Interpreting Your Report
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Hi djmammo,
Thank you for all you do! I've since had a bilat breast MRI, just received the results. Its funny how things work out. Initially, dr's were watching my left breast. I think there's more concern for my right after reading the report. I don't completely understand it but I do understand the recommendation for MRI guided biopsy. I'm only going to type the concerning parts of the report, I was hoping you could help me understand and the MRI was done with and without contrast:
The right breast reveals clumped patchy nonmass-like enhancement within the central breast just medial of midline third at the approx the 3:00 position which show some mixed and washout enhancement characteristics along with another somewhat patchy clumped area of nonmass-like enhancement within the central right breast just anterior of midline below the level of the nipple which shows some mixed and washout characteristics. Additionally, within the right breast there is clumped nonmass-like enhancement far superior middle third at approx the 12:00 position which shows mixed enhancement characteristics with area of washout. There are no corresponding mammographic abnormalities.
Impression: The right breast reveals multiple areas of clumped patchy nonmass-like enhancement. DCIS or lobular carcinoma cannot be excluded. Recommend MRI guided biopsy of the most suspicious of these areas within the central breast just anterior midline below the level of the nipple. BI-RADS Category 4: Suspicious abnormality.
Based on the report, it identifies 1 of the areas to biopsy. Is that typical? I've never gone through this, I'm thinking test all the bad areas. But maybe that's not realistic or common.
Thank you!!
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I'm not a pathologist but I know they can tell breast tissue that appears stimulated as in pregnancy and/or lactation. If neither of those apply, perhaps some medications you are taking? Hormone replacement? This would be a question for the pathologist that generated the report.
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6 month follow up imaging has become routine after a benign biopsy assuming that was their only recommendation.
In my experience nodular fibrosis can mimic IDC on ultrasound if it shadows enough and this may have prompted the biopsy but you can ask your rad if that was indeed the case.
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All new solid masses are biopsied, this is routine, please go ahead and have the biopsy. The B4 suspicious classification is necessary for ins to pay for the biopsy no matter what the rad thinks it is.
All things considered, the findings given above fall into the 'more likely benign' category and sound a bit like a fibroadenoma but be aware that there is a fair amount of overlap in the appearance of good and bad masses in the breast. Also your age is in your favor. Let us know how the biopsy goes.
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Hi again djmammo,
Today my biopsy came back B9. That was with a bi rad of 4.
I want to thank you for all the insight you provide during a very stressful time.
I am sending prayers for all the beautiful and brave woman fighting this disease.
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djmammo,
You are the best. Thank you for doing this.
I am a 54-year-old woman with significant liver cirrhosis (due to Hepatitis C) and a history of acute renal failure. I recently had a 42-day inpatient stay with 10 days on a ventilator in ICU due to right-sided pneumonia, pleural effusion, and acute kidney failure. Upon discharge I received a follow-up chest CT the check the lungs and a breast mass was incidentally found. I had a diagnostic 3D mammogram (first mammogram) and ultrasound. Below are the u/s results:
_______________________________________________________
EXAM: US BREAST LIMITED RT
CLINICIAN'S HISTORY: Right breast nodule, upper/outer aspect
Breast mass, right
HISTORY REPORTED TO TECHNOLOGIST: breast nodule seen on ct
COMPARISON: None.
TECHNIQUE: Sonographic evaluation of the right axilla.
FINDINGS: Corresponding area of CT and mammographic concern, at the
10:00 position right breast, 1 cm from the nipple is a 1.1 x 1.1 x 1.3
cm oval, irregular, microlobulated hypoechoic mass associated with
shadowing. This is immediately below the skin surface.
The right axilla was evaluated sonographically, a few mildly prominent
lymph nodes are present including a right axillary lymph node with
focal cortical thickening measuring 4 mm, this retains a fatty hilus.
ASSESSMENT: BIRADS 4 - Suspicious - Biopsy should be considered.
Recommendation: Ultrasound-guided biopsy of mass at 10:00 position of
the right breast, there is a mildly prominent axillary lymph node
which would be amenable to FNA.__________________________________________________
I didn't understand most of this but after reading your thread and other information here, I realize this isn't good.
