Interpreting Your Report
Comments
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thanks for the detail interpretation. It makes me feel much better. Waiting for the result is a very difficult time. Really appreciate you spending time helping out the people here. It means a lot to us! I will update the final result once my biopsy is done
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hi I went for a mammogram and u/, the radiographer came in and told me they found a complex cyst and I had a 98% of everything being benign and it was my choice whether to wait 6 months or do further testing now. I said I wanted to do further testing. My next appt is later this week. My report doesn't seem exactly congruent with what he said because I expected to have a BiRad score of 3 in that case. Now I'm sick with worry. When they say “is suspicious" for finding 4 is that code for probably cancer. He also said they would have to substantiate the need for not waiting to insurance so could that be why report seems a little more serious than he said?
Finding 1: Targeted u/s in the region of palpable abnormality in the right breast demonstrates no discrete abnormality.
Finding 2: There is an oval mass measuring 7mm with circumscribed margins in the left breast at 1 o'clock measuring located 6cm from the nipple.
Finding 3: There is a round mass measuring 3 mm with smooth margins in the left breast located 7cm from the nipple.
Finding 4: There is a round mass measuring 3mm in the left breast at 9 o'clock located 1cm from the nipple.
Finding 5: There is a lobular mass in the left breast at 4 o'clock located 3 cm from the nipple.
Finding 7: There is an oval mass with circumscribed margins in the posterior upper outer quadrant of the left breast.
Ultrasound Findings
Finding 2: US demonstrates lymph node in the left breast at 1 o'clock located 6 cm from the nipple
Finding 3: US demonstrates a lymph node in the left breast at 1 o'clock located 7cm from the nipple
Finding 4: Ultrasound demonstrates a complicated cyst in the left breast at 9 o'clock located 1 cm from the nipple.
Finding 5: There is a lymph node measuring 4mm in the left breast at 5 o'clock located 5 cm from the nipple.
Finding 6: ultrasound demonstrates a lymph node measuring 7mm in the left breast at 4 o'clock located 3 cm from the nipple.
Finding 7: the finding in question is not seen on ultrasound
No solid or cystic lesions are seen in the examined region of the right breast.
Impressions:
Finding 1: Finding in the right breast is benign.
Finding 2: Lymph node ... is benign
Finding 3: Lymph node...is benign
Finding 4: complicated cyst in the left breast located 1 cm from the nipple is suspicious. An ultrasound guided cyst aspiration is recommended.
Finding 5: Lymph node ...is benign.
Finding 6: Lymph node ...is benign.
Finding 7: Mass in the upper outer quadrant of the left breast is probably benign. F/U in 6 months is rec'd.
Bi-Rads category 4: suspicious abnormality
ETA: I am 37, two children under 5. Breastfed two years of the last 5. Stopped breastfeeding in early November. No history of breast cancer in my immediate or extended family. I'm overweight and the report says I have heterogenousdense breasts
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This is my report. Biopsy was done on 4/19. Any chance at all that I'll get a pathology report saying it's something benign? I know I should be planning on this coming back as bad news but I can't quite wrap my head around it
R92.8 DIAGNOSTIC MAMMO LEFT MG DIAGNOSTIC MAMMOGRAPHY DIGITAL LT
Procedure Acknowledge Date: 04/12/2019 12:22 PM
Examination: Diagnostic mammogram and breast ultrasound which includes magnification 2-D views left breast CC lateral projection,full field lateral 2-D images left breast, and left breast/left axillary ultrasound.
COMPARISON: Screening mammogram 3/19 and prior mammograms..
HISTORY: Patient called back from screening mammogram 3/19 secondaryto new clustered calcifications in the left upper breast.
FINDINGS:
DIAGNOSTIC MAMMOGRAM:
Breast density: Heterogeneous and dense which can obscure small nodules..Grouped pleomorphic calcifications spanning 11 mm in diameter associated with a macrolobulated medium density nodule are now noted in left upper breast roughly twelve-one position 6 to 7 cm from the level the nipple. No architectural distortion. No other new nodules.
