Interpreting Your Report
Comments
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Hi - my first post here - just got a call from my gyno yesterday where she read the results of my ultrasound on 12/31 (purpose of ultrasound was due to dense breast tissue, no other symptoms):
"In the 11:30 position of the right breast, 2-3 cm from the nipple, there is a possible 7x5x5 mm irregular hypoechoic mass. This may represent confluence of structures close to the nipple. However, it appears separate from the nipple on some views. Further evaluation is recommended."
I'm scheduled to have another targeted ultrasound on Monday, followed by a diagnostic mammogram if the radiologist finds it necessary.
What can I expect from this visit on Monday? (or is it different dependent upon the practice). I've never had a result like this before. Everything's always been fine (I am almost 49 yo). I'm hoping that I will get concrete answers on Monday and not have to wait a few days for the results to come back.
Thanks for any perspective. I am stressed out about this even though I am trying not to be.
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thanks djmammo, I appreciate your voice of reason. Hoping it’s nothing.
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Djmammo....thanks so much for your help on this board. I had my core needle biopsies x 2 on Thursday. Awaiting results, they said Tuesday so we will see. The report they loaded regarding the biopsies says IMPRESSION: "histological findings will be correlated".
Can you explain what that means? My interpretation is that they feel they got good samples? Or would it mean that they think the two biopsy sites will reveal the same results? Or is it code word for they looked suspicious?
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"histological findings will be correlated" is code for "when the path results come back I will compare them with my impression of the imaging findings and let you know if they match or not". Phrases like that take up less space.
It refers to a comparison and subsequent report that is a requirement for the radiologist that performed the biopsy.
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Djmammo,
I had the discordant ultrasound guided biopsy last month. MRI report came back, I’ll copy below. Do biopsy clips typically end up ‘adjacent’ to the mass, or in the mass? I thought “medial” meant interior middle, but the term adjacent is later used in the report. Second biopsy is this Thursday. Coming to terms that I may not get good news when it’s all said and done.
Quick summary: mammogram showed architectural distortion. Ultrasound showed irregular, hypoechoic mass with irregular margins and eccentric shadowing. Biopsy showed fibroadispose tissue with a blood clot. I had a breast reduction about 8 years ago, so have been hoping it was only scar tissue. But none of this was on my prior mammograms, the most recent was three and a half years ago. (I just turned 40.)
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CLINICAL DATA: Left retroareolar mass with benign biopsy, discordant to the mammogram and ultrasound findings.
BACKGROUND ENHANCEMENT: Minimal. FINDINGS: In the retroareolar region, there are post biopsy hematoma changes seen. Just medial to this post biopsy hematoma and biopsy marker, there is a 1.2 x 0.6 cm sized irregular shaped enhancing lesion seen which shows persistent enhancing characteristic. The lesion has irregular margins. Findings are corresponding with the mammographic abnormality. Further evaluation with surgical excision of this lesion with needle localization of this clip and lesion would be of additional help. No other suspicious mass or non-mass-like enhancement seen. No axillary lymphadenopathy seen. No skin thickening seen.
IMPRESSION: Irregular shaped area of enhancement seen in the left retroareolar breast measuring 1.2 x 0.6 cm in size adjacent to the prior biopsy site and clip. Based on morphology, findings are still suspicious for a neoplastic process. Excisional biopsy of this lesion is recommended. BI-RADS 4 - suspicious abnormality.
Thank you!
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It could conceivably still turn out to be benign, but it does sound like the intended target was not sampled. Cancers usually have "wash out" kinetics on MRI rather than "persistent" but this is not written in stone and the other features are suspicious enough.
At this point the usual recommendation is to have it removed rather than re-biopsied.
Even with a successful biopsy, marker clips can move a bit after placement especially if they get stuck to the introducer and get pulled back a little when the introducer is withdrawn.
"Medial" indicates relative position of two structures. If A is medial to B, then A is closer to the midline than B. It can refer to the body as a whole (using the spine as midline) or within a specific organ (the nipple marks the midline of the breast). If something is further from the midline than something else, it is "lateral" to it. Here is an explanation.
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Djmammo....thanks so much for your help on this board. I am 46 years old. I started my mammo with US when I was 39, no family history of breast cancer. In the last few years I had pain and discomfort around and in menstrual cycle on one or both breasts. In 2017 on US is found something I think with not particular name.This is the result from US
09/12/2017 HISTORY: N64.4
TECHNICAL FACTORS: High resolution linear grayscale ultrasonographic imaging of
both breasts evaluating all clock positions/zones and retroareolar regions were
obtained.
