Interpreting Your Report
Comments
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MRI is very sensitive but can be fairly non-specific in its findings. If that is the entire report it is missing some important details such as enhancement patterns and comparison to prior imaging assuming you've already had a mammo and/or initial US study.
The next step after any questionable finding on breast MRI is always an US so you are having the correct follow up study. The "masses" and lymph node can be better evaluated that way.
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Hi DJMammo - thank you for doing this. I had an mammogram on 12/26, was called back for a diagnostic mammogram and ultrasound for suspicious areas in both breasts. It turned out to be cysts. However, radiologist recommended that I get a breast MRI given my family history (mom, 2 maternal aunts, paternal grandma). This identified two different areas - one in each breast. The irregular margins & shape really scares me from the left breast - why would this be classifed as Br-rads 5? I really appreciate your help as I've been besides myself with worry on and off since 12/26 and have started preparing myself for having cancer.
There is moderate background parenchymal enhancement with
multiple scattered foci bilaterally which are likely related
to background.
Right breast: There is a 1 cm area of non-mass enhancement
in the anterior depth lower central right breast at
approximately 6 o'clock. There is rapid initial and
persistent delayed kinetics. No other suspicious findings
are present in the right breast.
Left breast: There are benign-appearing cluster of cysts in
the posterior depth medial left breast which corresponds to
the cluster of cysts and probably benign complicated cyst
seen in the left breast at 9:30, 8 cm from the nipple on
prior ultrasound. There is no suspicious enhancement present
at this site.
There is an 8 mm irregular enhancing mass with irregular
margins in the posterior depth lower slightly outer quadrant
of the left breast at approximately 5 o'clock. There is
rapid initial and predominantly plateau delayed kinetics. No
other suspicious findings are seen in the left breast.
Extramammary findings: There is no suspicious axillary or
internal mammary lymphadenopathy.Component Results
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Anything on an MRI that enhances and has irregular margins deserves a biopsy, its a B5 because whoever read it feels strongly that it is a cancer. Did the reader of the MRI have your mammo and US at the time they read the MRI? They were not mentioned and they should have been. They need to be compared and findings correlated. The other area is "non-mass" enhancement and could be nothing or an area of atypia or DCIS.
Either way those two areas of concern will likely be re-evaluated with spot compression mammo views and a diagnostic US. If they can be seen on US they can be biopsied under US. If not then the bx will have to be MRI guided.
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Thanks DJmammo - they actually rated me a 4, not a 5. I know irregular is bad but it didn't have a washout so I'm trying to talk myself off the wall here. Should I request a confirmation ultrasound and diagnostic mammogram or should I just get this over with and get the biopsy? I'm scheduled for Wednesday
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Is there a reason why the radiologist would leave that information off the report? I did have a baseline mammo and ultrasound at a different facility with both came back negative but the BS felt a lump which she wanted investigated further. Why would it be a birads 4?
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Hey. I was wondering if you could glance at my report. My history: Had my screening baseline mammogram in July 2018. Found a lesion in R breast at 1 o'clock, had Ultrasound to follow up. Was instructed to follow up in 6months. So fast forward to Dec 2018...began having breast tissue enlargement in RT breast, nothing in left. Went to doctor and he recommended that i have my follow up us that was scheduled for Jan 25.
Here is my US report from 1/25:
Dense tissue noted throughout right breast. There is a stable appearing lesion with mild vascularity noted at 1:00 5 CMFN measuring 0.5x0.5x0.9 mm ( previously measured 0.7x0.5x0.6) There is a new hypoechoic vascular lesion with shadowing imaged at 9:00 7CMFN measuring 0.6x0.9x1.0 cm. There is a indeterminate lymph node right axillia.
Impression:
1. Dense breast tissue
2. Stable hypoechoic nodule right breast 1:00
3. Hypoechoic vascular lesion with shadowing noted 9:00.
4. Indeterminate lymph node right axillia.
BiRads 3
Recommendation: Physician consult and Fine Needle Aspiration of suspicious lesion at 9:00 right breast.