No other signs of architectural distortion or other suspicious clustered calcifications..
ULTRASOUND:
Ultrasound of the left axilla and left breast was performed by 2 separate observers. No axillary adenopathy. In the left breast twelve position there is a macrolobulated solid-appearing shadowing mass measuring 12 x 10 x 13 mm. This mass contains numerous internal pleomorphic calcifications. Angulated borders. Taller than wide appearance. Palpable as a firm but slightly mobile nodule on limited examination. No additional cystic or solid-appearing nodules detected in this quadrant the breast. No abnormal appearing duct dilation or Intraductal mass. No adenopathy..
CONCLUSION: Suspicious mass left breast twelve position 6 cm from level the nipple for which ultrasound core biopsy is advised to further assess..
RECOMMENDATION: Ultrasound core biopsy left breast twelvenodule with post procedural clip placement mammographic films..
Results and recommendations were discussed with the patient at the time of this examination. Patient understands findings and recommendations. At the conclusion of the study, patient was given both a verbal and written report describing findings and recommendations. Patient currently being scheduled for ultrasound core biopsy left breast mass by our breast navigator.
Please note, this case was reviewed using the R2 CAD Second Look system.
ASSESSMENT: BI-RADS 5: Highly suggestive of malignancy.
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Its a bit of a contradiction, anechoic with irregular margins. Anechoic would indicate a simple benign cyst, but they ususually have razor sharp borders.
The cyst aspiration is the best route. If it turns out to be solid they can easily do a core biopsy at that time. Let us know how it goes.
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A true complicated cyst is a benign entity. Cyst aspiration should sort that out.
The report has to say "suspicious" and have a B4 if insurance is to pay for the procedure. We use B4 no matter how benign it looks if we want to biopsy/aspirate it.
If it were only a recommendation for a short term follow up of that L UOQ mass then it would be a B3 but it is protocol to use the higher of the Birads when dictating the report. Let us know how it goes.
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With that description I am not surprised that it was given a B5 by that reader. The good news is there was no obvious lymph node enlargement on US.
I suspect that after the path comes back, you will go for an MRI and a surgical consult, not necessarly in that order.
Post the path report when you can.
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Thank you Djmammo for replying. I guess it's that bad. I was holding my breath when they were looking in my armpit.Why an MRI?
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Its routine now for pre-op planning. It can better predict the actual size of the tumor, demonstrate any other hidden tumors on the same side and in the opposite breast, and demonstrate all the lymph nodes on both sides. Its the one time ins will pay for an MRI without a question.
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Good that insurance will pay. What do people do without it.
Thank you for answering my questions. You are certainly a great person to have here
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can you take a look on my report? I don’t know why the other rediology deleted his or her response. Thanks
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Hi djmammo, I wrote you a private message but not sure if I attached the report correctly. First week of March I woke up with a swollen painful right red breast. Doctor said mastitis even though I have not breast fed in 5 years. I am 31. The redness did go away but breast remained swollen and my pores larger than normal. My WBC was high and went back to normal after the antibiotics. U/s was done and the only thing found was mild thickening. Mammogram showed dense breast so additional images recommended. A skin punch biopsy was done and only showed inflammation of the tissue. MRI was done last week- I attached the report BIRAD 4a- showed on my right breast non-mass enhancement which was persisten on the duct and dilated duct. Mild thickening was also noted. I am afraid I have Inflammatory breast cancer and DCIS too. An MRI Guided biopsy is schedule for this Wednesday and I am freaking out. Please give me your opinion regarding the attached MRI Report. Thank you so much.
