Interpreting Your Report
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big relief today. Was totally prepared for awful news based on my report and the description of the lump, but it was a complex sclerosing lesion. I asked the nurse who had been in the room during my scan did she think it was going to becancerous based on its appearance and she said yes.
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I am still confused about some of the information in my report.
In my previous scan in August, there was no 'feeding vessel' and now there is as well as it grew from 4 mm to 5 mm. The images with the measurements noted are larger on current scans vs previous scans. Previously it was not palpable and it is now and was stated on my report. On my current images disc, there is one slide that says "a 5 mm possible lymph node" but on the paper report it says "4 mm lymph node - no changes from previous scans". Previous scans in August had a slide that said "4 mm hypoechoic lesion/nodule/complex cyst" but on the corresponding paper report it said hypoechoic complicated cyst."
Not palpable to palpable. No feeding vessel to having feeding vessel. 4 mm to 5 mm. Nodule/complex cyst/complicated cyst, to possible lymph node. All of these sound like 'changes' yet the current paper report says 'no changes'. To me these seem like changes and is most of what is confusing to me.
I had a great uncle that had breast cancer and do not know if my grandmother (maternal), mother, or sister possibly had it as they died at an early age. I am 53.
Am I confused over nothing? Am I worrying about this and should not? If this were you, your wife/mother/sister, would you pursue more information - possibly a biopsy?
I appreciate anyone's help and insights. This is all so new to me.
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I would absolutely ask for that biopsied. Really surprising based on my experiences and how insistent radiologists were on biopsying that yours are not recommending that, especially given your matrix of age, family history AND the characteristics of your lump with lymph involvement. You should demand they biopsy that.
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Schedule an appointment with your doctor, bring your report and have them explain it. Do the same with the radiologist that read it. It is their duty to explain your findings to you. You have been asking the same very specific questions for a while now and you deserve answers from the people causing your confusion. Its time to get some answers from the people responsible for your care.
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djmammo - Thank you. Radiologist will not meet with patients. Gynecologist told me not to worry because hypoechoic was the best news. My next step is searching for a breast specialist to take my images and reports to for interpretation and explanation. I have been unsure about doing so as I did not want to pursue a specialist if it was not something that warranted further investigation. I don't want them to think I am being ridiculous and/or overreacting if it is something obvious that I am just not able to see due to conflicting information.
Thank you for your time. I apologize for all the posts/questions.
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when pathology report says DCIS but then I’m told there is suspicion of invasion, does that mean it could actually be IDC? Not sure what that means. They are doing additional tests on the biopsy to see if it’s invasive.
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djmammo - Would it be possible to PM you so I can get a better understanding of what to ask at my next appointment based on my reported results? I am trying to get into a breast specialist or breast center and want to be able to ask the best questions possible. As I mentioned in my previous reply, the radiologist that completed these on me did not speak to me and will not meet with me. My gynecologist received a very short paper version of the report and said to wait the year. I do not feel comfortable waiting without clarity especially since it is now palpable and has a feeding vessel. I appreciate your patience with my inquiries.
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Motheroftwo: That was my exact experience five years ago. Send specimen off for additional staining and fortunately remained pure DCIS. But would love to hear even after five years, what that really did mean.
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Any thiughts on this?
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Mommyathome, the image you've posted can hardly be read. Is there other way you can share that letter with all of us here? Please, remember that for your safety and security, we strongly suggest you do not share any personally identifiable information on our public boards, such as full name, phone number or address.
Thank you!
The Mods
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DCIS is one step away from being IDC. If they find any evidence of invasion in the biopsy sample, it may affect how they do the surgery to remove the DCIS by including lymph node sampling.
Also when the area of DCIS is removed, the pathologist will examine it very closely to see if there any areas of IDC, how many and how big. This is important as it may affect your future treatment plan.
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I tried to enlarge the report but it is not clear enough to read.
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thanks djmammo
So it’s possible I could need chemo and not even know until after surgery
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Yes, that is possible. No definitive long term treatment plan is made until the surgical specimen is fully examined. In many places an interdisciplinary team (that includes the surgeon, radiologist, medical and radiation oncologists etc) discuss your case at length and decides the best plan after which it is presented to you.
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ultra sound report says bi-rad 4C is this bad news
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my biopsy isn't till march 7th, 5 mm mass
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djmammo - Thank you.
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I am 64. I noticed a small hard lump under my left nipple. My mammogram did not show anything.
My ultrasound did. I was told it was too close to the skin to do a biopsy and would have to be removed and tested. I have a surgical consultation coming up on March 4.
These are the results from the ultrasound.
Left breast lump. Targeted left breast ultrasound. 5 x 3 x 4 mm. subcutaneous nodule lesion w/ heterogeneous echogenicity and microlobulated margin.
BI-RADS category 4 breast 2
Tissue is predominately fatty.
Any help understanding these results would be appreciated. Also what I can expect at the surgical consultation. Thanks!
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If it is directly under the skin as described, then its origin is indeterminate. The 2 adjectives used to describe it could go either way. They don't mention its location in relation to the ducts whether inside them or outside them. There is no mention of vascularity. Either way it is very small.
Your surgeon will review the imaging and explain to you how they plan to remove it.
