Interpreting Your Report
Comments
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You might mention this history to the rad who read your breast imaging if you haven't already.
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I am not sure. I have always used my breast dr for all of that. Here is a screen shot.
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The description up in the body of the report would contain better info.
The disclaimer at the bottom is not one I have seen before. Did a radiologist read this scan or someone of another specialty?
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Hi everyone. I'm new here so sorry if I'm posting in the wrong area. Yesterday I had additional mammo views and ultrasound on left breast and I'm really nervous about the results. Report states:
Indication: grouped left lower outer breast microcalcifications on screening requiring further characterization
Breast composition: heterogeneously dense which may obscure small masses
Findings: the grouped microcalcifications are again identified and appear to be of varying sizes and shapes. One of them demonstrates teacup like appearance on the true lateral projection which is compatible with milk of calcium, a benign entity. The calcification are within heterogeneously dense tissue. No discrete lesion or architectural distortion apparent on mammography.
Targeted left breast sonogram was performed and at 4:00 about 5 cm from nipple there is a Hypoechoic multilobulated 1.4 x 0.6 x 1.2 cm lesion with multiple internal echogenicities reflecting calcification. Finding is fairly posterior. No associated vascularity. The abnormality corresponds to the mammogram. The left axilla was imaged and no suspicious adenopathy identified.
Impression: a 1.4 cm left breast 4:00 mass with microcalcifications accounts for the screening mammogram abnormality. Finding is suspicious and requires tissue diagnosis.
Recommend left breast ultrasound guided biopsy.
Bi rads 4
I'm scheduled for biopsy on Jan 8. However, the radiologist wanted biopsy within the next week and said not to postpone. She also made references to me being young and to get it taken care of right away. I'm 43. Any insight would be greatly appreciated. Radiologist had 3 prior mammograms for comparison.
Thanks in advance
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Calcifications "of varying sizes and shapes" is the definition of pleomorphic calcifications and these are always a red flag and therefore always biopsied especially if associated with a mass.
That being said there are both malignant and benign masses that will contain calcifications and a biopsy is often necessary to tell them apart.
If the rad wants to expedite the biopsy they must be concerned about this finding.
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Thanks for the quick reply. It looks like I have a few terms that are red flags if I have researched correctly. Obviously I’m very worried. Could you explain what multilobulated means? Is it the same as microlobulation? Also, is “the finding is fairly posterior” another red flag or just a description for location?
Thanks again
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Could you explain what multilobulated means? Is it the same as microlobulation?
Multi- is not an accepted term, microlobulated is. Here they are in order of significance
Margin: 1) Circumscribed
2) Not circumscribed - Indistinct - Angular - Microlobulated - Spiculated
Also, is "the finding is fairly posterior" another red flag or just a description for location?
Location. More toward the chest wall than the nipple. No other clinical significance.
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sent you a private message
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thanks for the clarification djmammo
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Quick question on how a “mass” is measured. Mine says 1.8cm*1cm does this mean it’s width by height? Thanks
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If on US the mass is measured in 3 dimensions on the images, L W and H, not necessarily in that order. On a mammo it can only be measured in 2 dimensions on each view but are combined to get L W and H.
If only one measurement is given then the convention is to use the largest dimension.
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I am feeling super frustrated. I went to my breast dr.this morning and he was unable to find the 1.3 cm area of enhancement that showed up on the MRI. Now I have to wait to have the MRI with biopsy. They can’t get me in until the 9th or 10th. My drs last day is today so now I still need to find a new breast doctor. Is it possible that the Ultrasound didn’t find anything there because I am a CCC cup? Is it possible there was nothing there to begin with?
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This is a common occurrence. Often after "non-mass enhancement" is encountered the second look US shows nothing obvious because there is no mass. Sometimes there are very subtle changes in the appearance of the tissue as a whole like (as an analogy only) finding a patch of plaid in a see of stripes. There is often no focal target. In order to know where to biopsy the procedure often has to be done with MRI. Every now and then when you go back to have it done at MRI they cant find it. In a patient that is still cycling this is often related to the timing of the scan during the menstrual cycle. During some weeks the normal tissue can enhance more than usual and appear abnormal. Ask if they took your LMP into consideration.
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In these situations I usually compared the MRI to the mammo to see of there were any findings at all in the area of interest no matter what they looked like just to get me to that patch of enhancing tissue, and then I would do a stereotactic biopsy of that area often with very good results.
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I had a hysterectomy a few years ago
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Did they take both ovaries too or just the uterus? (TAHBSO or just TAH?)
If they left just one ovary in, you are still cycling biochemically.
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they left my right one which has a lemon sized cyst and doesn’t produce what ever it is supposed to produce
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Let us know how the MRI biopsy goes, and what the path shows.
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Hi DjMammo - I wondered if you might be able to shed light on something for me. If not, I totally understand.