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Just following up on my complicated cyst. When I went to the breast center she didn’t even feel it warranted FNA aspiration but she did and it went away when she did that. It contained a gel-like clear ooze. The reason I went in originally though was for a change in physical appearance in my right breast, I wasn’t sure if it was something from breastfeeding so long or something suspicious. She did think it looked a little weird and did a repeat ultrasound on it and looked thru my right mammogram again (which they didn’t have have a lot of images of this side for some reason even though it’s why I originally went in). She couldn’t find anything but since I have very dense breasts her and the other doctor agreed it wouldnt be crazy to get an MRI done as well so in a few weeks I’ll have that.
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I got my biopsy results today. Invasive ductalcarcinoma in the left breast. The radiologist who came to the meeting said that he did not see any lymph node involvement but that doesn't mean that it isn't there. It was a preliminary report so I did not get a copy of it. The radiologist said that it was either estrogen/progesterone low or negative. So I guess I'm moving onto the diagnosed areas. My nurse navigator is arranging an appointment with a surgeon (one who does breast surgeries) in the next two weeks.
Thank you Djmammo. I will post the report when I get it
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Well, since I posted my u/s results here a few days ago I thought I would share my biopsy results.
I was expecting the worst given the wording of the u/s report. It was given a BI-RAD score of 4 (no subcategories). I figured it was probably a 4c or even a 5.
The biopsy report came back as invasive ductal carcinoma, approximately 1 cm, no suspicious-looking lymph nodes although they didn't biopsy any lymph nodes. All in all it seems like it is a fairly treatable cancer -- Grade 1/well-differentiated (Nottingham score of 4), Ki-67 low at 9%, highly estrogen positive (>95%) and progesterone positive at 55%. HER2 negative.
So I went to my first oncology team meeting yesterday. I had recently found out that my liver cirrhosis (history of Hep C) is worse than I originally thought and is probably near end-stage. Some of my labs are correspondingly abnormal, such as my hemoglobin and platelets, so I am at a significant risk for excessive bleeding from surgery. Surgical oncologist said he is not comfortable even doing a lumpectomy (bleeding risk and also potential hepatotoxicity of anesthesia). Chemo and radiation are out for the same reason. So they started me on an aromatase inhibitor (anastrozole). And that's it.
The rationale is that my risk of recurring cancer is lower than my risk of dying of liver cirrhosis. So here I am, sitting around with this cancerous lump in my breast and no plans to do anything about it except for the AI treatment. Anyone else ever been in this same boat?
I wonder which I will die from first. To add insult to injury, I am no longer eligible for a liver transplant because of the cancer diagnosis. My friends and family seem to think that livers are just sitting around marinating in jars and all I have to do is ask for one. Frustrating...
Guess I won't be buying any green bananas.
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I've read about this too and I have the same concern. I am a birads 3 with bilateral cysts, focal asymmetry in the left breast and 2 nodules in the right. I am still perimenopausal at 51. Thanks.
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Hi, all! I was finally able to get my MRI approved. I'm 35 years old and have severe itchiness, skin thickening, and red/crusty nipple. Posting my MRI summary since I'm unable to post the picture. I'm kind of nervous because I have extensive family history of breast and ovarian cancers. I have a biopsy scheduled for next Friday. My surgeon wants to review with his radiologist before deciding what technique to use. Thanks for any input!
Breasts are almost entirely fatty.
There is mild background parenchymal enhancement in both breasts.
Bilateral rim enhancement consistent with fat necrosis (I hada breast reduction in October, 2016).
Marked skin thickening in the left breast compared to the right.
Correlation clinically is now recommended and consider a punch biopsy.
Impression: diffuse edema or high T2 signal of the skin of the left breast most pronounced inferiorly. Minimal enhancement of the skin lower left breast. Possibility of malignancy cannot be excluded but cannot be determined or biopsied by imaging guidance.
BI-RADS category 4. Suspicious findings.
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Although skin thickening accompanies some types of breast cancer (IBC) it is only a reflection of the blockage of the lymphatics of the skin with tumor cells from the cancer inside the breast. It is not per se involvement of the skin itself with cancer.
