Interpreting Your Report
Comments
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Hi djmammo,
I made the MRI as advised and kindly check the report:
FINDINGS:
Breast parenchyma:
The breasts parenchyma is of diffusely dense pattern with heterogeneously fibroglandular
elements filling most of the breast volumes and asymmetrical distribution on the both sides.
Mass lesions/cysts:
Both breasts:
Bilaterally multiple well-defined nodules, subcentimetre in size, intensely enhancing post contrast
injection (about 55 in the right breast while about 79 in the left breast) and curve analysis showed
type I curve pattern, located and distribution overall both breasts. Otherwise no suspected masses
or areas of parenchymal distortion. No collections.
Other lesions/cysts:
Multiple variable size cysts, which are located between the fibroglandular elements of the both
breasts, the biggest cyst is well identified located at 12 o'clock position of the left breast measuring
2.7×2.2 cm.
Axillary regions/chest wall:
No axillary pathologic lymph nodes identified on both side.
Nipple and areolar complex are unremarkable. Retromammary fat without specific abnormality.
Chest wall muscles are intact.
CONCLUSION:
Compared to the previous breast MRI no significant changes, however asymmetrical
fibroglandular elements of the both breasts associated with interposed multiple cysts and a
multiple enhancing nodules, corresponding functional curves confirming to type I, most likely
benign aetiology(consider fibroadenomas).
BI-RADS Classification:
RIGHT BREAST BI-RADS III. LEFT BREAST BI-RADS III.
But the ultrasound report was:
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
One more thing, I'm facing pain under my urm for more than a week now especially that area between my arm and breast, is that related to anything?
Sorry for the long message but I'm really worried and not satisfied with the MRI report because the mass/cyst on my right breast grew in size once in the last report in September and before in last January
Hope you could advise.
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Hi Djmammo
I had an ultra sound that showed a 1.3 cm mass on my outer left breast at 2:00. The mammogram showed nothing.. The biopsy diagnosed Mammay carcinoma - Lobular Like. I just had the MRI. I haven't gotten the report yet, but the insurance billing code stated this to be a malignant neoplasm of overlapping sites of left female breast. Does that mean the tumor is much larger than 1.3 cm. What does that description mean? Is it a common description. I am worried that the tumor is much larger than originally diagnosed. Thanks
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That's just the billing code for the insurance company. They pick the one that has the highest reimbursement for a particular test or procedure that can conceivably apply to your diagnosis. The names of these standard codes are made up by the insurance company not your doctors, and do not necessarily reflect your particular situation.
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djmammo,
I had my first ever mammogram and was told to get an ultrasound. Here is the result of the ultrasound:
Ultrasound left breast
Comparison: Mammogram
Clinical History: Nodule
Findings:
Ultrasound examination of the four quadrants, retroareolar region and axilla of the left breast was obtained and reviewed.
At 10:00 5cm from the nipple is a 5 x 6 x 5 mm irregular marginated solid nodule with distal shadowing, with internal vascularity, taller than wide, concordant with the spiculated nodule on the mammogram. This is highly suspicious of malignancy.
At 2:00 5cm from the nipple 8 x 5 x 4 mm intramammary lymph node with benign sonographic characteristics also seen on the mammogram.
Impression:
Nodule at 10:00 5cm from nipple 5 x 6 x 5 mm, highly suspicious of malignancy, amenable ultrasound directed biopsy.
Birad assessment category 5
All this sounds to me like it is very likely to be malignant but I had an appointment with a surgeon and he felt the lump and said he didn't think it was anything. He ordered the biopsy but said it was only a 20% chance that it would be malignant. I thought that a category 5 birad was 95% chance of malignancy. Is it normal for there to be such a large disconnect between the radiologist's findings and what the surgeon is telling me?
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Ultrasound of the breast is far superior to a clinical breast exam no matter who is examining you. This goes for initial detection and for diagnosis.
All the adjectives used in that report for that nodule are highly suspicious characteristics both on the mammogram and the ultrasound, B5 is appropriate given that wording.
The good news is the size is less than 1cm in diameter which has a better prognosis with treatment depending upon the histology, likely invasive ductal from the description, and other attributes of the tumor. If this was found on a screening mammogram its a nice pickup at that small size, and likely having a classic appearance to draw their attention.