I am still waiting to get the FNA scheduled. I was referred to a new imagine center because the Radioogisl that does biopsies was leaving my old imaging center. The referral has got lost I was told when I called yesterday.I had to pick up a copy of my films from the imaging center to take with me to the new place the doc is sending me for the biopsy. And of course I looked at them (I am a nurse). The margins appears irregular to me and the day I had the ultrasound tech said it was very irregular.
Any insight into this would be appreciated.
Thanks
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I always want to check with US first since if it can be seen at US it can be bx'd at US and that is far less time consuming than an MRI biopsy.
The enhancement curves are not perfect, there is overlap between the different patterns. We usually go by morphology more than anything else.
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If they are ordering an FNA then it should be a Birads 4.
A core bx is better than an FNA for a definitive diagnosis in my experience.
Hypoechoic + vascular + shadowing + irregular margin are suspicious features.
They should have included measurements of the node, both length, cortical thickness, and appearance of the fatty hilum to support the "indeterminate" impression.
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Thank you. From what I have read core biopsy was better too. I will ask about that on Monday when I call the doctors office. They didn’t give any description of the node or measurements. I was thinking BiRads 4 as well based on what I have read. Thank you for your help and advise. I truly appreciate it.
Eliz
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My pathology report showed HR+3. What does the "3" mean?
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Im new. And this is my first post. I had a normal mammogram and ultrasound in Aug. Right before Christmas I discovered a lump that seem to come up overnight. I made an appointment and my doctor said it's probably a cyst but ordered mammogram and ultrasound.
Mammogram report 1/7/19
2.7 cm cyst , Birads 2 Heterogenous
Ultrasound report 1/7/19
27mm cyst 12:00 with floating debris.
Doctor sent me to surgeon because of the size of the cyst.
Surgeon does FNA, schedules MRI and genetic testing.
Biopsy Report
1/25/19 Differential Diagnosis includes Atypical duct hyperplasia, Dcis and invasive carcinoma.
MRI Report
2/4/19 Right breast
Mild background enhancement. There is a 6 mm area of non mass enhancement in the right breast in central breast. Benign kinetics. No dominant mass. Benign cyst medially in right breast.
Birads 3 Probably benign.
Genetic Testing +bard1
Now being referred to breast specialist.
I'm so confused. Everything says probably benign but biopsy doesn't. I just don't understand. Can anyone help me understand this? What is Differential diagnosis and why are ADH, DCIS AND IC listed there?
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Kiki
Can you post the entire path report
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Djmammo, Thanks for your response. Sent you a private message.
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can I send pictures of my report
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Motheroftwo36
they do not allow pictures of any sort. You will have to type up everything. I sympathize with you, mother of two and also 36.
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Hello Djmammo,
I'm new and I'm awaiting my core Biopsy. Could you take a look at and share any light to my two reports. Thanks for your help
Impression
No specific radiographic features of malignancy in the left breast.
There are two masses in the right breast at 12:30 o'clock 1 cm from the
nipple in the subareolar region and at 1:00 2 cm from the nipple. Tissue
diagnosis of these two masses is recommended and can be achieved with
ultrasound-guided core needle biopsies.
Findings and recommendations were given to the patient when she was
here. She was advised to make an appointment to return for the procedure
prior to leaving our department today.
11:30 AM.
FINAL ASSESSMENT : BIRADS category 4, B, suspicious.
Approved By: Purna Sharma MD 2/13/2019 4:43 PM PBCRR02RNarrative
Comparison: Baseline mammogram.
ISTORY: Patient complains of a black right nipple discharge November,
2018.
DESCRIPTION: 2-D and 3-D imaging is performed bilaterally.
There is heterogeneously dense breast tissue present bilaterally.
Left breast: No suspicious lesions are seen.
Right breast: There is a lobulated equal density noncalcified mass in
the medial slightly superior right breast 2 cm from the nipple measuring
1.3 cm.
Right breast ultrasound: Ultrasound evaluation of the right breast is
performed in the subareolar and periareolar regions in this patient with
a history of nipple discharge. Ultrasound was also performed to evaluate
the mammographically identified mass in the medial right breast, 2 cm
from the nipple.
