Interpreting Your Report
Comments
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My question is for djmammo and others who have undergone MRI,
I recently had a bilateral MRI as my 2 year f/u imaging after Stage I lobular breast cancer in 2016.
The MRI identified a "4.5 mm enhancing nodule with washout kinetics in left breast"AND a "5mm enhancing nodule with washout kinetics in right breast". No further detailed description was offered as to the morphology of the nodules nor subcategory of the BIRADS rating which was 4 - suspicious. In both cases it is recommended that I get US guided biopsies IF US identifies the nodules. If not, then MRI guided biopsies. The report referenced a comparison to my 2016 pre-lumpectomy MRI.
I called my BS's office and imaging center for more detail and was told that no further information was included in my MRI report.
Is it typical for an MRI report to be this light on specifics?? (no description of nodule morphology? no subcategory of BiRad 4 - A, B or C?)
Also, after "Impression", the report reads "Bi-Rads category (4) Suspicious. Letter: (BRAD45). What does "Letter: BRAD45) mean?
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My MRI report indicated a 5 mm mass and listed a couple of other things I didn't understand. It wasn't real specific. I don't know what BiRADS 45 means though. I was told when they did the MRI biopsy the images were taken from different views than the initial MRI and that's why there was more specific info.
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Regarding the wording of the US report: if those are accurate descriptions of the abnormalities by the radiologist, there aren't many benign masses I can think of with that appearance. Together with your history of chest irradiation the biopsies will likely come back abnormal.
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I am expecting it to be malignant, I should know tomorrow. Thank you very much for your reply.
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I am 46yo and have had yearly mammograms since age 35 (my mother had breast CA at age 63) and have never been called back. I had my first 3D mammogram last Friday and was called back for an ultrasound.Thanks in advance for any thoughts on the results.
Here are the mammogram results:
Comparison is made to exams dated: 1/11/2017 and 12/10/2015.The tissue of both breasts is heterogeneously dense. This may lower the sensitivity of mammography. There is a new 2 cm round asymmetry with an indistinct margin in the right breast middle depth central to the nipple seen on the craniocaudal view only.
No other significant masses, calcifications, or other findings are seen in either breast.
IMPRESSION: INCOMPLETE: NEEDS ADDITIONAL IMAGING EVALUATION
The new 2 cm round asymmetry in the right breast appears indeterminate. An ultrasound is recommended.Ultrasound results from Wednesday:
There is a 1.1cm wider than tall irregular mass with an indistinct margin in the right breast at 6 o'clock anterior depth. This irregular mass is hypoechoic with posterior acoustic enhancement. Color flow imaging demonstrates no vascularity present.
There is also a benign appearing 7mm wider than tall oval simple cyst with a smooth internal wall in the right breast at 7 o'clock anterior depth. This oval simple cyst is anechoic with an abrupt boundary. This correlates with mammography findings.
IMPRESSION: SUSPICIOUS FINDING- BIOPSY SHOULD BE CONSIDERED- FOLLOW UP RECOMMENDED
The 1.1 cm winder than tall irregular mass in the right breast at 6 o'clock anterior depth resembles a complex cyst or a solid mass and appears suspicious of a malignancy. An ultrasound guided biopsy is recommended.
The 7mm wider than tall oval simple cyst in the right breast at 7 o'clock appears benign.
BI-RADS: 4 Suspicious finding- biopsy should be considered
I am scheduled for a biopsy this Tuesday. And then leaving the country on Friday for 2 weeks. Hoping to have the results before I leave.
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Hi
I'm new here and a little concerned. I'm 39 and had my first mammogram done in oct. My mom past away 4 years ago due to breast cancer. I work for a obgyn so it was advised I go and get a mammogram done. So I did.
It stated that I had very dense breast and a follow up was recommended birads 0. I did the follow up last week. I had the mammogram and ultrasound done. And was advised to have a mri done. That I'm going to do on Monday morning. So I got my report from the mammogram and ultrasound basically my results says things like. Architectural distortion, irregular Hypoechoic mass, lobulated enlonged mass, oval Morphologic suspicion, birads 0. So I'm freaking out a little ugh!
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It looks like the mammo finding was a cyst but something else was seen that requires a biopsy. It has mixed features, some OK some suspicious. The wider than tall, posterior enhancement and no blood flow are all good signs.
Let us know what the biopsy shows.
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Thanks for the information. The radiologist told me the cyst was found on the US and not seen on the mammogram. They did another mammogram after the US to confirm the cyst location.
I will let you all know what the biopsy shows
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yes she told me let’s see what the mri says first, most likely a biopsy will be needed but let see what the mri says first
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Hey, I saw you’re a radiologist, I was wondering if you can possilbe tell me what the blue and red colors mean on an ultrasound? Sorry if this is off topic, I’m in the waiting period for to results and just curious if it’s something concerning
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LXS I'm not a radiologist but that would be where they were checking blood flow.
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Lxs, benign things like fibroadenomas have blood flow too
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Those are from the Color Doppler, which measures blood flow. The colors indicate direction of flow. Red is assigned to the direction of arterial flow and the blue to the direction of venous flow. It not only detects the flow but can determine if there is turbulence in a vessel and also calculate the velocity of the flow in vessels and measure vessel diameter at a stenosis. Its primarily used to detect vascular disease (carotid, femoral etc) but we use it to determine if a solid mass has a blood supply.
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Hi, so I did my mri yesturday morning. I received a call from my dr at 6:00 last night. He told me that something was found in both of my breast. Birads was a 4. Still unsure what it is. I really don’t understand that. But are my chances of it not being cancer bettercause it’s in both breast or is it still just as possible?