FINDINGS:
Right: No cystic, solid mass or architectural distortion is identified.
Left: 2 o'clock 3 cm FN well-circumscribed hypoechoic solid nodule with its long
axis horizontally aligned to the fascial planes of breast-0.7 x 0.3 x 0.4
cm-new.
ULTRASOUND BI-RADS CATEGORIZATION: BI-RADS Assessment Category 2: Benign
finding.04/16/2018 HISTORY: Previous B/L breast ultrasound 9/12/2017: "No ultrasonographically
suspicious findings...."
PRIOR: Multiple: Most recent September 12, 2017
TECHNICAL FACTORS: High resolution linear grayscale ultrasonographic imaging of
the left breast from 12-3 o'clock were obtained.
FINDINGS:
Left: 2 o'clock 3 cm FN hypoechoic solid nodule vs complex cyst
well-circumscribed with its long axis horizontally aligned to the fascial planes
of the breast-0.4 x 0.5 x 0.2 cm-slightly decreased.
The remainder of the left breast focal upper outer quadrant fails to demonstrate
any ultrasonographically suspicious finding.
ULTRASOUND BI-RADS CATEGORIZATION: BI-RADS Assessment Category 2: Benign
finding.06/07/2018 Study Result
Impression
IMPRESSION:
1. No mammographic or ultrasonographically suspicious findings as described and
discussed above.
2. FINAL BI-RADS CATEGORIZATION: BI-RADS assessment category 2: Benign findings.
3. Yearly mammography is recommended.
A copy of this report will be forwarded to your patient in lay language in
accordance with MQSA requirements.Narrative
MAMMOGRAPHY-B/L DIGITAL SCREENING W/ CAD
ULTRASOUND-B/L BREAST-COMPLETE
HISTORY: No palpable masses or complaints at the time of evaluation. Z12.31
LAST CLINICAL BREAST EXAMINATION: June 2018.
LIFETIME RISK: 9 %
PRIOR: 9/8/2016, unilateral right additional views
8/6/2015, bilaterally 3/20/2015, 7/30/2014, 7/25/2013, 7/23/2012, unilateral
left additional views 7/22/2011 and B/L 7/19/2011.
TECHNICAL FACTORS: Full field digital 3D tomosynthesis mammography was obtained
in the MLO and CC projections of both breasts. 2D/"C-View" images were created
from the data set. R2-CAD/computer aided detection was performed.
FINDINGS: The breasts are symmetric in size, shape and have scattered areas of
fibroglandular density to heterogeneously dense glandular pattern. There is no
skin thickening, nipple retraction, dominant soft tissue mass, suspicious
appearing clustered microcalcification or architectural distortion identified.
MAMMOGRAPHY BI-RADS CATEGORIZATION: BI-RADS Assessment Category 2: Benign
finding.
Due to the density of the breasts B/L breast ultrasound is indicated and was
performed.
BILATERAL BREAST ULTRASOUND
PRIOR: Multiple
TECHNICAL FACTORS: High resolution linear grayscale ultrasonographic imaging of
both breasts evaluating all clock positions/zones and retroareolar regions were
obtained.
FINDINGS:
Right: No cystic, solid mass or architectural distortion is identified.
Left: 2 o'clock 3 cm FN complex cyst/internal debris vs hypoechoic solid
nodule-0.5 x 0.2 x 0.5 cm-essentially unchanged.
ULTRASOUND BI-RADS CATEGORIZATION: BI-RADS Assessment Category 2: Benign
finding.12/13/2018 Study Result
Impression
IMPRESSION:
1. No ultrasonographically suspicious findings.
2. FINAL BI-RADS CATEGORIZATION: BI-RADS Assessment Category 2: Benign finding.
3. The patient should return in June 2019 for her yearly mammogram.Narrative
BILATERAL BREAST ULTRASOUND
PRIOR: Multiple: Most recent June 7, 2018
HISTORY: Bilateral pain on and off.
TECHNICAL FACTORS: High resolution linear grayscale ultrasonographic imaging of
both breasts evaluating all clock positions/zones and retroareolar regions were
obtained.
FINDINGS:
Right: No cystic, solid mass or architectural distortion is identified.
Left: 2 o'clock 3 cm FN well-circumscribed hypoechoic solid nodule-0.6 x 0.2 x
0.5 cm- unchanged.I had just few days ago appointment with breast surgeon. The doctor said everything is ok and I need to follow after 6 months mammo and US. Doctor said it can be lymph node or fibroadenoma , but I am very worried because it's stays in my breast but nobody knows what actually it is. I think removing it is best for me. I would be thankful if you can give me some insight as to what I should do.
