Interpreting Your Report
Comments
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Who did the procedure? I am not a fan of fine needle aspiration for other than cysts as occasionally the report will come back "insufficient sample". If the pathologist states that its "adequate for diagnosis" in the report then go with it.
All that aside the contents of that line from the report sounds like good news. See this article:
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Thank you so much for your reply , I do not have the ultrasound report yet, hopefully it will contain the info that is missing, I have not been set up for bx yet, hopefully that will be next. Thanks again.
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Thank you for the info you offer here djmammo, it is truely appreciated
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Thanks djmammo, I appreciate your help and time.
The procedure was done by a radiologist. I saw a different general practitioner for results than I had seen previously, he said the same thing about FNA. He said he didnt like them for anything more than cysts too. I think thats why he has reffered me to specialist anyway. The report does not say adequate or inadequate, it does say minimal.
Conclusion - submitted FNA left breast 2 o clock 60mm from the nipple; minimal benign cells only. Correlation with imaging findings is required to ensure the sample is representative
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DJmammo, on a PET scan, does a description "bony lesion with a central lucency and sclerotic rim in the intratrochanteric region of the proximal left femur" with "minimal FDG activity with an SUV max of 2.3" sound like it requires further investigation or is this description consistent with a bone island?
What does "central lucency" mean?
This area on my left femur was seen on whole body CT at my initial staging in June 2017 and my oncologist called it a bone island and opted not to investigate further. I then went through neoadjuvant TAC and then adjuvant Xeloda.
I had a bone scan in September 2018 and nothing showed up on the left femur. The same area then showed increased uptake on my bone scan in February 2019 (about 5 months later). Only difference was in September I was on Xeloda. I finished Xeloda in October, so at the February bone scan, I had been off chemo for almost 5 months.
My understanding is a bone island is a benign sclerotic lesion and doesn't usually have any increased uptake on bone scan. So I can see why it wasn't seen in September. But I'm not understanding why there was increased uptake on the bone scan in February and why the area again lit up on a PET scan in May. If it is a bone island, my understanding is it shouldn't light up on either a bone scan or a PET scan.
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Hi djmammo!
Biopsy tomorrow. How nervous should I be?
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I don't read PET scans but usually if something is seen in the bone on such a study a routine x-ray of that bone should tell you if its a bone island or a metastatic lesion. If this was on a PET CT the CT portion of the exam should tell them what it is.
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Thanks, djmammo. It was a PET-CT. It was called an "indeterminate bony lesion with central lucency and a sclerotic rim" that "corresponds to an area of increased uptake on the patient's recent bone scan." Nothing is noted about size or anything else. I am having an MRI of the area tomorrow. Is MRI good for determining if it's a metastasis?
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Thank you djmammo!
No breasts to image as I had mastectomy last year after diagnosis. Hopefully all is good and not a Regional recurrence. Sounds like it is not time to panic. Thank you! I will let you know the outcome.
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Hi Djmammo,
I got the results of my tests today. The NP I saw today said I could wait 6 months for a follow up, or she could refer me to a general surgeon and have it removed. Unsure what to do.
History; Left breast mass at 5:00 for 5 weeks
Comparison: 5/15/19 digital mammogram with DBT
Findings: High resolution real-time imaging is performed in radial and antiradial planes., limited to the patients identified area of palpable abnormality. At 5;00 , 11 cm from the nipple a 2.0 x 0.8 x 1,8 cm oval heterogeneous mass is identified with broad margin overlapping with the deep margin of the dermis. A subcutaneous tract appears present, communicating with the mass. Likely this represents an epidermal inclusion cyst (sebaceous cyst).
Impression: Probably benign finding. Consider sonographic follow up in 6 months.
Bi- Rads Category
3 Probably benign
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The description is classic for this entity. This is related to the skin not the breast tissue. Its not solid, its full of a very foul smelling semi-solid cheesy material that can sometime be expressed through its connection with the skin that they described (which is a diagnostic feature of a sebaceous cyst). This is a benign condition.
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djmammo... Is there a downloadable program for patients that have their mammography CDs? I requested them thinking I could view them on my home PC... Nope.
I want to see the differences in my 3 films.
Thanks,
C
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Most discs supplied by a medical records department will have a simple image viewing app on them called a DICOM viewer, in addition to the images. Every one that I have encountered are for WIndows and wont work on a Mac. If you open up the disc to view the files you can look for it.
If none of the above works click here: https://www.radiologycafe.com/radiology-trainees/dicom-viewers to download one.
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Thank you! I have now downloaded it.... Files are Mac, not windows...
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Unfortunately, my files are MAC not Windows. So I will ask my neighbor with MAC if I can use their computer.
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Click on the link i posted and download the viewer appropriate for your computer. The images are in DICOM format and can be viewed on any platform Mac or Windows with the appropriate DICOM viewer.