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I was advised to make a biopsy appointment as soon as possible
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Ja9831....just want to let you know that there are a lot of false positives on MRIs. It is however the best screening tool for dense breasts. Try not to panic. Remember they have to prove you have breast cancer before you do. So sorry about your mom. Good luck and keep us posted.
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Dear djmammo: first I want to thank you for all your help on this site.
had my routine Muga yesterday with continued good ejection fractions. 60-70%. I have had at least 12 of these. Same tech, machine. Etc.
Portal result includes:There is a relative photopenic halo around by the heart raising the question of pericardial effusion.
I read could be false positive due to implant position.....how often do you see this, and is it an “over read”. There has been no change in implant size obviously.
Is a follow up echo in order. ? Asymptomatic...retired RN so I know what a pericardial effusion could mean. Stable CT in December, no lymphs seen, no progression noted. Have 6 nodules bilateral lung “sleeping” which we are not sure could be left over plain old nodules left over from the 50 original in 2014. I remain on H&P.
Thank you in advance.
Brenda E
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Nothing yet...the report was on portal last night. I’m a pretty calm person, but this made me a little uncomfortable. I see oncologist Thursday. Should I call in today to get started on scheduling or just wait
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Thank you...no symptoms. I have been wondering which test is best vs cost..echo / Muga.
With Echo there wouldn’t be any injection. Between heart and Ct, I’m getting a dose of something 2 out of 3 months. It seems to me each time I feel just a little more worn down.(also Herceptin and Perjeta).
Thanks,
Brenda E
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my report states that I have a benign looking nodgul maybe a lymph node Why biopsy then?
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Hello djmammo! I had an MRI last week, and I'm going back today for a targeted u/s. Can you help me understand this part of my report:
RIGHT BREAST: In the lateral central right breast at 9 o'clock, 7 cm from the nipple posterior depth there is non mass enhancement measuring 2.6 x 1.4 x 1 cm (AP x transverse x CC) (image 87, series 10, image 38, series 18). This area primarily demonstrates rapid uptake and persistent kinetics. There is a small focus of rapid uptake and wash out kinetics. This questionably corresponds to the area of architectural distortion in the right breast from 11-12 o'clock.
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Good news is there is no mass. There is non-mass enhancement, that is, an area showing greater contrast enhancement than the surrounding tissue, not necessarily bad. Persistent kinetics (they may mean plateau kinetics) is the middle ground between good and bad types of enhancement. Sometimes if corresponds to DCIS. Are there calcifications on your mammo in this area?
The area they are most worried about is that area with "washout kinetics" which can be seen in cancers and if this does correspond to the AD on the mammo then this is what they will want to biopsy. see below
Breast MRI enhancement curves:
- type I curve: progressive enhancement pattern
- typically shows a continuous increase in signal intensity throughout time
- usually considered benign with only a small proportion of (~9%) of malignant lesions having this pattern
- type II curve: plateau pattern
- initial uptake followed by the plateau phase towards the latter part of the study
- considered concerning for malignancy
- type III curve: washout pattern
- has a relatively rapid uptake shows reduction in enhancement towards the latter part of the study
- considered strongly suggestive of malignancy
0 - type I curve: progressive enhancement pattern
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Can you explain to me what all of this means? I do have an ultrasound biopsy scheduled for tomorrow. But I am completely lost with what any of this means. Or if or what any of it I should be concerned about. Thanks so much
DIGITAL DIAGNOSTIC MAMMOGRAPHY UNILATERAL RIGHT
EXAMINATION:
Right DIGITAL DIAGNOSTIC MAMMOGRAM ADDITIONAL VIEWS
ULTRASOUND BILATERAL BREASTS
HISTORY:
Additional workup for Abnormal mammogram.
Recall Protocol per Breast Center worksheet
FINDINGS:
DIAGNOSTIC MAMMOGRAM
Additional views were done of the right medial breast there is a
nonspecific 1.2 cm area of asymmetry medially.
ULTRASOUND BILATERAL BREASTS:
Ultrasound performed of the RIGHT MEDIAL BREAST.
There are small cysts seen at the 12:00 region 1:00 region
At the 6:00 position near there is a oval-shaped circumscribed 0.6 x
0.3 x 0.5 cm hypoechoic mass that is likely unrelated to the
mammogram.
ULTRASOUND LEFT BREAST 7:00-11:00 region
At the 7:00 position there is an oval-shaped lobulated indeterminate
0.7 x 0.3 cm hypoechoic mass.
At the 11:00 region there is an oval-shaped 0.7 x 0.3 x 0.4 cm
heterogeneous hypoechoic area.
There is dense tissue at the left breast 10:00 11:00 region.
IMPRESSION:
ACR BI-RADS CLASSIFICATION:
Category 4b - Suspicious Abnormality- Biopsy Should Be Considered.
Moderate level of suspicion for malignancy. Left breast
ACR BI-RADS CLASSIFICATION:
Category 3 - Probably benign findings-Short Interval Follow-up
Suggested
right breast
RECOMMENDATION:
Ultrasound core BIOPSY LEFT BREAST 7:00 region recommended.
Follow-up mammogram and ultrasound RIGHT BREAST 6 months recommended0 -
Thank you so much for the clarification! I don't believe any calcifications showed up on my mammo, or at least I didn't see that noted on the report.
I had the targeted u/s this afternoon, and they still can't see anything on that. Could that be due to being heterogeneously dense?
The radiologist and dr are recommending an MRI-guided biopsy at this point.
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Hi Djmammo. My MRI didn't show any new suspicious areas, but I'm curious about what the following means:
There is a moderate amount of diffuse background enhancement throughout
It showed for both breasts. Is this just a reference to dense breast tissue?
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Yes, that term is analogous to breast density on a mammogram.
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