EDIT:
I forgot to add that since 5 months i have not had my menstrual cycle, and there has been no pain in my breasts.
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DJmammo,
Here is a copy of the further testing that was done. Does it seem like 6 month follow up is a good plan in regards to the findings?
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If something is oval, has a parallel orientation, and does not increase in size over time, and demonstrates no suspicious findings they are followed for two years and then dismissed if stable.
Giving a differential of 2 benign entities is not the same thing as "they don't know what it is".
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Hello,
I am new to this site, and my stereotactic core biopsy is scheduled tomorrow. Below is the report from my diagnostic mammogram on my right breast on 12/26. The radiologist very briefly discussed DCIS with me but made it sound like no big deal. After reading about it, I am very concerned. Does the fact that she brought it up mean she is convinced I have it? Are there any benign conditions that would explain these findings? Of note, she also did an u/s of my left breast and found 2 simple cysts which she did not find suspicious. Thank you.
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Right breast: Magnification views confirm a small group of pleomorphic calcifications in the upper outer quadrant, anterior depth, 6 cm from the nipple. The calcifications span 4 x 4 x 4 mm. These are changed compared to prior mammograms. They are suspicious and stereotactic core needle biopsy is recommended.
IMPRESSION:
Right breast: Small group of calcifications are suspicious. Stereotactic core needle biopsy is recommended.BI-RADS 4-SUSPICIOUS FINDING. Biopsy should be considered.
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djmammo, Thank You so much for your help. Does it mean that I have to worry about it? How can I find what is it? And what should I do next? Because they don't know what that it is, but benign (oval shape) shall I follow up US and mammo after 6 months or remove it sooner?
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Djmammo,
Thank you! Reassuring to hear that the usual recommendation in my situation is removal. I was given a few options, and my husband was surprised that I agreed to the open excisional biopsy instead of the more conservative options. My gut was telling me just take the whole mass sooner than later.
Additionally, thank you for the explanation of medial vs. lateral. Funny enough, I will use that little lesson in my day job. My realm is patents, a big part of which depends on how well I can describe even the smallest detail.
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There are many benign things that present as calcifications. If the calcs have a certain appearance and pattern however (pleomorphic and branching) we start thinking about DCIS.
When there are suspicious calcifications present but without a mass it would more likely be DCIS than invasive cancer. In DCIS the abnormal cells are still completely inside the duct and cannot spread. Once it breaks through the duct wall it is considered invasive and treatment will be different than for DCIS. Now there can be microscopic invasion but that cannot be seen on an imaging study, just on microscopy.
I have heard some surgeons refer to having DCIS as a "speed bump" in your life. It still needs to be treated (surgery, radiation, tamoxifen) but pure DCIS does not metastasize.
We bring up all or most of the things it could be so you know what to expect and because we are required to. We may not think it is a particular disease process but we are obligated to mention the bad things that will require treatment as touched on above.
A 4mm group of calcifications is very very small. A good pick up on the part of your radiologist actually.
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Hi, me again. Just got the clear on the breast cancer side of things. Waiting on hematology to call me back. Findings read "cytology phenotypically suspicious for sll". Since I already have sll, every other pathology has been more definitive wording in the past....for instance would say "consistent with SLL."
When I speak to hematology should I be pushing further inquiry or relying on their recommendation? Do they usually want an excisional biopsy when something hits the middle ground like this? I'm worried they will kind of dismiss it and leave me in limbo so I want to be prepared with the right questions and expectations.
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I had a baseline 3D mammogram in September that came back as BIRADS 2 (due to implants) with extremely dense breast tissue. Prior to my baseline, I had several lumps and pain in my left breast/armpit. Saw a doctor in November to check my lymph nodes in my armpit and he said that they felt fine. Saw my OBGYN the first week of December so that she could feel the lumps and tell me what she thought. She thought they felt normal but ordered an ultrasound for me. Had my ultrasound on New Year's Eve and, besides finding several cysts, the radiologist said everything looked fine (including axillary lymph nodes). I am still having pain in my left breast and pain/achiness/burning in my armpit. If it were just my breast, I don't think I would worry so much since I definitely saw all of the cysts. But I can't get over the feelings in my armpit and am worried that something was missed. Should I push for an MRI? Since everything came back OK, I don't know if they would order one and I doubt that it would be approved by insurance. Thoughts? Advice?
