Interpreting Your Report
Comments
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I was offered a Lumpectomy before the discovery of the DCIS --- with a 2.5 cm IDC with lobular features and a 7.5 line of DCIS do you think I will still be able to have the lumpectomy -- my breast are very large. Will it be impossible? I'm not worried about surgery -- I'm worried about the time I will be under anesthesia and it seems a lumpectomy will take less time.
Also, why in heavens earth has this never shown up on mammogram. Last year I had the diagnostic mammo and it didn't show up then either --- I've never in my life been called back for any reason. My breast are no longer dense as they were when I was young. If this was lobular I would understand --- but it's IDC and a lot of IDCS. Makes me wonder how many people are missed on Mammograms.
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In my recent ultrasound report there is a mass that worries me. I have several other simple or complicated cysts, all stable.
This however worries me:
In the 9 o'clock position, 2cmfn is a somewhat diamond-shaped isoechoic mass with parallel orientation, measuring 14x4x11 mm. This likely represents a focus of fat within the dense tissue.
I was given a Birads 3 with 6 months follow up.
I am not comfortable with the aproach, I already met with my GP regarding my concerns and my request for biopsy was refused.
I was diagnosed with sclerosing adenosis and apocrine metaplasia in a fibroadenoma, 3 years ago at the age of 33. No one seems to take that seriously either, although it increses my risk of breast cancer.
I am worried to wait for 6 months with the mass who is indeterminate at this point.
I have a lot of anxiety.
Please let me know what you think.
Thank you.
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"...do you think I will still be able to have the lumpectomy -- my breast are very large. Will it be impossible?
===Only your surgeon will be able to answer that question for you.
"I'm not worried about surgery -- I'm worried about the time I will be under anesthesia and it seems a lumpectomy will take less time."
===Ask to speak to your anesthesiologist ahead of time about that. If it were me I would want the appropriate surgery to avoid a recurrence, not a more convenient one that might require another in the future.
===I know people routinely have bilateral mastectomies by their breast surgeon and their team followed by immediate reconstruction by a plastic surgeon and their team without them worrying about the length of anesthesia. If you have had problems with that before be sure to tell your docs.
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Thanks - you're right - I've got to get over this anesthesia fear. I think I developed the cancer from drinking too much wine over the years -- it probably affected my mind also - poor decision making.
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Aw jessie123, don't put yourself down! I don't think we cause our own cancer - at most we contribute to it accidentally. I hope you enjoyed the wine you've drank over the years! Also, it's natural for us as non-doctors to be concerned about things that doctors know are actually not worrisome. They are experts, we are not!
That's why it's so helpful to find a doctor you feel comfortable with and trust, so you can bring your concerns to them and they won't make you feel bad but *will* share their knowledge and education with you in a supportive empowering way.
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Ok so here is my story-went for routine Mammo and Sono 12/22 and below were the findings-
Report
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
Otherwise, negative bilateral breast ultrasound.
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.Went for biopsy on 1/11 however it was not done since they couldn't find the area. Below are the findings-
Report
US BIOPSY NOT PERFORMED - RIGHT BREAST ULTRASOUND OBTAINED
CLINICAL HISTORY: Z80.3 Family history of breast cancer R92.8 Abnormal findings on breast
imaging exam
COMPARISON: Breast ultrasound 12/22/2018
Targeted sonographic evaluation of right breast was performed, with attention to the 11:00
axis, 3 cm from the nipple.
The area of concern demonstrates no sonographically discrete solid or cystic lesion.
Specifically, the previously described "hypoechoic area with irregular margins" was not
identified.
Extensive discussion with the patient at the time of the exam was entered into. The
patient was given the option of a general biopsy of the region. It was recommended to the
patient that she return for short-term follow-up sonography to confirm the absence of
suspicious findings. MRI of the breasts without and with contrast may be useful for
confirmation of these findings.
IMPRESSION:
Normal targeted right breast ultrasound.
RECOMMENDATION: Six month follow up right breast ultrasound recommended. MRI of the
breasts without and with contrast may be useful for further evaluation at this time.