Ultrasound guided biopsy is the way to go for diagnosis. Let us know who will be doing the biopsy and subsequently what the path shows.
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Thank you for your reply. It is what I thought and am not too concerned since the tumor is quite small. I have an appointment for a biopsy next week and I was told that the radiologist would be the one taking the sample. I'll be sure to post the results when I find out.
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DJMammo,
Does the same imaging-pathology correlation typically occur after a wire-guide excisional biopsy as an ultrasound-guided biopsy? I ask because of the radiology report from my wire-guided excisional biopsy last week. What types of "final recommendations" are usually made? Multiple specimens were taken because the biopsy clip was not within the first specimen. It was within the second specimen. (I was in OR almost 3 hours.) I don't have a copy of the pathology report (or any addendums) yet, but I do know that (thankfully) there was again no sign of malignancy. Just general fibrocystic changes. (I have a fair amount of scar tissue because of a previous breast reduction.) Could the mass have been missed again? I want to be believe no and that this roller coaster is over. But I jokingly told my husband last night that'd be my luck to have it missed twice.
Mammographic Guided Needle Localization left Breast
INDICATION: Mass in the left breast
The biopsy clip was localized for needle placement. The skin was cleansed using aspetic technique and anesthetized with 5 cc of 1% plain Xylocaine. A localization needle was inserted into the area of interest and repeat cranicaudal and mediolateral views verified the needle position to be adjacent to biopsy clip.
Multiple specimens were obtained from the operating room which contains the localization wires. The specimen radiograph shows a biopsy clip seen within the specimen.
IMPRESSION:
1.Needle localization and excisional biopsy of the left breast. A final recommendation will be given when the pathology report is available.
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Once the localization is done and the target removed, that is usually the end of my active involvement with the case unless something else came up. We just make sure the marker and the wire(s) have been removed at call up the OR to tell them so. I don't believe I ever did a post localization-path report addendum. At that point the rest is between the pathologist and the surgeon and you.
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So...got to see the biopsy report, and though all involved docs said not malignant my GP included, she recommended i see a breast surgeon, who says there is some discrepancy between findings? She also doesnt think there's any cancer (definitely not IBC), but it seems no one is really sure what caused it or what it is exactly?
No idea what this is and nervous. I've been given antibiotics and told to come back for another ultrasound in 2 weeks and a follow up visit. I'm small-breasted so she doesnt want to make a "dent" from excision if it goes away on its own. But if it doesn't they might have to remove it,? what could it be? I've been on the antibiotics for 2 days now and it hasnt really gone much smaller. I have had no local injury that i can think of, am not breastfeeding. I'm 51 and at peri/menopause and taking low dose b/c pills for that. everyone seems a little baffled. Any clues? Getting scared again.
Report is:
"Fat necrosis with many Gram-positive cocci in clusters, extensive granulomatous acute and chronic inflammation with abscess formation, histiocytic reaction and stromal fibrosis. Adjacent scanty unremarkable breast parenchyma. No atypia or carcinoma identified.
Note: Section shows extensive acute and chronic granulomatous inflammation with scanty breast parenchyma seen in the background. Pancytokeratin is negative for carcinoma. GMS and Gram stains highlight many clusters of cocci. Acid-Fast Bacilli (AFB) stain are negative for organism. Please refer to right breast wound culture results for details of the bacteria. Overall, the etiology of the changes is unclear, with differential diagnosis including granulmatous lobular mastitis, infectious disease and reactive changes to yet identified process, among others. Clinical and the radiology correlation is recommended. Case also reviewed by another beast pathologist. "
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Cityrat
It says you have a chronic infection/inflammation. The type of bacteria is not the most common as breast infections go but it saysthey found no cancer. Two days is too short a time to judge if the antibiotics are working. Some chronic infections do require some surgical intervention in order to heal completely. Good to have a surgeon on board early.
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Does,nt sound good
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Doesnt sound good
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" reactive changes to yet identified process, among others."
is what worries me. reactive changes to what, possibly?
"Clinical and the radiology correlation is recommended." (BC said she couldn't really correlate them so she wasn't "letting me off the hook."
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Hi DJMammo, and all others on this topic thread. This is my first post, but I've been lurking around for about a week.
