Interpreting Your Report
Comments
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There are a couple of ways you can go.
Call the radiology department of a local/nearby/regional university that has a med school and tell them you need your imaging reviewed and see what they say. You can start at their website, some will say explicitly that they offer that service. Not sure of the cost or if ins covers it. This one looks reputable: https://www.massgeneral.org/imaging/services/second_opinion.aspx
There are a many commercial sites on line you can find on Google that will do this for a fee. Not sure of the quality or price. Check the credentials of the staff on their website if they post them. I found several by searching "how to get a second opinion on your x-rays".
There is a service my hospital used when more than one of us was on vacation so that things got read on time. They refer to them as "overreads" rather than second opinions. I can vouch for the high quality of the readings as I know the founding radiologist. He is one of the smartest people I know, has written many books and articles. I am not sure they take requests from civilians, one of your docs may have to make the request and send the images. They are expensive. ProScan.Com (I am not affiliated in any way with that site or business).
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Thank you, djmammo, as always, you are enormously helpful! I appreciate this very much.
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Spoonie77 and pesky904 -
I have been dealing with this for just under a year. My original 'findings' was August 3, 2018 and confirmed on 8/8/18. I tried to get a second opinion about having to wait 6 months, but lost that battle and waited the 6 months. During the 6 months waiting, it became palpable which it originally had not been. This 'change' still did not warrant an earlier scan or shortened follow up. At my 6 month 'follow up', my growth/mass/yet to be named with a diagnosis had grown very little, but still had growth, and also was showing a 'feeding tail' which was not there before. This still did not warrant enough 'change' and they told me to wait a year. This really made me uncomfortable. I could feel it even more easily, noticed the changes, and did not understand why no one thought any of the changes were changes enough. The radiologist that found it, and did the follow up, never talked with me or explained the findings. My referring gyn only read the written report that contradicted some parts of the images and he did not study the images. I compiled the reports and images, and handed them to my gp and asked him if he would look at them himself to see if he could help with the insurance battle of wanting a second opinion. With the radiologist report and my gyn basically signing off on these, insurance was a battle. My gp did finally look at the images and reports and said he would get a second opinion if it was him. This took about 8 months. The door finally opened though. I was never able to get a different radiologist to look at my reports - insurance battle and doctors saying there was nothing to worry about remained a big roadblock. They don't have something growing in their breast that does not belong there. The statistics of findings being 'most likely benign', 'probably benign', '80ish' percent of growths are benign are not 'good enough' and do not confirm benign. I have a great uncle that had breast cancer, my father died from cancer, and have had a brain tumor as well as a tumor in my leg. My female history is considered 'higher risk' as it is unknown - grandmother, mother, and sister all died young - before breast cancer may have shown. As my husband said when he himself was diagnosed with prostate cancer, "It is not a '25%' chance (stats for his case) doc, either I have it or I don't. That sounds like 50/50 to me." He seems to feel the same way about my growth as well. All stats aside, it pretty much is a 50/50 chance for me, or really anyone, either I do or do not. With all of this being said, I kept at it, kept asking, and finally got someone to listen. My gp opened the door for my second opinion both with insurance and with being able to get into someone. I found that whenever I called someone to do so though, they did not want to just read the reports. They wanted to do their own exam as well as read the previous images/reports. I found a breast specialist a little over an hour away and got an appointment with him. Their exam was much more thorough than any I have every had. They still cannot conclusively say what it is, possibly an intrammary lymph node that has increased in size (it has been labeled several different things), and will do a biopsy. I am sure the biopsy will be benign. I have had many tell me I am pushing for something not necessary, but for me, it is the not knowing for sure that causes too much stress making it very necessary.
Push for a second opinion even if it means getting many 'nos' first or another exam all together. If you are worried, you will not stop worrying until you have the answers you need. It is your body, your worry, your concern. You are valuable and worthy enough to fight for yourself to get answers. Start asking over and over if needed. Do not take 'It is not necessary' until you are comfortable with that answer.