BI-RADS 3-Probably Benign Finding(s)
The patient was informed of these findings and recommendations at the time of the exam.Went to a Breast surgeon who recommended an MRI which I had on Sat and below are those findings-
Report
MRI-3T BREAST PRE AND POST IV CONTRAST BILATERAL
HISTORY: N64.4 Mastodynia N60.01 Solitary cyst of right breast R92.2 Dense
breasts
Right breast 11:00 irregular hypoechoic area seen on screening breast ultrasound. An
attempted ultrasound-guided core biopsy was attempted however the lesion was not
identified. A breast MRI was recommended for further evaluation of the area.
TECHNIQUE: MRI of both breasts was performed using a dedicated breast coil, utilizing a
3T magnet. Pre and postcontrast images were obtained. Axial non-fat suppressed T1,
followed by dynamic axial T1 fat suppressed images were obtained, during and following
intravenous administration of 7 cc Gadavist. Axial fat suppressed T2 images were also
obtained. Post processing subtraction was performed on a Siemens scanner, including
subtraction, analysis of enhancement curves, and reconstruction on a Hologic Aegis
workstation. Per ACR guidelines and Zwanger-Pesiri policy, a creatinine level test was
performed prior to this exam. Results were as follows:
Creatinine 0.9 eGFR 75.
COMPARISON STUDIES: Mammogram and breast ultrasound 12/22/2018
FINDINGS: The breast parenchyma is composed of heterogenous fibroglandular tissue. The
breasts demonstrate minimal background parenchymal enhancement.
RIGHT BREAST:
Within the peripheral lower outer quadrant multiple irregular enhancing masses are noted
the largest measuring up to 1.8 cm in size. A 5 mm enhancing nodule is located anteriorly
approximately 1.0 cm inferior to the nipple. The total area of abnormal enhancement
measures approximately 7 cm in the anterior-posterior direction.
LEFT BREAST:
There are scattered enhancing nonspecific foci. There are no suspicious enhancing lesions
in the left breast.
AXILLA:
Right axilla 1.3 cm lymph node with asymmetrically thickened cortex.
IMPRESSION:
Abnormal enhancement within the peripheral right lower outer quadrant. Multiple enhancing
masses noted.
Right axillary abnormal lymph node.
Recommendation: Targeted right breast and right axillary ultrasound advised with
ultrasound guided core biopsies of abnormal lesions.
BI-RADS 4- Suspicious Finding(s)I don't know what to make of all this. They originally saw something in the 11:00 position (which was on previous US back in 2017) however the MRI talks about the lower outer quadrant (which to me is not the 11:00 position-but I don't know) Can anyone make heads or tails of the MRI results?
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That's a lot of information. I will try to "bottom line it" for you.
On the MRI there is no mention of anything that looks like cancer in the area of concern on the original US.
The MRI shows something questionable in a different area, not uncommon. An ultrasound will be done in the new area and this time you have an old whole breast US for comparison to the new post-MRI scan. It would seem to me the 1.8cm MRI finding should be readily visible on US if its real and perhaps there might be a hint of it on the old one again if its real. Let us know what they see.
======
One of the problems with digital based imaging like US, MRI, CT etc is that one needs to know what is real and what is not real (artifact). This sounds odd but its something radiologists have had to contend with for years and the more experienced ones can tell the difference better than the less experienced ones.
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DJMammo please help!
In my recent ultrasound report there is a mass that worries me. I have several other simple or complicated cysts, all stable.
This however worries me:
In the 9 o'clock position, 2cmfn is a somewhat diamond-shaped isoechoic mass with parallel orientation, measuring 14x4x11 mm. This likely represents a focus of fat within the dense tissue.
I was given a Birads 3 with 6 months follow up.
I am not comfortable with the aproach, I already met with my GP regarding my concerns and my request for biopsy was refused.
I was diagnosed with sclerosing adenosis and apocrine metaplasia in a fibroadenoma, 3 years ago at the age of 33. No one seems to take that seriously either, although it increses my risk of breast cancer.
I am worried to wait for 6 months with the mass who is indeterminate at this point.
I have a lot of anxiety.
Please let me know what you think.
Thank you.
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The portion of the report you shared with us contains none of the adjectives used to describe a cancer. The features mentioned (isoechoic and parallel orientation) tend to be associated with benign entities. They went on to indicate they think its fat which is a normal component of the breast. What about this report worries you?
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DJMammo,
Thank you very much for taking the time to reply. I know cancers can also be isoechoic. I am concerned mostly at the “somewhat diamond shaped” feature. This is also the biggest mass in size I had so far. I am at higher risk for breast cancer.