I am a health care provider but not familiar with breast cancer. I am upset right now because of the combination of liver, kidney, and now the possibility of breast cancer. I am on meds for liver failure (which has stabilized due to meds and careful diet) and kidney failure.
I'm trying not to panic and take it one day at a time. I guess my question is.... is there much possibility that the biopsy could come back negative? I have biopsy scheduled for mass and lymph nodes next week. I do understand that only the biopsy can tell for sure.
Now I am even wondering if breast cancer mets to the lung could have been responsible for the pleural effusion and subsequent renal failure.
I woke up the other day and the entire right side of my body was tingling and numb.
Thank you for listening and for any info you can provide. It helps just to get this out.
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Even if the breast mass turns out to be a primary, It's doubtful that the chest findings are related to metastatic disease given the size of the breast mass and the relatively minor changes present in the lymph node. The pleural fluid could always be sent to the lab if that becomes a clinical concern.
After what you have been through, a core bx of the breast should be a piece of cake. Personally, I am not a big fan of FNA's as they often do not provide enough material for diagnosis unless a path cytotech is on hand with a microscope to confirm an adequate sample is obtained. I prefer to perform a core biopsy on lymph nodes with an 18g device. They are safe in the proper hands, that is, someone who does them regularly and often and more reliably provides an adequate sample for histology.
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Thank you very much djmammo. That is reassuring. I've already come to terms with the likely fact that the mass is cancer, but I have been worried about the lymph node. Good that the fatty hilus is still there and the cortical thickening is not huge. I wasn't sure what to make of that.
From what I've read (Medscape and here, not Google) and like you said, the core biopsy would be preferable. Not sure why they aren't doing that.
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I'm sure they will do a core in the breast but some people are a little nervous about using a spring loaded device in the axilla.
My subspecialty was IR for many years starting in the late 80's before going to 100% breast imaging in 2003 so I am comfortable doing cores there.
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Hi, could you take a peek at my post? Its top of page 43. I could really use some feedback on my MRI report. Never had an MRI before, I don't understand all the stuff about enhancement and washout. But I do recognize DCIS and lobular carcinoma, so I'm a bit concerned.
Thank you, Betty
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If there are multiple areas of concern that are completely identical, we assume they represent the same process and only biopsy one of the areas. This is also common when dealing with multiple areas of similar calcifications on a mammogram.
As far as the findings themselves are concerned, if there is no discrete suspicious mass, areas of non-mass enhancement can be almost anything from enhancement related to one's cycle to ILC. It showed wash-out type kinetics which raises the level of suspicion a bit. MRI is always read with the mammo and US available as they contribute to an overall impression of what is going on.
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Thank you! Waiting for hospital to call back to schedule the MRI guided biopsy. They said the radiologist had to approve my doctor's order before they would schedule me.
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djmammo, thank you very much. I just got my path report today and this is what it says.
Diagnosis
Left breast, L1 10 o’clock, 6cm from nipple, biopsy
Fibroadenomatiod Change
Radiation Change
No Evidence of Carcinoma
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Hello, I just turned 50 had mammogram through local breast screening. I knew something was up when the tech told me they could call me back. Got the call 2 days later after Dr. Viewed images. I have copies of the images that were forwarded to my family Dr. and I can see some spots but I really haven't got a clue what I am looking at and I am trying very hard to avoid Dr. Google.
Breast Density (b) the breasts are composed of scattered micro glandular densities
Abnormal Mammogram
Breast: Left
Finding(s):within the upper outer quadrant of the left breast, anterior third depth, there is a 1.4 cm focal asymmetry.
Assessment: Indeterminate focal asymmetry within the upper outer quadrant of left breast. Further evaluation with spot compression views and ultra sound are recommended.
Call back: Yes
BI-RADS (0) further workup required.
My follow up is on the 7th of May. The nurse told me the radiologist will tell me on the spot what his findings are.
While I am not a worrier by nature, this is all new to me and I like to be prepared for all scenarios.
Thank you
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Thank you, that is sort of what I have interpreted from reading a bit so very very hopeful....
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Wondering if a clogged milk duct could look malignant on US? Or is it super easy to differentiate? I was reading abt galactocele and they seem to mimic malignancy in some cases. Can galactocele look malicious on mammogram as well?
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I have never made the diagnosis of "clogged milk duct" on imaging but I hear it all the time on here. Must be a clinical finding.