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Radiologist suspected intraductal mass. Breast surgeon could not see dilated duct with debris on her own ultrasound equipment, which was much older. I'm not sure if she didn't look at these images or just wasn't concerned. She did not think the palpable mass was in a duct, but took a biopsy. I'm waiting for a second opinion with a surgeon that came recommended, instead of just taking first possible appointment this time. Also waiting on biopsy results. Should I be concerned? I have stressed so much the past few weeks, but feel more calm and just curious now.
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Does this mean no cancer? And wow there’s a lot of cysts
Clinical history: patient has diffuse pain and discharge with blood.
Findings:
At 2 o’clock,1.0cm from nipple, there is a 0.7 x 0.6x 0.6cm hypoechoic lesion that is parallel and well circumscribed. Differential considerations include both a fibroadenoma or papilloma. There is a cyst at 12 o’clock, 3cm from the nipple measuring 0.6cm. Another cyst is noted at 6 o’clock, 5.0cm from the nipple measuring 0.7cm. A cyst is noted at 8 o’clock, 4.0cm from the nipple measuring 0.8cm. No abnormal axillary lymph nodes.
Opinion:
There is a 0.7cm hypoechoic lesion at 2 o’clock, 1cm from the nipple. Deferential considerations include fibroadenoma or papilloma. Ultrasound guided biopsy should be considered.
Birads:0
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My report tells me the size of my mass, however I can't figure out if the measurements given mean taller than wide or not!!
Is 1.6 x 1 x 1.8 cm good or bad??
On my previous MRI 6 months ago the widest point was 1.3 cm so I'm certain it's grown
It's an oval, lobulated, hypoechoic mass with "no significant internal blood flow" .on MRI it was considered a "rim enhancing focus". I am put at BIRADS 4 No subgroup was noted. Core needle biopsy scheduled next week.
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Last year I had an excisional biopsy that revealed ADH. At 6 month follow up I asked for a breast MRI as I have some dense areas. I knew MRI could pick up a lot of benign things that have to get investigated but I still wanted one MRI as sort of a baseline after excisional reveled ADH.
Findings of Breast MRI: There is mild bilateral background parenchymal breast enhancement. In the 11 o'clock position of the right breast 5 cm from the nipple there is a 1.3 cm x 1.2 cm oval cystic partially lobulated and slightly spiculated enhancing mass. The mass exhibits rapid enhancement with persistent delayed phase. There is no washout. In the lateral aspect of the right breast there is a 4 mm benign intramammary lymph node exhibiting very minimal enhancement. There are less than 5 foci of enhancement in the breasts bilaterally believed to represent enhancement in normal background breast parenchyma. There is no abnormal enhancement or masses in the left breast to suggest left breast carcinoma. Small 4-5 mm simple bilateral breast cysts are noted. The skin and nipples appear normal. There is no axillary or internal mammary adenopathy. Post biopsy scarring is identified in the inferolateral aspect of the right breast.
Carcinoma couldn't be ruled out and it was listed Birads 0. It was recommended that I get a mammogram and ultrasound as well. I did that the other day and don't have the full report yet.The Radiologist who looked over the mammogram and ultrasound talked to me at the end and said it was a very wise move on my part to get the MRI because this mass was hidden in dense breast tissue. He said it was not easily visible on mammogram and while they were able to find it with the ultrasound, it is possible that it was missed last time (the ADH was micro-calcification not lump). He confirmed that the mass was both smooth and also irregular and spiculated. He told me that was an unusual finding, something they don't normally see. I'm not sure what to make of that. He rated the mass birad 4 (he didn't want to specify a, b, or c. They don't normally do that there). He recommended it be biopsied. I have a follow up with the BS next Wednesday to make a biopsy plan.
Does anyone have any information about masses that are both smooth and spiculated? Is that abnormal in your opinion? I would think radiologists have seen it all so it seemed strange for him to say that it was an unusual finding. Appreciate any insights. Thanks!
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It means they have narrowed down their diagnosis to two different possibilities, neither of which is cancer however papillomas are removed due to a slight malignant potential.
The pathology report will tell you if it is cancer or not.
And no, that is not a lot of cysts. ;-)
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MRI is the routine followup for a biopsy showing ADH.