Before I was dxd this summer (july) with breast cancer, in the spring (may) I had a chest x-ray because of pain I was experiencing at the time
I'm wondering is it typical for breast cancer masses to be missed on chest x-rays? Mine was a 2 cm mass in the L UOQ.
I know X-Rays aren't as sensitive as Mammos but surely masses in the breast that large should be seen in a chest x-ray, correct?
Thoughts?
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This is what my chest X-Ray and my Mammo report states, if of interest:
Impression
IMPRESSION:
No acute cardiopulmonary findings.Narrative
XR CHEST 2VW, 4/30/2018 11:58 AM
INDICATION:
R06.00: Dyspnea, unspecified type
R07.89: Chest wall pain
ADDITIONAL CLINICAL INFORMATION:
Ordering Provider Reason For Exam: eval L sided posterior/lateral pleuritic
chest wall pain, dyspnea
Technologist Note: Left sided chest pain and shortness of breath for one week.
Additional: None
COMPARISON:
9/1/2009
TECHNIQUE:
PA and lateral chest
FINDINGS:
Lungs are clear. There is no consolidation, pneumothorax, or pleural effusion.
The heart size is normal.Mammo
MAMMOGRAPHY: Additional full-field digital mammographic views of the left
breast were performed with CAD. The left breast is heterogeneously dense which
may limit sensitivity of mammography for small masses.
The additional views confirm the presence of a spiculated mass in the upper
outer quadrant of the left breast.
ULTRASOUND: Targeted ultrasound of the upper outer left breast was performed.
Corresponding in size and location to the mammographic finding of concern is a
2.2 cm hypoechoic shadowing mass that is taller than wide and has irregular
margins.0 -
Ahhh ok, that's what I had been wondering. Thanks so much for clearing that up. I really appreciate it.
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Hi, I have non Hodgkin's lymphoma and leukemia. I have repeated breast biopsies when I fail my mammograms due to enlarged lymph nodes from the lymphoma. however, this is the first time I've had masses outside of lymph nodes. Biopsies scheduled for Thursday and they are ordering a Breast MRI anyway because of the complex nature of things. This seems pretty malignant doesn't it? Trying to ignore the lymph node talk...has anyone had a similar radiology report they can let me know the outcome of good or bad? I hate waiting but cancer is always waiting...I am pretty sure I have breast cancer now too. 😐
MAMMOGRAM FINDINGS:
Digital tomosynthesis (3D mammography) was performed in conjunction withs standard mammography. Computer-aided detection was utilized by the radiologist in the interpretation of this digital mammogram examination.
There are scattered areas of fibroglandular density.
Finding 1: There are enlarged lymph nodes in both axilla with representative biopsy of a lymph node in each axilla as evidenced by biopsy clips. Outside facility biopsy of a right axillary lymph node with clip placement on 7/23/2018 showed B-cell lymphoma consistent with small lymphocytic lymphoma , chronic lymphocytic leukemia (SLL/CLL). Surgical clips in the axilla from prior excisional biopsy yielded SLL/CLL in 3/2017.
Finding 2: There is an oval mass with indistinct margins in the right breast upper outer quadrant at 10 o'clock located 4 centimeters from the nipple
Finding 3: There is an asymmetry in the lateral region of the right breast located 6 centimeters from the nipple as well as additional asymmetries in the upper outer and central right breast.
Finding 4: The finding in question is not seen on mammogram.
ULTRASOUND FINDINGS:
High-resolution real-time ultrasound scanning was performed.
Finding 2: Ultrasound demonstrates an oval solid mass with poorly defined margins measuring 17 x 6 x 11 mm in the right breast upper outer quadrant at 10 o'clock located 4 centimeters from the nipple. Finding is avascular.
Finding 3: Ultrasound demonstrates a hypoechoic mass measuring 4 x 2 x 4mm in the right breast at 9 o'clock located 6 centimeters from the nipple which likely represents the correlate. The finding may represent an intramammary lymph node but is too small to resolve. Additional similar morphology hypoechoic masses are present in the right breast:
At 9 o'clock, 3cmfn, a 4 x 2 x 3mm hypoechoic mass.
At 10 o'clock, 10cmfn, a 5 x 3 x 5mm mass which may also represent an intramammary lymph node or low-lying axillary lymph node as seen on mammogram
At 12 o'clock, 7cmfn a 6 x 2 x 4mm mass.
At 12 o'clock, 4cmfn a 6 x 3 x 6mm mass.
Finding 4: There is an avascular irregular solid mass with poorly defined margins measuring 5 x 3 x 3 mm in the right breast upper outer quadrant at 10 o'clock located 4 centimeters from the nipple. Finding is within 3mm of the dominant mass at 10 o'clock, 4cmFN. This mass has a different morphology from the dominant mass and the additional described masses in finding#3 in the right breast.