Galactoceles are found only during breast feeding/lactation. Are you breast feeding?
They have a fairly recognizable appearance on mammo and US if you know what you're looking for.
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Hi DJ. I am a 42 year old. I have been seeing breast surgeon's since I was in my thirties, do to breast cysts, and a family history of breast cancer( mother). I had my routine breast exam and bilateral mammogram come back negative this year,( 3-18-19). I had asked to add suplimental us to my testing. My left breast us came back with a birads 3. Can I afford to wait six months for more testing( reccomendation). I am particularily frightened about tge fibroadenoma..I tried to post the repost the report. But can't for some reason. It lists what is most likely a complicated cyst and most likely a fibroadenoma
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Thanks for your response, Djmammo.
I am breastfeeding my 18 month old. The finding is in my left breast which my daughter never fed from as she feeds primarily from my right breast. I wonder of its old milk which is showing up like a lump. My surgeon has asked me to go for another US which is 3 weeks away. The biopsy might take longer and I am freaking out.
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Complicated cysts and fibroadenomas are benign. How much confidence do you have in the people interpreting your exams?
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Thank you so much dj, for answering.I guess it's the birads three that scares me and the reccomendation of followup us on the left breast us in 6 months. Always before what I had were simple cysts, birads 2. So, I am concered if it's only" probably benign,"fibroadenoma and. Complicated cyst,( both under a cm)..Shouldn't they do a biopsy? And why was my mammogram and breast exam normal, then the us the same day, had these findings .Sorry too many questions. I am scared though.
The breast surgeon and Radiologist, seem very competent. I am just freaking out.
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If these things are not visible on the mammogram then technically the mammogram is "normal".
B3 means the reader has to be at least 98% sure the finding is benign.
Any new finding is either followed if it looks benign, or biopsied if a) it looks malignant, or if b) they can't tell one way or the other.
No radiologist wants to miss a cancer. If they thought it looked worrisome they would have recommended a biopsy.
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Thank you. DJ. That is reassuring.
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I had a screening mammogram and a recalled diagnostic mammogram + Ultrasound. The radiology thinks it is a 0.5x0.4x0.3 cm cystic mass with irregular margins, and recommend to do cyst aspiration and possible ultrasound guided core needle biopsy. I'm so terrified. How likely this can be a cancer?
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Hello! I am new to this forum. In fact, this is my first post. I am a dedicated breast radiologist, and I have been practicing for many years reading mammograms, performing sonograms, and performing biopsies. In fact, I have done over 3000 biopsies in the last 15 years. So I thought that I would join this forum and lend a little of my experience to the people here.
I agree with djmammo, having the exact wording in the report would be helpful. From what you said above, it is a very small "cystic mass". The overwhelming majority of cystic lesions are in fact completely benign. Still, if the lesion has any suspicious characteristics, many doctors will perform an aspiration with a small needle. If it resolves leaving behind no solid component, then it is virtually always benign. If a solid part persists after the aspiration, the doctor then usually proceeds to do a core biopsy of that area. But from what you have said above, I suspect that it will be benign. Any additional information or wording from your reports would be very helpful. Regardless, good luck on your procedure, and I pray for you to get happy results.
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Thanks for sending the report. First, it sounds like the facility that you went to is doing very high quality work. I'm glad that you got a 3D mammogram. They are unquestionably better than 2D mammograms. It is also nice that the sonogram was performed "under close supervision by the radiologist". This is very important because the radiologist can assess the adequacy of the study immediately and get additional images as needed. They also directly correlated the mammo findings with the sono findings...this is extremely important since sometimes what is seen on mammography is not the same thing as is seen on the sonogram. Correlation is very important. So I think that you should have confidence in this facility and its recommendations. The report calls the mass "anechoic" meaning that it is completely black on sonography. This usually means that it is filled with water and thus indicates a high likelihood of it being a benign cystic structure. No mention is made of any solid component, and the only suspicious finding at all is regarding its "irregular margins". From the report, I would be very surprised if this turned out to be malignant. If I had to guess, this might turn out to be a case of apocrine metaplasia. This is a benign and extremely common condition that produces complex appearing clusters of cysts. So my advice to you is continue your followup at this facility as recommended. Let us know what happens.
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