I appreciate everything you do for all of us!
Thank you.
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DJMammo,
I am a nurse and not a doctor. While I have a lot of respect for the profession, I know mistakes can be made at any point. I have a bad feeling this time and it doesn’t go away. I have started experiencing needle like pain in my L axilla, which occurs randomly throughout the day, and sometimes the same pain is felt in the L breast with this mass I’m talking about. I think it’s possible that the ultrasound was misinterpreted, that’s why based on the findings and symptoms, I want a biopsy to give a definitive answer. I am in Canada though and the system is more rigid here. I have no idea how to get a second opinion, as I’d need a referral from my GP. I already had two breast cancer scares (age 18 & 33).
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Follow your gut and get a biopsy. I had a feeling about a thickening in my breast for over a year and was just told it was dense breast tissue. I begged for an ultrasound in addition to my mammogram and during the ultrasound I asked the technician to go over the area I was concerned with. It took her a long time but she finally found an area of concern. I asked for a biopsy the next day and it turned out to be stage II bc, with one positive node. You have to be your own best advocate and fight for yourself. I asked for a lot of things that were not routine in the course of my treatment as well - ovaries removed, 2d checks on her2 status, 10 years of an aromatase inhibitor when norm was 5 years and so on. Just my two cents. It's your life and peace of mind is huge.
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Hi djmammo
Just a couple more questions re: My u/s report below. The second nodule is described as being "oriented parallel to the skin", while the worrisome one is not. What does that mean? Is that typically a telltale sign? Also, the radiologist asked if I had any nipple changes and I said I hadn't. But I realize now that there is inversion that I have never noticed before. Would that also raise a red flag? You mentioned that this report would be a BIRADS 4A , but would that change based on this?
Thanks so much
REPORT:
The palpable lump in the left breast corresponds to a hypoechoic solid nodule at 5 o'clock, 1.0 cm from nipple. The margins are lobulated and the shape is slightly triangular. It is close to one of the retroareolar ducts. Measurements are approximately 0.9 x 0.6 x 0.5 cm. No internal vascular flow seen.
There is a second solid nodule also at 5 o'clock, 2.0 cm from nipple. The shape is oval and its oriented parallel to the skin. Measurements approximately 1.1 x 0.8 x 0.4 cm. No internal vascular flow.
SUMMARY: Two solid nodules in the left breast. The palpable lump has triangular shape and some indeterminate sonographic features. Ultrasound guided biopsy is recommended
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Hello LizM,
Indeed very scary. I'm so sorry to hear this has been your experience and wish you all the best during the course of your treatment. I hope for a cure! There are so many possible outcomes. I might overreact, but I don't think it's fair to keep someone waiting, when their life is on the line. I am very diligent with my check ups, even since I was told I'm higher risk. I started with yearly checks since I was 18 years old. Things were stable for 15 years (only 1 fibroadenoma which was a complicated cyst in the end - aspirated and benign). I went on with my life, never really concerned I have anything more than benign issues. Fast forward 3 years ago while vacationing in my country I went for an US which identified a highly suspicious mass (Birads 5), had lumpectomy and diagnosed with sclerosing adenosis and apocrine metaplasia. All this after having an “all clear US" in Canada one month prior. I came back and fought for getting more close monitoring. A few doctors I have seen over the years were very dismisive. Given my age and no family history, I don't qualify for MRI. I decided to pay out of my pocket for one US a year and my GP sends me for one, so I go twice a year. Needless to say I don't trust much, because I have a few experiences here which didn't go well.
I have made an apointment to discuss with the radiologist at this centre where I got my US. I have to pay again for consultation and will ask for a biopsy. The pain I have in my left armpit is not normal. I hope someone will listen to me and do something. I am 36 and have an 8 year old who I want to see growing up.
Thank you for your input. I highly consider all your advice.
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The second nodule is described as being "oriented parallel to the skin", while the worrisome one is not. What does that mean?
====When a mass grows in the breast it expands in the direction of least resistance. A benign mass is incapable of invading adjacent tissue so when it grows it expands along the tissue plane from side to side in an US image which is parallel to the skin surface. It cannot expand in the other direction. A cancer starts in the duct and as it grows it follows the duct which is oriented vertically in an US image (actually back to front of the breast toward the nipple) giving the "taller than wide" appearance.
Birads is based solely on imaging it does not take symptoms or history into account.