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Lymphoma/leukemia are outside my field of expertise. Glad to hear they ruled out breast cancer.
In any pathology report the difference between "consistent with" and "suspicious for" is usually the size of the biopsy specimen they received/examined. The larger the sample, the more definitive they can be.
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Hello djmammo. Last week my wife had an mamagram and US done because she is now 40 and she also has had a benign mass (Fibroadenoma)biopsy/removed from right breast when she was younger. I don't understand these findings I typed below and it will be 2 weeks before a surgeon can get us in for a consultation for biopsy. Radiology Doc couldn't tell us anything. They found 2 spots on her left breast. Currently, I'm freaking out more than my wife is. Is this report something I should be really worried about or am I just freaking myself out for no reason right now? Birads 4b sounds really concerning. Any help appreciated!
Tissue density: The breast tissue is heterogeneously dense.
Findings:
Mammogram findings. The dense tissue may obscure some lesions mammograhically. Chronic biopsy changes of the right breast upper outer quadrant. In the left breast, there is a small but elongated mass medially, best shown on tomogram images partially obscured by overlying parenchyma tissues. This measures less than 2cm in length. Additional small circumscribed ovoid mass slightly further medial and prosterior. No suspicious Calcifications found in either side.
Ultrasound
In left breast, ultrasound reveals an irregular Hypoechoic mass in the 9:30 sector 6cm from nipple measuring 1.5 x 0.9 x0.5 cm. Internal echotexture favoring a solid lesion. Adjacent small Hypoechoic well-circumscribed lesion measuring 4 mm in the same coordinates with similar sonographic characteristics.
Impression
1. Two adjacent masses in the left breast 9:30 are indeterminate. Correlation with biopsy is recommended
2. No suspicious findings in right breast
Category Birads 4b suspicious (intermediate)
Recommendation
Needle biopsy left breast
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Hello, thanks @djmammo for your efforts.
I had a radial scar removed in 2016 and a papilimatosis in Feb 2018. All b9.
I go for follow up, and here is a summary for what I need your advice on:
Jan 2018: At 12 o’clock B position, cyst with septum measure 0.8 x 0.4 cm.
At 12 o’clock B position near muscle, hypoechoic mass lesion with well-defined border measure 1.1 x 0.5 cm seen on the previous exam done on 04/06/2017 (no change by comparison with the previous study).
Sept 2018: At 12 o’clock B position, lobulated cyst with thick content and septum measure 1.2 x 0.4 cm (increase in size by comparison with the previous study). Follow-up is recommended.
At 12 o’clock B position near muscle, hypoechoic mass lesion with well-defined border measure 1 x 0.5 cm (no change by comparison with the previous study).
Jan 2019: At 12 o’clock B position, lobulated cyst with thick content and septum measure 1.4 x 0.6 cm due to atypical cyst (increase in size by comparison with the previous study). MRI is recommended.
At 12-1 o’clock B position near muscle, hypoechoic mass lesion with lobulated border measure 1.5 x 0.6 cm could be due to atypical cyst (increase in size by comparison with the previous study). MRI is recommended.
The radiologist told me don't worry but you have to make an MRI. When I asked her for biopsy she said no need to go through this process as the cyst is far and close to the chest.
Right breast ACR0: Incomplete, typically because more information is needed. MRI is recommended.
I'm worried this time. What do think. What are the probabilities? Could that be cancer?
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If that finding at 12 o'clock is the same one seen for over a year it could be a cyst that became gradually more complicated over time and slowly becoming more solid in appearance. A septation was seen initially which is a common finding in a cyst. Because it changed in appearance, and a little bit in size you have to make sure a solid nodule did not develop inside the cyst and MRI is a good way to evaluate this, if they think it is not in a position to be easily biopsied. Also with your history of two prior excisional biopsies it would be good to see all of the breast tissue on both sides as sometimes papillomas and radial scars are not solitary. You should ask your doctors these questions if you havent already, as I can only guess their thought process.
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Djmammo, yes, these are the report findings
Normal fibrogladular architecture. Spot magnification views demonstrate persistent circumscribed 12mm mass 6:00 position left breast. There is internal micro calcifications. In addition there is a persistent circumscribed mass at the 1:00 position left breast measuring approximately 3mm
Grayscale ultrasound images demonstrate Hypoechoic mass with mild angulated margins and internal color flow at the 1:00 position measuring 5mm. Additional circumscribed mass with internal calcifications measures 7mm.
