Interpreting Your Report
Comments
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Hello I could use some help interpreting this report.
"Scattered finbrogladular tissue (ACR
, with moderate background parenchymal enhancement.In the right 12:00 axis 3.6 cm from nipple there is an irregular homogeneous enhancing (type 1) mass that measures 1.3 x .9 . The margins are irregular.
Recommendation - Second look ultrasound
Birads4 Suspicious
I understand most of it but would like another's perspective. I am curious what details can be seen via ultrasound that wouldn't be clear in the mri? I had a harmatoma removed in the right breast in November, could this be scar tissue?
I am surprised to not be heading straight to biopsy. I have been high risk for 9 years, with ALH, and a 47 percent lifetime risk. My ultrasound is scheduled for Thursday. I have had lots of them post mammogram but never post Mri.
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still hoping for some help with this. I had my ultrasound today and the radiologist disagreed with the MRI findings. Specifically the irregular margins part. so who is right? I have a biopsy scheduled for Monday.
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still hoping for some help with this. I had my ultrasound today and the radiologist disagreed with the MRI findings. Specifically the irregular margins part. so who is right? I have a biopsy scheduled for Monday.
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still still waiting on a some help with my topic....
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Ladies waiting on a reply, djmammo volunteers his time here and normally answers with lightning speed--he does this sacrificially. Maybe he's on vacation and trying to "unplug," but based on having read this thread for months, when he's available, he will answer.
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US and MRI evaluate masses in completely different ways. They each have their strengths and weaknesses based upon the the physics of each modality. MRI has better contrast resolution and US has better spatial resolution. The concept of the "Second Look US" is well accepted and a very valuable tool.
The MRI is best at locating abnormally enhancing masses but US is better at evaluating the margins and internal architecture, so we use one to locate and the other to better evaluate. Also, it is so much faster and easier to do an US guided biopsy that we all want to know if we can see the MRI finding on US for practical reasons as well.
I don't have enough information at this point to hazard a guess as to what this is (your rad has already compared all your exams from this and prior years) but a biopsy is the best way to go and is not all that bad a procedure. Click here for more info on this.
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Architectural distortion can mean many things. It can simply be superimposed breast tissue that is simulating architectural distortion. It can also be seen with a high risk benign lesion called a "radial scar". These often are not visible on a sonogram. It can also be seen with a cancer. Cancers that present with architectural distortion are usually visible on sonography but not always. If the architectural distortion is clearly identifiable on the mammogram, a biopsy is indicated even if nothing is visible on the sonogram. This sounds like your doctors are taking appropriate caution to be sure that you don't have a cancer or a high risk radial scar. Let us know your biopsy results. Good luck and God bless.
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Thanks for the information. I had my 5th biopsy in the last 8 years today....ultrasound guided core needle. The info regarding the margins being seen better on US was helpful. It is hard to continue going through this. I just had a 3cm Hamartoma removed in November so finding something else so soon felt shocking. Now I wait...again.
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Hi there! I'm sitting here in limbo, and just wondering if I should be doing less sitting in limbo and more planning and prepping for the near future (as in cleaning my house, freezing meals, figuring out how to finish the homeschool year with my kids,etc.) ...or do I just keep sitting. Haha
I'm 33, no past history of cancer. But on my father's side we have strong cancer. Grandma- Breast cancer. Grandpa- colon cancer. Dad- prostate cancer. Aunt- breast cancer. Aunt- breast cancer. On my mothers side, no cancer. But both mom and grandma have had multiple benign tumors removed.
About 4 weeks ago, I found a lump. Dr sent me right in for an ultrasound the same day. Ultrasound found 3 masses. One in the milk duct, one about 4cm from the nipple(this was the only one I could feel), and one 10cm from the nipple very close to the chest wall. And dialated milk ducts.
Radiologist decided to do bilateral mammogram, which found 6or 7 cysts on the other breast, but no masses. Scheduled me for a biopsy.
During the biopsy all went well. The mass #3 collapsed when poked, and she was excited it was just a cyst. But after 3 days, the cyst refilled to bigger than before. (I couldn't feel it before...now I can).