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Just got my report back from my 1st follow up appt. I was diagnosed last summer with a cyst. Upon follow up I was given more detailed info
Repeat ultrasound examination was performed in the 1:00 position of the right breast 7cm from the nipple. Again seen is a 16x12x8mm complex septated cyst, grossly stable from prior examination. This is likely benign. 6 month follow up recommended. Birads 3
This seems like a pretty large cyst, no? My question is what does the “septated cysts" part mean. Also, no biopsy was recommended which surprised me. I thought for sure given that it's a complex cyst that they would want to biopsy and make sure there's nothing in there. What is standard procedure for this sort of cyst? Should I call and request it? My next follow up is in August. I don't have pain anymore (I had terrible pain at first which is what led me to doc in the first place) and the cyst can't be felt.
Edit- djmammo I was also curious with the lack of detail in the report. Wouldn’t a complex cyst have more to it than just being “septated”? Wouldn’t the radiologist write out the specific findings (like mention a solid component or some of the other terminology typically associated with them?) Or is just normal for radiologists to label it as complex and not be specific about the rest? I wish I had thought to ask more questions during the appt! I will say that I saw the screen during US and other than the odd shape I couldn’t see any debris or gray areas or anything. The cys just looked totally black so I didn’t think much of it until I saw later that it was labeled as complex. The tech did pull up the reading for blood flow but it showed up as not beingnear the cyst. Not sure if that’s good or bad.
Thanks
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I went in for a baseline mammogram and ended up needing a diagnostic as well. 2cm cluster of pleomorphic calcifications. Birads 4-suspicious
I had a biopsy today, and spoke to the radiologist. I left still not understanding what pleomorphic calcifications are.
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"I left still not understanding what pleomorphic calcifications are."
Is it a dinosaur? Sounds like dinosaurs to me.
J/K!
I think that a lot of doctors might be really good at being doctors, and not so great at being educators. Which is fair, but is very frustrating for many of us. This board has been super helpful.
I'm a high school teacher and since I started this road, I've been thinking often that medical centers should hire science-specialized educators to supplement the medical care and work with doctors to support patients. I'll add that one to my pipe dreams about universal health care.
Good luck with your biopsy! I hope it goes fast and easy with good results!
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This seems like a pretty large cyst, no?
***No.
My question is what does the "septated cysts" part mean.
***Some cysts show a white line crossing its interior on US. Its like a room partition. To be benign, it must be thin like a pencil line, of uniform thickness and no lumps or bumps on it. It would then be referred to as a complicated cyst, not complex.
Also, no biopsy was recommended which surprised me. I thought for sure given that it's a complex cyst that they would want to biopsy and make sure there's nothing in there. What is standard procedure for this sort of cyst?
***If there are no solid elements no biopsy is recommended if benign criteria is met. For a routine septated cyst, the choices are watch it or aspirate it. The fluid is then sent to the lab in the latter.
Edit- djmammo I was also curious with the lack of detail in the report. Wouldn't a complex cyst have more to it than just being "septated"?
***yes
Wouldn't the radiologist write out the specific findings (like mention a solid component or some of the other terminology typically associated with them?) Or is just normal for radiologists to label it as complex and not be specific about the rest?
***If solid elements are present they must be included in the report since it changes the management.
I wish I had thought to ask more questions during the appt! I will say that I saw the screen during US and other than the odd shape I couldn't see any debris or gray areas or anything.
***What was odd about the shape?
The cyst just looked totally black so I didn't think much of it until I saw later that it was labeled as complex.
***US images are one very thin slice through a target like a CT. One slice does not show you the entire structure. How many images of that cyst where "totally black"? Did you see the entire cyst?
The tech did pull up the reading for blood flow but it showed up as not being near the cyst. Not sure if that's good or bad.
***Lack of blood flow in the target on Doppler imaging is a good thing.
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thanks for your reply djmammo
The odd shape to me was that it was not a perfect circle. More long or oval. The first time I got an US for it I actually thought it was 2 cysts squished together side by side. Now that I understand the descriptive words used I can see that it was just 1 cyst with a wall dividing it. I watched the tech during the entire exam and each time she stopped to take what I'm assuming was a still shot for measurements or to be magnified all I could see was black. Nothing inside the blackness protruding from the walls of the cyst which is why I was a little surprised that the report says the cyst was classified as complex and not complicated as I understood complex cysts to have a lot more to them. I have heard that some radiologists use these terms interchangeably so maybe that's the case. Seeing “complex" on the report though did have me a little more concerned.
When I go for my follow up in August do you think it reasonable to ask for a biopsy of the fluid? This next follow up will be my last for this issue unless something has changed. I’m 37 so unless I notice a change on my own I won’t be back for any imaging until I turn 40. Wondering if a biopsy is a good idea.Also can these types of cysts go away on their own as is the case with simple cysts?Thanks for your feedback as always
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I'm 27 and had a bilateral US last week after I felt a lump on the RT breast. That was reported as a fibroadenoma. However, they noticed an unusual mass on my left breast. The report is abbreviated and I don't see many words in either category, but any insight would be appreciated. I have a biopsy scheduled on Monday. I felt like I got a bad feeling from the radiologist but I could have been imagining it.
LEFT: At the 3:00 position there is a mildly irregular lobulated mass measuring 0.7 x 0.9 x 0.4 cm. There is peripheral vascularity. This is indeterminate and ultrasound-guided biopsy is recommended. BI-RADS CATEGORY: 4 - Suspicious Abnormality.
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If that is the entire description of the mass on the left, it is a bit brief. Important details of its appearance are not included.
The good news is its very small, you're a bit young, and fibroadenomas are often multiple. Anything solid that does not completely fit the criteria for a benign mass, gets a biopsy. Statistically this should be benign. Let us know what the biopsy shows.
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