The mass described could be classified as a complex cyst as there are both cystic and solid elements present and the solid portions enhance, and these are always biopsied. As far as the margin is concerned, we always go by the more suspicious feature of any mixed finding as it is described in the report. Anything with an abnormal border, even if it is only a small portion of the border, is viewed with suspicion and biopsied.
Let us know what the biopsy shows.
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I don't understand parts of the mathematics behind this stuff very well. I'm not trying to be rude or overly demanding.
6.8 mm solid nodule with calcifications is seen in the 3:00 position of the left breast
BI-RADS category 4 -Suspicious Finding Biopsy should be considered
^ ^ That's from the spot magnification views and ultrasound ^^
I have a fair amount of breast and other cancers in my family.
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Thank you DJMammo
My appointment with the BS got pushed out a week due to surgery but I went to the breast center and got a copy of my report for the second look mammo and ultrasound.
Mammo finding: Comparison breast MRI revealed an enhancing mass located within the right mid breast slightly lateral to the nipple line. Margins are partially well-circumscribed and mostly spiculated. This lesion is suspicious. On mammography, moderate residual fibroglandular tissue is present. Today's mammogram reveals an ill-defined focal asymmetry/mass corresponding to the abnormality on MRI. This lesion is regarded as suspicious.
Ultrasound finding: Multiple images of the entire right breast were obtained including all 4 quadrants and the retroareolar region. There is a simple cyst at 1:00 - 2:00 position right breast 1 cm from the nipple measuring 5mm. There is a heterogeneous mass with microlobulated margins at 10:00 - 11:00 position 5 cm from the nipple measuring 1.4cm. This represents the ultrasound correlate to the Mammographically as well as the MRI findings.
Impression: There is a suspicious mass within the right breast which was discussed in detail on MR breast exam dated 5/7/2019. Ultrasound and Mammographic correlates are visualized on today's respective studies. Specifically on ultrasound, a 1.4cm hypoechoic lesion with microlobulated margins is identified at the 10:00 - 11:00 position right breast 5cm from nipple.
The things standing out to me at the moment are: hypoechoic, microlobulated, mostly spiculated. Given my last biopsy revealed ADH I'm a bit concerned. Is there anything else in this report that stands out? Biopsy is the next step but given that this might have been missed by last year's mammogram and ultrasound, I don't feel confident in getting an ultrasound guided biopsy, even if they can see it now. I would feel better with an MRI biopsy since MRI found this mass hidden in dense tissue. I will see what the BS says. Any thoughts on what type of biopsy might be best? I'm disabled and can't do the table type where your neck is turned which is why last year I went right to excisional biopsy last year. I'm glad I did since they found ADH. Thank you so much!
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That is really not enough information to suggest either good or bad. US findings of the mass, and a description of the size and pattern of calcs would be necessary to make that call.
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After an MRI, if a mass is found on US that corresponds in size and position to the MRI finding, the mass is biopsied under US. That's pretty much how every radiologist does it. Also the US is so much faster and easier on everyone that I always prefer to do bx's under US if I can. I have had to do relatively few MRI guided biopsies over the years as I have always worked with excellent breast US techs who seem to be able to find almost anything I asked them to look for.
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Hi. Spoonie77 suggested I post here, so I am posting.
I am re-reading my pathology report and it is written unlike any I have seen online. All of the things written are unimportant conditions according to various resources, but I was dx with ADH by my breast surgeon, and now I am so confused. I see the MO on the 26th, I just am so lost while I wait. If you have a moment, here is what the diagnosis on my report says:
"Complex sclerosing lesion with extensive columnar change, columnar cell hyperplasia and apocrine metaplasia, with focal atypia, and sequela of previous biopsy." It says this both for the excisional biopsy and the lateral margin.
I know that a sequela is scar tissue, but looking up the rest all suggests there is nothing to be concerned about. Any help is appreciated.