At my follow up appointment, the dr. Said even though my biopsy reports say no malignancy, she sees too many red flags for her to be comfortable with the suggestion of being rechecked in 6months. She decided to put in a referral to the large cancer care clinic that's about 2 hours away from me. Which has my worry flaring all the way back up.
Mammogram was Birads 4
Biopsy results:
Comment: Biopsy A is suggestive of origin from an inflammatory process or adjacent to an inflammatory process but continued follow up and clinical correlation is suggested with consideration of additional biopsy if clinically indicated.
BIOPSY A(the large mass I felt): sections show fibroadipose tissue and breast tissue marked with acute and chronic inflammation. Focal microcalcifications is noted. One area is suggestive of poorly formed granulomatous inflammation but definite granulomas are not identified. A collection of blood clot and inflammatory debris adherent to one of the tissue fragments shows large apocrine-type cells. Definite malignancy is not demonstrated.
BIOPSY B (mass in the milk duct behind the nipple): section shows fibroadipose tissue and tissue co sistant with the nipple origin. Scattered chronic inflammatory cells are present. Malignancy is not demonstrated.
BIOPSY C ( collapsed cyst on chest wall): section shows fibroadipose tissue and breast tissue. The breast tissue shows chronic inflammatory cells. An acute component is not demonstrated. Malignancy is not demonstrated.
For the mammogram results it showed these:
A) lobulated hypoechoic mass with no definite internal vascularity. 2.2x1.7x1.8 cm
ductal ectasia present. 6x8 x5mm Intraductal mass present. C) 5mm ovoid hypoechoic mass
Any help desifering words would be great.!!
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Just curious..... Who is MammoRad? Are you just popping in here on your own or are you an approved person to act as an expert on this website? Obviously djmammo is the real deal but have you been vetted and approved? Just a big city girl here, asking big city questions.
Thanks!
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djmammo-
Nothing. Over all...I'm super healthy. Hardly sick. No injuries, no piercings, no surgeries (except 3 csection that were 12,10 and 8 years ago).
Here's a few more detail questions on my mind-
Is rhere a reason the pathologist would change the wording between. "Definite malignacy not demonstrated" to " malignancy not demonstrated".
Reasons for a cyst to refill so quickly?
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djmammo-
Nothing. Over all...I'm super healthy. Hardly sick. No injuries, no piercings, no surgeries (except 3 csection that were 12,10 and 8 years ago). Also, that breast side is visually larger than the other. It "normally" is my small side. So there is very obvious inflammation of some sort going on.
Here's a few more detail questions on my mind-
Is there a reason the pathologist would change the wording between. "Definite malignacy not demonstrated" to " malignancy not demonstrated".
Reasons for a cyst to refill so quickly?
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DJmammo, I had a PET scan yesterday (my left femur lit up). My question is actually about the injection. The tech administered the injection and then took me in for the scan about 22 minutes later. It seems to me that that was a very short time between injecting and then doing the scan. Shouldn't it be about an hour? And are there any issues that can arise from not waiting long enough after the injection?
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That's outside my area of expertise but I would imagine the PET techs know at what intervals to take the images after the injection.
In addition, when looking at the first post-injection images, there are likely areas that light up and tell them if enough time has passed.
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possibly. They did not recheck it via ultrasound to be sure it was refilled. She just did a physical exam. And then she said she wanted to send me a referral to Seattle Cancer Care for more testing and a second set of eyes. So I assume they will ultrasound it there.
If it is a hematoma...will that shrink back down?
Just got the call for an appointment on June 5th. Feels like a forever long wait.
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I just had my 6 month follow up ultrasound and my results were posted. 2 terms are confusing to me. Would you explain "through transmission" in FINDINGS and "subcentimeter" in IMPRESSION.
Thank you in advance!
COMPARISON: Diagnostic ultrasound from 11/21/2018; diagnostic
mammogram from 11/21/2018 and previous.