Ultrasound evaluation of the subareolar region demonstrates some dilated
ducts without any intraductal masses.
At 1:00 2 cm from the nipple there is either a cluster of cysts or a
cystic mass measuring 0.9 x 0.5 x 0.9 cm. This is felt to correspond to
the mass seen by mammography. There is some peripheral vascularity.
There are no posterior effects. biopsy.
Adjacent to this mass is a second, hypoechoic mass at 12:30 o'clock 1 cm
from the nipple in the subareolar region measuring 1.1 x 0.4 x 0.8 cm.
The margins of this mass are not well visualized likely due to
obscuration by adjacent breast tissue. There are no posterior effects or
intrinsic vascularity. This mass is felt to be solid.Left breast: No suspicious lesions are seen.
Right breast: There is a lobulated equal density noncalcified mass in
the medial slightly superior right breast 2 cm from the nipple measuring
1.3 cm.
Right breast ultrasound: Ultrasound evaluation of the right breast is
performed in the subareolar and periareolar regions in this patient with
a history of nipple discharge. Ultrasound was also performed to evaluate
the mammographically identified mass in the medial right breast, 2 cm
from the nipple.
Ultrasound evaluation of the subareolar region demonstrates some dilated
ducts without any intraductal masses.0 -
so I have palpable lumps yet the mammogram and ultrasound don't detect them. They are very obvious by touch. The ultrasound and mammogram did both pick up innumerable punctuate calcifications but the mammogram stated benign yet the ultrasound stated suspicious. Can u explain what this can mean?
The ultrasound recommends a biopsy at the calcifications in the palpable mass
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The terms used in the report are not standard and not enough of the features of the findings are completely described.
None of the terms used are those that describe a cancer but there are no terms that make them seem completely benign either.
Birads 4B is sort of an intermediate degree of suspicion for cancer, better than having a 4c or 5.
Let us know how the biopsy goes.
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I would need to read the whole report and consider your questions in context.
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djmammo
Mammogram report:
EXAM: BC DBT with Diagnostic Bilateral Mammo
HISTORY: Palpable Lump or Mass the patient complains of a palpable area of concern in the outer portion of the right breast
Comparison:
Computer Aided Detection was used
DENSITY: There are scattered areas of fibroglandular density
Digital Images of both breasts were obtained in the craniocaudal and mediolateral views
In the right breast only for multiple areas containing innumerable areas of calcifications. These are located more in the lateral and upper portions of the right breast. No discrete masses are noted.
Several benign appearing calcifications are noted in the subareolar region.
There are no similar calcifications in the left breast no abnormal calcifications or mass left breast is seen.
No dominant mass, adenopathy, skin changes, nipple retraction, or radiographic signs of malignancy are identified.
Workup of a palpable lesion should not be dissuaded in light of negative mammograms as these breasts could obscure a small lesion.
ASSESSMENT: Benign
BI-RADS: 0
RECOMMENDATION: Right breast ultrasound was ordered by doctor with this order.
Ultrasound Report:
EXAM: BC US Breast Complete, Right
COMPARISON: None
HISTORY: Palpable Lump or Mass
Multiple transverse and longitudinal scans of the right breast were obtained
FINDINGS:
Most marked in the 10 o'clock position of the right breast, are innumerable punctate calcifications. These correspond to the innumerable calcifications noted on mammograms. No discrete cystic or solid masses are noted.
No acoustic shadowing is seen.
Normal fat filled lymph nodes are noted in the right axilla and
ASSESSMENT: Suspicious
Recommendation: Biopsy of the calcifications in the palpable area of concern, which are localized to the lateral aspect of the right breast only.
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Djmammo,
I don't have a biopsy report. I have a radiological consultation report. In it is a clinical history which says differential diagnosis includes atypical duct hyperplasia, ductal carcinoma in situ, and invasive carcinoma.
Should I ask for copies of my biopsy report?
Thanks for your help!
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I recommend that everyone obtain copies of all their reports and copies of all their imaging on CD's and have them handy to copy for each new doc you see.