Back story: 55, one baseline mammo at 50. 20 year old implants removed and replaced in 2014. Baseline mammo was Birad 2, benign findings. Discovered a lump in RIGHT breast shortly before Christmas. Scheduled annual and mammo at GYN. He declined screening mammo, as I had a lump and sent me to a BS. Appt for DX Mammo on January 16.
Had DX Mammo and US. Was taken to the doctors' waiting area. After about 30 minutes I was taken back to mammo for magnifications and spot compression. Back to doctors' waiting area. Watched other women come and go, until I was the only one left. The nurse finally comes to get me and says "Did you bring anyone with you?" (Lovely. Spidey-senses on alert) In exam room and the nurse practitioner comes in. She's lovely and kind. Explained that I have busy breasts and they need two stereo BX and an MRI with contrast on my LEFT breast. Her words were (to the effect) "We need to get a BX of the front area and a BX of the back". Explains the stereo, although I know all about it. Doc comes in, she's lovely too. At this point I'm having a hard time focusing but cool as a cucumber. I do know that at no time was the word "benign" mentioned, nor "most times these are benign" etc. What I got was hand holding and "we'll get you through this. Call anytime with any questions." I did have the presence of mind to ask the Bi-Rad score (4) and a copy of my rad report. Which I got instantly. Scheduled for MRI and stereo on 1/22.
Having said all that (sorry for the word vomit), I am unbelievably annoyed at my rad report. I've seen examples here that put this one to shame. I understand that the radiologist has 37 years experience and this is an in-house specialty office, but I'm resorting to reading between the lines because that's who I am and this report is vague. I'm listing below, leaving out most RIGHT breast findings, as the lump is likely silicone droplet, Bi-Rad 3, Probably benign, short-term interval.
BILATERAL DIGITAL DIAGNOSTIC MAMMO WITH CAD
Comparison made to mammo 2014
There are scattered areas of fibroglandular density in both breasts.
There are developing multiple scattered amorphous layering calcifications in the right breast central to the nipple. These are seen in additional views.
There are developing multiple scattered amorphous calcifications in the left breast central to the nipple. No other significant masses or calcifications are seen in either breast.
IMPRESSION: SUSPICIOUS FOR MALIGNANCY
1. The developing multiple scattered amorphous calcifications in the left breast central to the nipple have a differential diagnosis of sclerosing adenosis and are suspicious. A stereo bx is recommended - two areas to be sampled: the groupings in the lateral and central aspects as seen on the ID CC magnification image.
2. The developing multiple scattered amorphous layering calcifications in the right breast central to the nipple likely represent milk of calcium and are probably benign. Recommend short-term follow if histology for the indeterminate left calcifications proves benign.
Mammo Bi-Rads: 4 SUSPICIOUS FOR MALIGNANCY.
If you've made it this far, thank you! My frustration is the rad report doesn't indicate clock areas, posterior, anterior, measurements, linear, branching, etc. I know SA is usually benign. Is the DD because they're ruling it IN? Or OUT? Scattered leans benign, amorphous leans suspicious; to me, as a lay person, this rad report is vague. And I wish they used a, b, c as well. Furthermore, they were pretty quick with BX scheduling. They plugged me in instead of asking what day works for me?
Can anyone provide insight on this report?
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I agree the report could have contained better descriptions but as I remind everyone on here that these reports are not written for you. They are not worded so patients can read and understand them, they are meant for your doctor and the next radiologist to be involved in your workup.
Amorphous calcifications can go either way, either DCIS which isoften called a "pre-cancer" or sclerosing adenosis, which is benign. Milk of calcium is benign. B4 a b c is used as a system for keeping track and determining the radiologist's positive predictive value, don't read too much into them.
Are the biopsy and the MRI on the same day? Which one are they doing first? What did the ultrasound show?
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Hi DJ, thanks for answering. Yes, the MRI w/contrast is same day, before the stereo.
The US appears concentrated on my concern (palpable mass 12:00 and skin indent 6:00) Here it is in whole:
COMPLETE ULTRASOUND OF BOTH BREASTS
CLINICAL HISTORY: Palpable area superior right and inferior right skin dimpling.
Comparison is made to exam dated 2014 Mammogram.
Real-time US of both breasts four quandrants and retroareolar regions was performed.
