous radiotracer uptake in the left axillary area. Clinical correlation required
- consider US of L axilla0 -
Thats what they would call an "incidental finding". Cant tell from that what level nodes they think are affected.
If the tracer used was sestimibi, thats the one where uptake was seen in breast cancers so they started using it for that under the name Miraluma (spelling?). If these were abnormal nodes from a breast primary, you should certainly see uptake in the breast itself at this point but they didnt report that.
Any injuries or infections in the arm on that side?
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DJMammo
Thanks for writing back! The mass is near the nipple (retroaerola), so I assumed that's what path meant. Name and numbers match up on the reports. There's addendums on both the path and rad reports now. A second pathologist prepared additional slides, and still no sign of malignancy. Second path opinion is that it could be PASH, fibroadenoma, or fibromatosis. Rad addendum indicates discordant. Had MRI today and excisional biopsy is scheduled after the holidays. Interestingly, Rad ordered the MRI in his initialbiopsy report, before the path was back. Wasn't sure what to think of that. I got to see the mammogram and ultrasound images this week as well. The mass has really irregular, jagged edges and appears to have varying densities, so I can see why there's a possibility it was missed. Thankfully, genetic testing results (ordered earlier this summer) came back negative yesterday. Having that outstanding certainly didn't help my anxiety level this past month.
Happy holidays!
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Hi, my name is Denise. I’m trying to figure out this report. Should I be worried? Both of these are in my left breast. A biopsy was recommended.
Hypoechoic mass with mild angulated margins and internal color flow measuring 5mm at 1 o'clock position Additional circumscribed mass with internal calcifications measures 7mm at 6 o’clock position.
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No injuries or infections on that side. The report is very vague, is a CT the next logical step or is there some other test they do since the ultrasound was not helpful? Thanks for replying back.
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Just had a quick question about my screening results. They called me back but because of holidays I can’t get in for over two weeks. The tech that called and said the “mass” could be seen on more than one view. I noticed the “nodule” was just on one view. What would be the difference between a mass and a nodule? Here is report:
COMPARISON: Mammograms performed at an outside facility dated 9/11/2012, 9/25/2012.
CLINICAL HISTORY: 41 years-old Female presents for screening mammogram. There are no current breast
complaints.
TECHNIQUE: Standard bilateral 2-D craniocaudal mammograms/bilateral MLO tomographic images with
V-Preview3 (2D synthetic views) images were obtained. Computer-aided detection was utilized with
this examination.
FINDINGS:
Full field digital mammograms of both breasts show scattered fibroglandular breast tissue. No
dominant masses, areas of architectural distortion, or worrisome microcalcifications are present on
the left. The breast tissue pattern is stable on the left.
On the right, there is a partially obscured mass in the middle third, about 8 cm from the nipple, in
the upper outer breast, probably at 9:00. This measures about 1.8 x 1.0 cm. Another nodular
asymmetry, seen only on the MLO view in the posterior third of the upper-outer breast, probably at
8:00, approximately 10 cm from the nipple. This measures about 1.5 x 0.7 cm0