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Thanks again djmammo. I did download the program. We couldn't get the images to load on either of our three computers. I didn't get a written report. Will ask surgeon for it tomorrow when I go in for my post-op/pathology report.
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DJ mammo I hope you can give me your optionion on this. I had 2 mammo and Ultrasounds last year. I have alot of burning and pain in the left breast. Shooting bee sting like feeling. A little background - I had a fibroadenoma with ADH removed from my right breast at 12 o clock in 2005 and another one grew back in its place. I am 46 years old mother of 2 on Estrogen replacement with early onset menopause.
April of last year..... FINDINGS: Scattered fibroglandular -- B. A benign appearing mass is present in the right breast. There is an oval mass in the left breast upper inner aspect middle depth. This is not significantly changed but correlates with area of clinical concern. No other significant masses, calcifications, or other findings are seen in either breast. INCOMPLETE: NEED ADDITIONAL IMAGING EVALUATION The oval mass in the left breast is indeterminate. An ultrasound is recommended.
Findings Color flow and real-time ultrasound of the left breast were performed on the areas of interest. There is a 12 mm mass in the left breast at 10 o'clock middle depth 6 cm from the nipple. This mass is hypoechoic. This correlates with mammography findings and area of clinical concern. Although the mammographic finding has been stable, this mass was not demonstrated on the 2007 ultrasound. Color flow imaging demonstrates that there is no vascularity present. *12 x 9 x 7 mm likely cluster of microcysts at 10 o'clock 6 cm from the nipple.
ultrasound and demonstrates long-term mammographic stability.
May of this year FINDINGS: Scattered fibroglandular -- B. There is a benign mass in the right breast. There is a new density in the right breast at 7 o'clock middle depth. No other significant masses, calcifications, or other findings are seen in either breast.
No mention of the left breast on my recent mammogram. I go back on the 30th for more in depth looks at the right.
Should I have the left rechecked when I visit the breast center tomorrow??
Thank you in Advance.
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Sure. No harm in that. You may have to have your doc change the order to include an US of that breast if they just ordered the right. Ask before you go otherwise the imaging center will have to call your doctor's office while you are on the table to get that order.
We had our referring docs use an order form that we created that basically said we had carte blanche to do whatever we felt was necessary to get the information needed to come to a diagnosis up to and including a biopsy.
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Hi djmammo,
My biopsy results for axillary lymph nodes came back benign. Recommend to re-ultrasound in 4 - 6 months. Thank you again, so much, for your input. It really helped to keep me from hitting the panic button unnecessarily!
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djmammo,
1st question: does the uptake on a bone scan increase as a lesion progresses? I had mild uptake in the proximal femur in a September 2018 bone scan - so mild, it was missed and was just recently noted after a second review.
I had increased uptake in a March bone scan in the same area. (This was unfortunately erroneously noted to be on the right when it's actually on the left, hence a delay in follow up scanning, but that's another issue altogether.)
Is it notable that an area "lights up" more than it did on a previous scan, or does the uptake vary in a given lesion at different times?
2nd question: the lesion is "indeterminate" on MRI. The report says it is not stereotypical of any one lesion but also doesn't exhibit any aggressive imaging features. I take that to basically mean "we don't know what it is but it looks benign." It says it is unchanged from comparison with a June 2017 whole body CT scan. However, I note that based on that CT report and this new MRI report, it has increased in size a very tiny bit.
Is there a certain amount that a lesion can grow but still be considered "virtually unchanged"?
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I had my US guided core biopsies on Wednesday and the preliminary pathology came in today....
Lymph Nodes are clear (Thank God)
Mass in left breast is, unfortunately, IDC.
Hormone status, etc. pending.
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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Thanks, djmammo. I understand.
Just wondering, when things are noted as "post-surgical changes" on any scan, what does that mean?
My breast MRI, bone scan and PET all note this in my entire ribcage/chest area. How does one tell the difference between what is an area of concern and what is a "post-surgical change"?
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Just wondering, when things are noted as "post-surgical changes" on any scan, what does that mean?
The phrase "Post op changes" is shorthand to avoid listing all those things altered by a recent procedure like scarring, presence of surgical clips, the absence of the abnormality that was removed, any alterations that are new since the pre-op images.
How does one tell the difference between what is an area of concern and what is a "post-surgical change"?
Years of experience.
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Well I have to say, considering they erroneously reported a lesion on the wrong side, hadn’t even reported it on a previous scan (my oncologist’s PA and I could see it clearly with our untrained eyes) and still didn’t catch the left/right error when comparing the scan with the mri they ended up doing on the wrong side, I’m not sure I trust their judgment about what is or is not a post surgical change.
Am I within my rights to request my scans be viewed by someone else? Or to ask for a detailed description of what they are calling post surgical changes?How does one go about getting a radiologist at a different facility to view their previous scans?
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That's a good question Pesky! I also have wondered how to get a 2nd opinion on readings.
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