FINDINGS:
The 0.3 x 0.2 x 0.3 cm oval circumscribed hypoechoic avascular mass with parallel orientation and increased through transmission at the right breast 8:00 position 6 cm from the nipple is stable compared to prior diagnostic ultrasound performed on 11/21/2018, and with demonstration of six months of sonographic stability remains probably benign.
IMPRESSION:
Stable probably benign subcentimeter right breast mass at the 8:00 position 6 cm from thenipple.
RECOMMENDATION:
Recommend for the patient to return for a bilateral diagnostic mammogram and right breast diagnostic ultrasound to ensure continued stability and/or benign progression.
BI-RADS 3: Probably Benign0 -
Buddyrock... It looks like great news!
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Hi djmammo
I had a diagnostic mammogram last Wed. and today I had a ultrasound. I have a appoint. next Tuesday with Dr to go over test results. I did get a copy of my mammogram report, would appreciate any insight you could give me as to what this report means. Thanks so much.
Exam type : 3D/2D Bilateral Diagnostic Mammogram
Comparison : 8/14/2018
Clinical History : Left breast mass at 5;00 for one month
Findings: Parenchymal pattern is unchanged, again showing minimal fibroglandular tissue in an essentially symmetric fashion. At 5:00, 12 cm from the nipple, an indistinctly marginated oval mass measuring 15 x 15 by at least 19 mm is noted. This corresponds to the area patient identified palpable abnormality. Internal architecture is inhomogeneous , No suspicious calcifications. Some architectural distortion appears present. No other focal abnormalities.
Impression: Assessment is incomplete. Recommend limited left breast sonogram.
Bi - Rads Category:
0 Incomplete - Need Additional Imaging Evaluation
Breast Composition
A. The breasts are almost entirely fatty.
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Subcentimeter: "less than one centimeter". This phrase is used instead of repeating the exact measurements in the impression
Through Transmission: This is a feature of a mass specific to ultrasound. Without going too far down a physics rabbit hole this is a finding seen in benign masses. It is the opposite of "posterior shadowing".
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Since you can feel it, and it is new since your prior mammogram they will likely want to biopsy this. I assume it will be visible on US and that is how it will be biopsied.
As far as a diagnosis is concerned, the report is missing a few important features such as presence of vascularity, shadowing vs through transmission, orientation in regard to the chest wall etc. so we will have to wait for the bx to find out.
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Howdy from Texas, Djmammo! First, thanks for all you do here, it's really amazing of you to give your time so selflessly.
I'm 48 - with a MAMMO BI-RADS 0 and U/S BI-RADS 4 from palpable lump right underneath my nipple. Feels like a hard blueberry but acc to report it is a 1cm mass. Not painful but more like uncomfortable given the sensitive location. Breast radiologist verbally told me it "might" be a papilloma but she "wasn't really sure." I have had NO nipple discharge, just the hard palpable lump. She said she could not biopsy it at the breast center, that I need to meet with a breast surgeon for excisional biopsy (I'll schedule it soon - have a lot of options here in Houston).
(Side note: my OB/GYN felt a lump further down in same breast - but they didn't see it in on the ultrasound)
Based on what I've read (no scary stories, just stats) - I don't have cause for true worry here. I have a significant list of ongoing health issues already (RA, mild lung fibrosis/restrictive lung disease, mild pulmonary hypertension, and have stable CHF as long depending on the PH under control). So, honestly? This breast thing feels like more of a nuisance than anything.
I just wish the U/S was a bit more detailed because I've seen your post about important terms used in ultrasound reports and mine seems vague. So I'm attaching my report here with this question (update: for some reason, the attachment will not go through - so I'll type it out. Sigh.)
Is there anything here that hints it could be anything other than a papilloma? Maybe a fibroadenoma? I've read that with papilloma, it usually presents with discharge, and not a lump. I have zero discharge, just the lump. Would appreciate your thoughts, and thank you in advance!
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CLINICAL: Patient complains of feeling a lump and pain in the retroareolar area of the right breast. Doctor feels lump in right breast, patient does not know where.