In order for this to occur there has to be a cancer present in the breast. The most common presentation of IBC on MRI is multiple small, confluent, heterogeneously enhancing masses with global skin thickening. If masses are identified on imaging then an image guided bx can be performed. If no mass is seen then a punch biopsy of the affected area of skin is performed, going deep enough to sample a portion of the lymphatic vessels that might contain tumor cells that can be detected under a microscope.
If you have posted your complete report, there is no mention of a mass in the breast.
Read More Here: https://www.ajronline.org/doi/full/10.2214/AJR.10.6157Here is an MRI image of a patient with IBC:
Let us know what your biopsy shows.
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Thank you so much for your response! It makes me feel a lot better as there were no masses seen on the MRI. The findings were limited to the skin. The site would not allow me to post my report. Looking forward to next Friday to be able to put this behind me
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Djmammo
so i have had my BMX and received pathology results over phone. They say I only have DCIS but then they say one of my lymph nodes had small tumor cells in it but overall they call it negative which I don’t really understand. The biggest confusion is how can it be DCIS but still be im my lymph nodes?
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bump.... really anxious on the above question!
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I just answered a similar question for someone else on here.
There is a subtype of high grade DCIS called 'microinvasive' that can go to the nodes but can be treated the same as other types of DCIS.
Is that mentioned in the path report? Ask your docs if this is what they are talking about.
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015981/
"Microinvasive carcinomas are distinct from DCIS in terms of clinicopathological features and biomarker expressions but are similar to DCIS in terms of clinical outcomes. Our results suggest that microinvasive carcinoma can be treated and followed up as pure DCIS."
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I posted my report about two weeks ago. Since the facility (Methodist) did my diagnostic mammogram and ultrasound can not schedule a biopsy until May 7th, I decided to get a second option from MD Anderson. Luckily I got an appointment today.
I spent almost a whole day there. First meeting is with a breast specialist in the moring. They requested all my imagines from last 5 years including a biopsy slide Kelsey did for me three years ago. Their radiologists reviewed my mammo taken from Methodist, thought it was a simple cyst. Then they sent me to do an ultrasound, gave a BI-RADS score 3 (good news right). But just to make sure, they did a FNB. On the US screen I witness the cyst collapse as soon as the needle touched it. Within 10 mins I got the preliminary rresult benign cyst. Really impressed on how efficiently things are done there, how professional their staff are.
THANks for all the help I got from here. Especially the two radiologists on this forum that helping people out.
Now I'm considered high risk patient, will start to do MRI screening in 6 months. I'm sure there will be more journeys. Hopefully, one day I will be a mature and educated patient who can handle this stressful situation better.
Wish everybody good luck and god bless.
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I had my 6 month mammogram Monday. Went in expecting some level of drama as my mammograms are never normal (usually end up with some kind of biopsy). Anyway, started the process with a 3D mammogram, and of course radiologist wanted extra views (expected this, not worried yet). Then they wanted to do an ultrasound of an area in my left breast (again, expected this, not worried yet). In the room where the US is done, they have an image from my mammogram up on the screen and I get a look at the area they are investigating. Now I start to worry as it is clearly a spiculated mass. US tech performs US on area of concern, then also does an US of my axillary nodes. This is cause for concern, as they've never done and US of this area in my history of imaging. I just kind of laughed and told the tech good luck finding nodes, they removed 14 of them back in 1999.
After all of this, radiologist still isn't happy (she's very thorough, I trust her explicitly). So she now has given me an order for a breast MRI with specific instructions to schedule it for 10 days after the start of my next menstrual cycle.
Oncologist called with my mammogram report yesterday:
Indication: Multiple prior surgical procedures bilaterally including lumpectomy in 1999 and recent excisional biopsy on the left.