Axillary lymph nodes are normal
Impression: suspicious masses at the 1:00 and 6:00 positions left breast. Recommend ultrasound guided core biopsy of both masses.
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Hi djmammo.
Thanks for your post! By the way this cyst is there since 2016. Can you please check the whole report, here is it
Left breast Ultrasound:
Behind nipple, cyst measure 1 x 0.5 cm.
At 10 - 11 o'clock B position, galactocele measuring 0.8 x 0.7 cm (no change by comparison with the previous study).
At 12 o'clock B position, cyst with thick content measuring 0.5 x 0.5 cm.
At 12 - 1 o'clock B position, cyst with septum measuring 2.7 x 1.2 cm (increase in size by comparison with the previous study).
At 2 o'clock B position near muscle, three cystic lesions with thick content measuring 0.8 x 0.5 cm, 1.2 x 0.5 cm and 0.8 x 0.4 cm (increase in size by comparison with the previous study). Follow-up after short time is recommended.
At tail of breast and in UOQ multiple cysts are seen measure between 0.4 cm and 0.6 cm.
At 4 o'clock B position, longitudinal hypoechoic area measuring 1.8 x 0.5 cm due to scar (post-surgery) (no change by comparison with the previous study).
At 5 near nipple, cyst measuring 1 x 0.7 cm.
At 8 o'clock B position, cyst with thick measuring 1 x 0.4 cm.
Normal skin and subcutaneous region.
No evidence of axillary lymph node enlargement.
ACR3
Right breast Ultrasound:
At 9 o'clock laterally position, cyst with septum measuring 0.4 x 0.3 cm.
At 9 o'clock A position, cyst with septum measuring 0.7 x 0.4 cm.
At 10 o'clock A position, cyst with lobulated border measuring 1.3 x 0.8 cm (no change by comparison with the previous study).
At 10 o'clock B position, cyst with thick content measuring 0.7 x 0.6 cm.
At 10 o'clock C position, cyst with lobulated border and septums measuring 1.5 x 0.6 cm (no change by comparison with the previous study).
At 12 o'clock A position, cyst measuring 0.7 x 0.4 cm.
At 12 o'clock B position, lobulated cyst with thick content and septum measure 1.4 x 0.6 cm due to atypical cyst (increase in size by comparison with the previous study). MRI is recommended.
At 12-1 o'clock B position near muscle, hypoechoic mass lesion with lobulated border measure 1.5 x 0.6 cm could be due to atypical cyst (increase in size by comparison with the previous study). MRI is recommended.
At 8 o'clock laterally position, cyst with septum measure 0.7 x 0.3 cm.
At 8 o'clock A position, cyst measure 0.4 x 0.3 cm.
Normal skin and subcutaneous region.
No evidence of axillary lymph node enlargement.
ACR0
Conclusion:
Left breast ACR3: Probably Benign Finding. Follow-up after short time is recommended.
Right breast ACR0: Incomplete, typically because more information is needed. MRI is recommended
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Hi all, just thought i’d pop by with my biopsy results...
According to the biopsy results I have a fibroadenoma. My doctor didn’t seem too concerned and advised me going forward to just conduct regular breast checks myself and if I notice anything out of the ordinary to come back.
Does this seem right?
A few years ago I had a biopsy on my other breast which diagnosed a tubular adenoma, this was diagnosed through a specialist breast clinic in hospital who monitored it for approx 12 months after. Do fibroadenomas not require monitoring at all?
Thank you all
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A fibroadenoma is a benign mass but they can get bigger over time. If you can feel it well, you can monitor it to see if it does. If you cannot feel it, some people recommend a followup at 6 months and 1 year so it can be measured. Similar to a tubular adenoma, if it gets larger rapidly, they are usually removed.
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"Solid, irregular, hypoechoic" all describing the mass are worrisome terms. I dont see any mention of "posterior shadowing" , "through transmission" or "internal blood flow" which are terms that better help us make a decision between benign and malignant. I also dont see any mention of the lymph nodes under the arm on the side of the mass.
A biopsy is indicated considering the findings. They will want to biopsy that mass and the little one next to it as well. If any of the lymph nodes are abnormal they might want to biopsy one of those too. Despite these findings, there is no reason to freak out, and ultimately it is counterproductive. Let us know how it goes.
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MRI is our most sensitive exam for finding breast cancer. If you are having an MRI next, my opinion of the findings in the ultrasound report has no value as you will be receiving much more accurate information as to what they are in the MRI report.
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