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Hi Dimammo --- On MRI I have a mammary carcinoma with lobular features at 2:00 on my left breast. When they did the breast MRI they also found an extension from the tumor anteriorly measuring 7.5 cm. ( you told me that means toward the nipple) I called the radiologist to question if that segment can be biopsied and when she looked at the screen she noticed something that I really don't understand - she seemed happy about it. Something about when she turned the screen she said that the lesion was there when my breast were extended or stretched down from the MRI -- she seemed happy and said she would tell my surgeon. I haven't been able to get an idea what that means. She did say that it won't show up on ultrasound because my breast will be compressed. Do you think that she seemed excited because the streak my not be as long as they thought. I'm having a lumpectomy next Thursday and am worried about a giant incision, but maybe that's not the case if that streak isn't really 7.5 cm -- maybe it was just stretched out. What do you think???? Thanks in advance for your help !
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hi djmammo I have a question I'm hoping you can answer. I have already been diagnosed. I am 38 so had not yet had a mammogram, I felt a lump at 2 o'clock position and was referred straight to breast surgeon. He did an US and it was given a birad 3. Oval, circumcised, parallel. Other good findings that led him to suggest waiting 6 months. I inisited on biopsy. It turned out to be lobular 1.5cm. Does the fact that it looked benign on screen make it less aggressive? Something I've wondered. When the oncologist saw the image he was shocked and happy that the surgeon sampled it.
Thanks
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There is no way for me to know what she meant.
As far as a scar is concerned, the well trained breast surgeons I know all use a circumareolar incisions through which they can access almost any part of the breast tissue and hide the scar in the margin of the areola.
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I was referred to this thread by MelissaDallas, thank you! I am confused by my original results and the preliminary ones of my 6 month follow up report. She said it may be a good idea to post in this thread. Here is what I have and what has me a bit confused: (I do not know why part of it is bold and the other not and I tried to change it. I aplogize.)
August 1, 2018
BI-RADS 0; Density Category B; needs diagnostic mammogram and ultra sound due to asymmetric density in upper outer quadrant of right; lesion noted
August 8, 2018
Persistent 4 mm nodule upper outer quadrant; corresponds to mammogram findings; not palatable
4 mm hypoechoic nodule or cyst with internal septation/internal debris 10 o'clock; outer quadrant right breast
BI-RADS III
Feb. 2019
(Now palatable, possible small dent in right breast)
hypoechoic lymph node - 5 mm with feeding vessel - no change from previous diagnostic mammogram and ultrasound (?- this looks like change to me); return in one year.
The current images even look different in that the sides/outer edges are different and the internal 'debris' mentioned in the first report looks as if there is more there now and you can see the 'feeding vessel' especially with the color doppler. The septation in first now looks thicker. Previously there was very little color- tiny spots of blue to the right side of it but now there is a great deal more of various colors in and around the 'mass/lesion' - lymph node.
The radiologist spoke briefly to me after my dx images in August. He did not speak with me at all on this one. Tech told me to talk to my doctor whenever they called.
Any insights would be greatly appreciated.
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Thank you for responding djmammo. I believe it was downgraded to a II but am confused by that in that it grew some, color doppler is more intense, now has a feeding vessel, and internally it is looking different as well. It is located 7 cfn at 10 o'clock right breast and corresponds to mammograms.
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hi djmammo. Going crazy with worry about upcoming biopsy after ultrasound for a second location right next to something that was previously biopsied as benign. Thought it was the same lump but radiologist said previous was at 6:00 and this one is at 5:00 and looks different. I am 33, no family history of bc. Fibrocystic breasts.
"The breast parenchyma is extremely dense, which lowers the sensitivity of mammography.
There is architectural distortion associated with linear calcifications in the left lower outer quadrant at approximately 5:00 location corresponding with palpable lump.
Targeted ultrasound demonstrates irregular hypechoic mass containing calcifications measuring 2.2x0.5x2.1 cm at 2 cm from nipple. Ultrasound of left axilla is unremarkable.
Birads 4."
I see I have some favorable and some not favorable terms in here. Of course, I'm trying to read a crystal ball. Any insight?
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