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Thanks for the clarification. I'm not hopeful, but in your opinion, is there at least a slight chance based on these descriptions that the biopsy could come back benign?
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djmammo
I am having a hard time making a decision - should I have the recommended 6 month follow up as an MRI w/wo contrast - I was recently diagnosed with ALH and had the area removed with excision biopsy.
I am worried about the gadolinium toxicity and not sure the benefit would outweigh the risk. 1. Could a less aggressive scan be used i.e. mammo/US? 2. Is the MRI w/wo contrast recommended for a baseline? 3. Is there less aggressive contrast dyes?
Thanks for any insight you can provide.
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I was at my routine gynecologist exam when he found a lump in my right breast. A lump that I had felt a few months ago, although it was somewhat smaller. I was fortunate to get a quick appointment for a Mammogram and Ultrasound, and now have an appointment for biopsy next week.The report makes reference to a mass that was seen in my last Mammogram- which was just in June of 2018. But, in that report no mention of a mass is ever mentioned. The doc at the radiology department said that the fact that it has grown slightly makes her pause, but she is not too worried.
Any information or guidance you can give would be appreciated. Just want a realistic idea of what I should expect.
Here is the info from report:
Right Tomosynthesis imaging was obtained including acquisition of CC and MLO views utilizing C-View technology. In addition, full field
true lateral and spot compression CC, true lateral, and MLO views over the area of interest and right breast ultrasound were done.
There are scattered areas of fibroglandular density.
There is a somewhat amorphous developing density in the posterior lower inner quadrant. On the MLO and true lateral projections there
is the suggestion that this represents a heterogeneous mass, possibly encapsulated, perhaps representing a hamartoma. This appearance, however, was not as convincing on CC. It roughly corresponds with the palpable complaint. This density has enlarged slightly since 2018 and was virtually not present in 2014.
In the medial central breast there is a 6 mm circumscribed nodule that is perhaps slightly larger than before.
No architectural distortion as seen. There is no skin thickening or nipple retraction and no suspicious clusters of microcalcification are present. There is no pathologic axillary lymphadenopathy.
RIGHT BREAST ULTRASOUND: Real-time ultrasound evaluation was targeted to the lower inner quadrant from approximately 2:00 to 6:00. At 3:00,
3 cm from the nipple and corresponding with the palpable abnormality
and probably corresponding with the posterior density on mammography,
NAME
VALUE
there is a heterogeneous masslike structure that from time to time seemed to be encapsulated but this was not consistent. It measured approximately 3.0 x 1.0 x 2.5 cm.
At 1 to 2:00, 3 cm from the nipple and corresponding with the small round nodule on mammography, there was a simple cyst measuring 3.9 x 4.3 x 4.0 mm.
IMPRESSION: There is a heterogeneous masslike structure in the posterior right breast at approximately 3:00. Findings are suggestive of hamartoma, but this is not definitive. Since this lesion is enlarging, ultrasound guided core biopsy is recommended.
BI-RADS Category IV: Suspicious abnormality; biopsy should be considered.
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An MRI is basically worthless without contrast.
If its renal toxicity you are worried about most centers do blood work on the spot to assess your renal function to insure there are no renal problems from the contrast.
As far as any other types of toxicity are concerned I am not very familiar as many are idiosyncratic. If you have a link to an article on the toxicity you mean, I'd like to read it.
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A hamartoma is a benign mass made up of most if not all of the types of breast tissue in a little ball outlined by a very thin capsule that shows up as a fine white line surrounding the mass. This has been referred to as the "breast within a breast" appearance of the hamartoma. At 3 cm if this were a cancer it seems to me it would demonstrate some suspicious features, but none are mentioned in the report you transcribed here.
Did you have any breast imaging between 2014 and 2018 where someone could go back and see if it were there and what it measured during those years?
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no other Mammograms to refer to, no. The 2014 was suggested to me as a baseline at age 36...and then I began doing them at 40.
Both the Mammogram and the Ultrasound report say that the mass does not appear to be completely encapsulated- or not consistent. Also, was wondering what it meant when it said “appearance was not as convincing on CC"?
Do hamortomas grow? It's only been 6-7months since my last Mammo
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Hamartomas grow very slowly.
One of the two basic mammogram views obtained is the crainocaudal, which is the picture taken from the top, (literally meaning "head to tail") and is abbreviated CC. The mediolateraloblique is the one taken at an angle and is abbreviated MLO.