Comparison: 9/5/18, 8/14/18, 7/23/18, 6/15/16
Findings: The study is reviewed by CAD. Tomosynthesis images are obtained in two projections.
There is heterogeneously dense tissue bilaterally, limiting sensitivity. Biopsy marker is present adjacent to several stable calcifications in the upper outer right breast middle depth. Surgical clips and distortion are seen in the left breast posteriorly. There appears to be a new spiculated density in the posterior upper outer left breast. Compared to prior studies however, the patient has undergone interim excisional biopsy which may have been more anterior.
Ultrasound of left breast demonstrates an irregular hypoechoic attenuating lesion at 2:00, 5cm from the nipple, measuring 1x1.1x0.9cm. No definite vascularity is seen within the area. Scanning of the axilla demonstrates 2 deep nodes that do not appear to contain a fatty hilum.
Impression: Spiculated mass upper outer left breast, scarring versus suspicious finding. There are also deep nodes that appear indeterminate. Breast MRI is recommended to further assess. If MRI cannot be obtained, then biopsy of the upper outer quadrant mass in the left breast under ultrasound guidance is recommended.
Result code (0) incomplete: Need additional imaging evaluation
Follow Up (0) needs additional imaging.
Unfortunately, the whole spiculated appearance of the mass (seriously looks like a well defined starfish), and the lack of fatty hilum in the nodes doesn't bode well. There is some hope the mass could be scar tissue (I have had 2 core biopsies and 2 excisional biopsies in that area in the last 3 years).
I guess I wonder a couple of things.... is there really a possibility of this being scar tissue, and if not...why not jump right to biopsy. The drawn out tests and waiting for results and next steps is so stressful.
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Hi Tmh, how frightening this must be. I would think that this could very well be scar tissue but that's just my thought. I too wonder why they don't just give you an excisional biopsy now but perhaps there needs to be a further indication that surgery needs to be performed (in terms of insurance?). I'm sure jdmammo will be by shortly to answer your questions. Prayers going out to you.
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Scars can look just like cancer on imaging. If one makes the decision to biopsy, you would have to biopsy the mass and the nodes.
The MRI will show all of each breast and both axillae. If the MRI is neg for cancer, you have avoided 2 biopsies. Since you have a history of a prior cancer your ins should OK the MRI without a problem.
The timing of the MRI according to a patient's cycle is critical when doing screening breast MRI (especially if extremely dense) as the normal tissue enhances more during certain phases of the cycle and may mask a very small abnormality but in our facility if there is already an obvious visible abnormality we were not so strict with the timing so we sacrificed some degree of sensitivity for speed.
The good news is the mass is very small and they dont think it is vascular (cancer=very vascular scar=avascular)
Let us know what the MRI shows.
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djmammo
Thank you so much for your reply, the process makes more sense now. I also feel better knowing this could in fact be scar tissue.
MRI should happen by 5/17, I'll post results
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I recently had a mammogram which showed up architectural distortions. They did a ultrasound and nothing showed up. Now they want to do a biopsy. If nothing showed on ultrasound, why a biopsy? Looks like they would just recheck in 3 months. Has anyone else had this to happen?
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Thanks cowgirl13
My insurance does require a precertification, but when I called them they indicated my history of BC would qualify me for the test. Based on djmammo’s response above the process makes sense, the waiting is just stressful. I see a psychiatrist for anxiety so I have good meds if needed, and my hubby and kids are good distractions
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I had a mammogram and it showed a mass. Then I was sent for an ultrasound and the doctor came after the ultrasound into the room and said they had to schedule a biopsy. Mine is scheduled for May 14th but in the mean time im going crazy trying to make sense of my ultrasound. Any help would be appreciated.
Findings:
There is a lobulated hypoechoic mass at 300 o'clock 7 cm from the nipple corresponding to the mammographic finding. This measures up to 2.1cm. Ultrasound guided core biopsy recommended.BI-RADS Code 4: Suspicious abnormality
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