IMPRESSION:
Finding 1: Bilateral axillary adenopathy with biopsy clips demarcating biopsied lymph nodes is most consistent with a systemic process. BI-RADS 2
Finding 2: Solid mass in the right breast upper outer quadrant at 10 o'clock located 4 centimeters from the nipple is suspicious. An ultrasound guided biopsy is recommended. BI-RADS 4B
Finding 3: Multiple similar hypoechoic masses in the right breast at 9o'clock, 6cmfn; 9 o'clock, 3cmFN; 10 o'clock, 10cmFN; 12 o'clock, 4cmFN,and 12 o'clock, 7cmfn are probably benign. Findings may represent small intramammary lymph nodes or small cysts. Pending pathology of the suspicious masses, these masses may be expectantly managed. BI-RADS 3
Follow-up in 6 months is recommended.
Finding 4: Solid mass in the right breast is suspicious. An ultrasound guided biopsy is recommended. BI-RADS 4B
BI-RADS Category 4B: Suspicious Abnormality
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There is nothing in the dictation that screams breast cancer. A definite cancer gets a B5, this is a 4B so the reader is not totally convinced its a breast primary.
It could be related to your lymphoma. Have you had radiation to your chest for the lymphoma that included your breasts? Here is a related article.
Let us know what the biopsy shows.
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Djmammo...thanks for the reply. They will first screen for bc, then if negative off for lymphoma screening. If it's lymphoma, from what I understand it would be another type and presenting as extra nodal with some aggressiveness to it. It would be a very rare complication without a lot of good outcomes so given the choice I think I would be rooting for a low stage breast cancer but I really have no idea because like everything it would depend on what the specific characteristics are. It will be early next week for bc confirmation and if necessary the lymohoma testing takes a bit longer. No, I have not had radiation to chest as my lymphoma is managed systemically.
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A couple more questions I thought of....this report is from Moffitt breast center as I was referred there from hematology. These radiologists only deal directly with cancer patients all day. I guess that had me freaked out they would go directly for a breast MRI and the 4B status. Like somehow they know more about what is and what isn't since they are looking all day at cancer specifically. Also, when you see this what makes you think lymphoma? Would it be the intramammary glands? It seems like a very odd report to me when I read others.
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DJMAMMO,
I finally had my follow-up. They did a diagnostic mammogram and an ultrasound. Everything was clear on both. They determined the first was overlapping tissues. I am clear until my routine next year. Thank you so much for the information you posted. You were right, it was too early to freak out.
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When you see this what makes you think lymphoma?
Just your history and the facts concerning breast cancer in lymphoma patients (contained in the article I referenced)
Would it be the intramammary glands?
Intramammary lymph nodes can enlarge with lymphoma.
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DJmammo,
Just got a call from breast imaging center that they had an appointmen later today for me instead of next week. Ready to figure this thing out. This is such a reach of hopeful wishing, but I was just curious if there is a chance that screening 3Dmammograms pick up “masses" that aren't there when you have diagnostic and u/s. They said they saw a 1.8 mass on two views, but I'm wondering if the screening 3Ds can pick up things that's aren't really there? Thank you
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Thank You! They found two spots on Mammo again and the u/s. Radiologist says one he thinks is either a complex cyst or Fibroadenoma and the other he says looks like a Fibroadenoma. He said they don't look cancerous and it's Bi-Rad 3. I will go back for another u/s to check for changes in 6 months.
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Hello-I am new here and worried. I am 49 years old with a family history of breast cancer (paternal grandmother and paternal and maternal aunt). I had a mammo and sono Dec 22nd and got a call Christmas Eve that I need a biopsy which is scheduled for next Friday. My ultrasound report showed the following and I am worried-I know a biopsy is the only definitive answer but has anyone had something similar?
BREAST ULTRASOUND BILATERAL COMPLETE
HISTORY: Z12.39 Screening breast ultrasound
COMPARISON: Breast ultrasound 9/13/2017 and bilateral mammography including 12/22/2018
Sonographic evaluation of both breasts in their entirety, was performed, including each of
the four quadrants and the retroareolar region, in clockwise fashion.
RIGHT BREAST:
10:00, 5 cm from the nipple, 1.1 cm morphologically normal benign-appearing intramammary
lymph node
11:00, 3 cm from the nipple, 1.2 cm irregular hypoechoic area, not significantly changed
in size
LEFT BREAST:
No cystic or solid lesion is identified. No abnormal acoustical shadowing is apparent.
IMPRESSION:
Suspicious right breast hypoechoic area now with irregular margins, 11:00 axis. R92.8
Benign Nodule Right D24.1
RECOMMENDATION: Biopsy recommended.
BI-RADS 4- Suspicious Finding(s)
This lesion would be amenable to ultrasound-guided percutaneous vacuum assisted core
needle biopsy which is performed at many of our locations.0