There is a sheetlike area of increased echogenicity in the superior right consistent with extracapsular silicone that correlates with mammo and palpable area. There is also a benign appearing cystic area right breast at 1:00. No acoustic abnormality in the area of skin dimpling at 6:00 right breast.
IMPRESSION: PROBABLY BENIGN
Palpable extracapsular silicone superior right, likely related to prior rupture (I questioned this in my head. My previous implants were intact, but capsulated)
Benign appearing cyst upper inner right may be physiologic, though a cystic collection of silicone is possible.
Ultrasound Bi-Rads: 3 Probably Benign
Not a darned thing indicated about left breast.
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DJ, as an afterthought, perhaps I should provide the 2014 mammo:
SCREENING DIGITAL IMPLANT MAMMOGRAM
CLINICAL HISTORY: 50 year old for routine screening mammo. There is no personal or family history of breast cancer.
This is the patient's baseline mammogram.
FINDINGS: Bilateral digital mammo, including implant displaced views, show what appear to represent bilateral double-lumen subglandular silicone and saline implants. Coarse capsular calcifications are noted on the left. No definite extravasated silicone is identified.
The breast parenchyma is radiographically heterogeneously dense which may decrease the sensitivity of mammography. There are numerous small benign-appearing low-lying axillary lymph nodes bilaterally. No other dominant masses, suspicious clusters of microcalcifications or areas of architectural distortion are identified.
IMPRESSION: No radiographic features are seen to suggest malignancy given the limitations imposed by the presence of breast implants. Further evaluation of the integrity of silicone implants could be performed with an MRI as clinically indicated.
There are numerous small benign appearing low-lying axillary lymph nodes bilaterally and these are probably reactive.
Bi-Rad Category: 2 Benign Finding.
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"Not a darned thing indicated about left breast"
Doesn't matter as the MRI will see the entirety of each breast soon. If they have any questions about what they see there, they will perform a directed US.
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My US reports says I have subtle 8mm angular Hypoechoic mass with indistinct margin and peripheral echogenic rim on my left breast . Also I have benign 21 mm mass parallel to skin and well circumscribed marginson at my right. Mammogram also supports the US results. Biopsy has beensuggested. We are so scared and concerned. Does it sounds really bad? I ammore concerned about angular shape and peripheral exhoic rim. They didn't find and lymph node affected. Please do reply at your earliest. Thanks
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The 8mm one sounds a bit worrisome. If a biopsy was recommended they are worried about it too. Remember that statistically most biopsies come back benign. If it isn't, 8mm is pretty small in the scheme of things. Let us know how the biopsy goes.
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thank you very much for the reply. I really appreciate it. Let me type the report in detail and please let me know you’re thoughts.
Left breast ultrasound: there is a subtle 8 x 4 x 3 mm angular mass with indistinct margins at 10:00, 8 cm from the nipple corresponding to the Mammographic finding. The mass is Hypoechoic centrally, and is associated with a perioheral echogenic rim. A few benign appearing small cyst still are also noted with well circumscribed margins. ONe of which is associated with a flat fluid level compatible with the fat density nodules seen inbound mammogram and characteristic of benign oil cysts. No abnormally enlarged lymph nodes appreciated within the left axilla.
Bi-rads 4 and biopsies are recommended.
Can it still be benign? I truely appreciate your feeedback
Thandk
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Hi all. I'm a 64 year old with no history of BC, just got the results of my diagnostic mammogram/ultrasound. Unsure of what to think.
Mammogram: 5mm oval mass in right breast, well circumscribed margins, no microcalcifications.
Ultrasound: 4 x 6 x 4 mm round markedly hypoechoicmass correlating to the position of mass found in mammogram. Partially obscured margins, posterior acoustic shadowing, nonparallel orientation.
That's a quick summary, but based on what I've read so far, it seems like the mammogram findings sound good (oval, well circumscribed) while the US details sound very troubling, especially the shadowing and orientation. It's listed as Bi rads 4 with no subletter on the report, and I am having a biopsy in a little under 2 weeks. Obviously worried, but the mixed bagof positives/less positives in the descriptions has me unsure of what to expect.