Comparison is made to exam dated: 5/20/2019 mammogram (note: my very 1st mammogram)
Color flow and real-time ultrasound of the right breast and axilla were performed.
All 4 quadrants of the breast and the retroareolar region were examined with ultrasound.
There is a 1cm mass with a smooth margin in the right breast central to the nipple anterior depth. This correlates as palpated. Color flow imaging demonstrates that there is vascularity present. The mass is within the nipple base and not amenable to biopsy. No clear relationship is noted to the skin surface. The mass may be representative of a papillary lesion. No abnormalities were seen sonographically in the right axilla.
IMPRESSION: SUSPICIOUS OF MALIGNANCY - FOLLOW-UP RECOMMENDED
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Hi djmammo:
I have a question about microcalcifications. Do you know what causes them? And when they are associated with malignancy, are they typically within the malignant region or can they be distant to it?
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Its a good location for a papilloma, its smooth and they are always vascular so thats a good bet at this point. We usually make the call if there is a discharge and we can see that it is clearly within a duct. Its a fairly sensitive area for a percutaneous biopsy so some people shy away from doing them that way.
Nothing in the report screams cancer but it has to be raised so ins will pay for the biopsy. Let us know how it goes.
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Djmammo - WOO HOO that sounds like very good news, thanks so much for the response, much appreciated!
(I'll update if anything changes, but for now I'm just going to schedule the Bx and forget about it lol)
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Well, I had the Breast MRI to follow my April suspicious mammogram and ultrasound, and as I expected, I’m now headed for a biopsy of the suspicious mass and two lymph nodes.
Bi-rads is a 4, not sure why it’s not a 5 at this point with the mass and nodes being suspicious.
MRI 5/22/19
Indication: History of left breast lumpectomy and multiple prior biopsies, abnormality noted in the left breast on recent mammogram and ultrasound.
Comparison: 4/29/19
Technique: Multiplanar multisequence MR images were acquired before and after intravenous administration of 14.5 ml prohance contrast agent. Post processing image analysis was performed at a separate workstation.
Findings: Breasts demonstrate mild background parenchymal enhancement.
Left Breast: There is an irregular spiculated heterogenously enhancing mass in the left upper outer breast at posterior depth. This measures 1.2 x 1.9 x 1.9 cm and is best seen on series 104, image 218 and series 7, image 35. This is closely located to the underlying pectoralis is muscle, however there appears to be a thin fat plane separating the pectoralis muscle from the enhanced mass.
Right Breast: No enhancing mass, dominant focus, or other abnormal enhancement is identified within the right breast.
There are at least two abnormal left axillary lymph nodes which demonstrate cortical thickening of at least 8mm (series 104, image 183). No abnormal internal mammary lymph nodes.
Impression: Abnormal enhancing mass measures 1.9cm in the left breast at the 2:00 position. This would correspond with the previously noted ultrasound finding seen on 4/29/19 exam. An ultrasound guided biopsy is recommended.
There are at least two abnormal left axillary lymph nodes for which ultrasound guided biopsy is recommended.
Bi-Rads assessment:
Result Code (4): SUSPICIOUS ABNORMALITY - BIOPSY SHOULD BE CONSIDERED.
Follow Up: (BX) RECOMMEND BIOPSY
Mammogram 4/29/19
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.
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I'd love some help interpretting my fine needle aspiration biopsy report if someone has time please. The general practitioner has reffered me to a breast specialist for follow up but there doesn't seem to be any red flags in the report. Im assuming its because the sample was not very big? 3 needles were used 4 smears submitted for testing.
Background.....mammogram requested as the gp found a lump when i went to the doc about nipple changes /itching ect in one nipple. Asymmetry was found on mammogram so I was refered for ultrasound. Ultrasound suggested it was a fibrocystic change or trapped fat was the cause.
Fna report
Microscopic: one of the provided smears includes two tiny groups of cytologically bland epithelial cells together with an occasional bare bipolar nucleus. No stroma, cystic component, inflammatory population or atypical cells are present.
Thanks in advance
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