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Hi Djmammo,
I'm about to have another appt w/breast doc because by left breast is now pointing up more that it used to (very obvious asymmetry, which seems to be getting worse but then again maybe I'm paranoid), and there is discomfort in that area. Here is my US report from about 1.5 years ago (after that I did have an MRI which was negative):
CLINICAL STATEMENT:
Clinical Indication(s): Patient complains of a tightness in the upper outer aspect left breast which extends to the left axilla. She has had this for three years. Patient also states she is BRCA positive.
IMPRESSION:
Nosonographic abnormality.
BI-RADS Category3:Probably Benign Finding.
PROCEDURE:
Multiple real-time ultrasound images of the left breast were obtained in the region of mammographic concern using a high frequency transducer.
COMPARISON:
Prior MRI dated 6/18/2015 and prior breast ultrasound 4/8/2015. Patient's most recent mammogram was 4/8/2015
COMMENT:
At the 2:00 location, approximately 4-5 cm from the nipple, there is a well-circumscribed nodule which measures 7 x 4 x 6 mm in size. It is slightly more hypoechoic than the adjacent fatty tissue. It does appear to have a linear echogenic hilum. Blood flow to this could not be demonstrated. There is weak through-transmission. It is oriented parallel to the chest wall. This is probably benign.
This ultrasound certainly does not substitute for annual mammographic evidence for breast screening examination.
The patient is reluctant to have mammographic imaging due to her past radiation exposure. I believe that that breast MRI with gadolinium could be helpful for further characterization of this lesion as well as routine screening, high risk patient.
If breast MRI is not performed then a short interval follow-up ultrasound in 3-4 months should be performed to evaluate this for stability. Another alternative would be to perform ultrasound-guided core biopsy could be performed.
My findings and recommendation for performing breast MRI were discussed with the patient.
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If the MRI done after the US was negative then the findings on the US were likely benign as MRI is more sensitive.
If these were done a year and a half ago and are negative, then they really have no bearing on your current situation, you will need more imaging.
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thank you!!
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Thanks for the explanation. The report doesn't mention it, but is the first nodule considered taller than wide and not parallel to the skin? I can't tell based on the measurements given
REPORT:
The palpable lump in the left breast corresponds to a hypoechoic solid nodule at 5 o'clock, 1.0 cm from nipple. The margins are lobulated and the shape is slightly triangular. It is close to one of the retroareolar ducts. Measurements are approximately 0.9 x 0.6 x 0.5 cm. No internal vascular flow seen.
There is a second solid nodule also at 5 o'clock, 2.0 cm from nipple. The shape is oval and its oriented parallel to the skin. Measurements approximately 1.1 x 0.8 x 0.4 cm. No internal vascular flow.
SUMMARY: Two solid nodules in the left breast. The palpable lump has triangular shape and some indeterminate sonographic features. Ultrasound guided biopsy is recommended
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"is the first nodule considered taller than wide and not parallel to the skin?"
If they didn't mention its orientation then its probably neither. I dont believe there is a convention on the order of the measurements so we cant tell from this report. Not everything is parallel or tall. Some are round or nearly round, etc.
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Hi DJMammo-
Can you help me interpret my MRI report? Should I be concerned? What type of benign conditions could this be? Thanks for your help
FINDINGS: The breast parenchyma is composed of heterogenous fibroglandular tissue. The
breasts demonstrate minimal background parenchymal enhancement.
RIGHT BREAST:
Within the peripheral lower outer quadrant multiple irregular enhancing masses are noted
the largest measuring up to 1.8 cm in size. A 5 mm enhancing nodule is located anteriorly
approximately 1.0 cm inferior to the nipple. The total area of abnormal enhancement
measures approximately 7 cm in the anterior-posterior direction.
LEFT BREAST:
There are scattered enhancing nonspecific foci. There are no suspicious enhancing lesions
in the left breast.
AXILLA:
Right axilla 1.3 cm lymph node with asymmetrically thickened cortex.
IMPRESSION:
Abnormal enhancement within the peripheral right lower outer quadrant. Multiple enhancing
masses noted.
Right axillary abnormal lymph node.
Recommendation: Targeted right breast and right axillary ultrasound advised with
ultrasound guided core biopsies of abnormal lesions.
BI-RADS 4- Suspicious Finding(s)0