Despite the worrisome findings in the US, is the fact that there is no mention of irregular shaping, spiculation, or vascularity potentially positive? And if this is malignant, is 5mm considered a small size tumor that would indicate an early (stage 1 ) detection? Thank you
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thanks again and one last question. Would you rate it Birads 4 a or b or c?
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djmammo,
Would you please tell me your thoughts:
Right Breast Ultrasound: At 1 o'clock within the right breast, likely correlating with the finding noted mammographically, there is a 3x4x3 mm hypoechoic lesion identified. There is no associated posterior acoustic shadowing, posterior acoustic enhancement, or internal vascularity. The lesion lies parallel to the chest wall. This is considered indeterminate. BIRADS 4.
Biopsy performed: The right breast mass was targeted with ultrasound. The patient was prepped in sterile fashion. Local anesthesia was obtained with 1% lidocaine. A 14-guage biopsy devise was used to obtain multiple tissue specimens (3) through the mass. A clip was was deployed at the biopsy site with ultrasound guidance. Local hemostasis was assured with direct pressure. The patient tolerated the procedure well. Pathology: benign breast tissue with a ruptured cyst with foreign body giant cell reaction, fibrosis, and chronic inflammation. No evidence of invasive or in-situ carcinoma. An immunostain for CAM5.2 is negative in the lesional area, confirming the benign diagnosis.
I know I shouldn't consult Dr. Google, but I can't help myself. And I read so much that states findings even on pathology reports could be wrong. Please advise.
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The mammogram tells us where the problem is (and how many are present) and whether or not it contains calcifications. The ultrasound gives much better detail regarding its internal structure and its margins as well as blood flow so my impression is weighted toward the US findings if there is a discrepancy. Statistically masses measuring less than 1.4cm on initial evaluation have a very good prognosis. Staging is based on the microscopic evaluation of the tumor cells retrieved on biopsy not on radiographic findings.
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Not sure what your question is. You have the path report and the rad who did your biopsy says it confirms their benign impression on imaging.
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Hi -- I received my MRI results back which showed 7.5 cm of something coming from my mass. This did not show up on Mammogram or ultrasound and was not biopsied. The report reads " A speculated, ill-defined, rapid enhancing with rapid washout, within superolateral breast lesion measuring 1.5 X 2.5 cm. There is extension of the mass, anteriorly approximately 7.4 cm best seen on sagittal sequence 104, image 10/33." My biopsy report called this mammary carcinoma with lobular features. I have no idea what I have. After the biopsy, but before the MRI I was told lobular by my surgeon, but when I went to the oncologist and he showed me the MRI and that skinny long line coming from my tumor I asked if it was in the duct or lobe --- he said duct and then said --- you don't have lobular --- that line is DCIS. My guess is mixed carcinoma. Does that long line sound like DCIS? My biggest question is --- what does anteriorly mean? My tumor is at 2:00 on my outer left breast --- so does anterior mean the long line is traveling up towards my head or is it traveling to the front of my body towards my nipple? Thanks for your help!
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A spiculated, ill-defined, rapid enhancing with rapid washout, within superolateral breast lesion measuring 1.5 X 2.5 cm. There is extension of the mass, anteriorly approximately 7.4 cm best seen on sagittal sequence 104, image 10/33. Does that long line sound like DCIS?
===The first sentence is what IDC looks like on MRI. Superiolateral means upper outer quadrant. If this extension refers to the long line it is probably a duct that is enhancing, and DCIS can cause an enhancing duct.
My biopsy report called this mammary carcinoma with lobular features. I have no idea what I have. After the biopsy, but before the MRI I was told lobular by my surgeon, but when I went to the oncologist and he showed me the MRI and that skinny long line coming from my tumor I asked if it was in the duct or lobe --- he said duct and then said --- you don't have lobular --- that line is DCIS. My guess is mixed carcinoma.
===You can have both IDC and ILC in one breast. As DCIS is a precursor to IDC you can have that in there as well.
My biggest question is --- what does anteriorly mean? My tumor is at 2:00 on my outer left breast --- so does anterior mean the long line is traveling up towards my head or is it traveling to the front of my body towards my nipple?
===Anteriorly means "toward the front" so in the breast it would mean towards the nipple. All ducts in the breast run towards the nipple. Upwards within the breast would be "superiorly" but the overall term for "up" for the body as a whole would be "cephalad" which literally means "towards the head".
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