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"I was dx with ADH by my breast surgeon, and now I am so confused. I see the MO on the 26th"
**https://www.drsusanloveresearch.org/atypical-hyper...
"All of the things written are unimportant conditions according to various resources"
**All path findings are important. They are however not all clinically significant.
"Complex sclerosing lesion with extensive columnar change, columnar cell hyperplasia and apocrine metaplasia, with focal atypia, and sequela of previous biopsy." "...but looking up the rest all suggests there is nothing to be concerned about"
**https://www.ncbi.nlm.nih.gov/pmc/articles/PMC50121...
"I know that a sequela is scar tissue...
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"...just confused about how this pathology report leads to a dx of ADH."
Two reports are generated after a biopsy if a radiologist did the biopsy, one from the radiologist and one from the pathologist. These would both be sent to your surgeon. If the surgeon did the biopsy then they just get the report from pathology. The pathologist reports the diagnosis in their report, and the radiologist decides if the diagnosis correlates with the imaging findings.The surgeon takes it from there.
Is what you posted the conclusion of the post-biopsy path correlation report from a radiologist, or is that from the official path report from the pathology department? I agree it sounds incomplete. At this point I am assuming "atypia" refers to ADH more fully described elsewhere in one of those two reports.
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I didn't see this reply (it didn't pop up as a notification), sorry about that.
This is the report directly from pathology. My surgeon is the one who ultimately discussed with me and posted the diagnosis, which appears in my hospital account "patient portal" with no further detail. The only time I saw a radiologist it was the initial mammogram for a lump, which made distortion on the mammogram, which lead to an U/S that was inconclusive, then a stereotactic biopsy which also didn't explain the distortion, and then the breast surgeon finally performed the surgical excision that led to this report.
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Hello, I read some advice in this forum to post my pathology report for help interpreting it. I'm wondering if I should get a second opinion on the diagnosis of ADH as it is only signed by one pathologist and I know there can be differences in opinion between ADH and low grade DCIS. I'm 34. The pathologist collected tissue from a major duct excision during the surgery, I'm not sure if it's the same pathologist who did the report:
In slide E, is present an intraductal epithelial proliferation involving some adjacent ducts. While most of these have cellular features of usual ductal hyperplasia, one duct shows more micropapillary structures. Immunostains for CK5/6 and P63 were done. These proliferating cells show abundant staining with CK5/6 and these ducts have a surrounding myoepithelial cell layer. Due to the unusual micropapillary pattern of proliferation, this focus is interpreted as atypical ductal hyperplasia. A focus of atypical ductal hyperplasia is also seen in block B. It is not well represented on the CK5/6 immunostain slide.
Final diagnoses
Right Breast Major Duct, Excision:
- multiple papillomas, some with hemorrhagic necrosis
- atypical and usual ductal hyperplasia
- fibrocyctic changes, surrounding breast tissue
Thank you very much for any additional insight!
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Four out my five mammograms have been call backs, so I am getting used to it. (I've had one biospy and I have two known fibroadenomas in one breast. I also had a cyst at one point.) But I still can't help but worry. I have to go back for a 3-D Mammogram this next Thursday. My mammogram report says the following:
There is a 1.3 cm asymmetry in the left breast posterior depth superior region on the MLO view only. This asymmetry was not previously imaged on the MLO projection. If it corresponds to the left inner asymmetry seen on the CC image, it would be stable over time. [This CC inner asymmetry is a known benign mass that I have had for at least 10 years.] If, however, it does not correspond, then additional work up will be needed. The 1.3 cm asymmetry in the left breast is indeterminate. 3D imaging view as well as possible ultrasound of the left breast are recommended.
There were no other significant findings.
After reading this many times, I figured out that they suspect the 1.3 cm asymmetry is a fibroadenoma that is known to be in that area and is the same size. However, I am confused as to why it was never "previously imaged" on the MLO view. I am so tired of call backs and the anxiety and disruption they cause each time; however, I am grateful that they have all, so far, turned out okay. I am going on a trip with my husband and I come back the day before my 3D diagnostic, then I leave to go to the beach for a few days with my friend. I hope I don't need a biopsy. This all makes me crazy. I would just like to be able to enjoy a few summer trips without worrying. I dread mammograms so much.
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C4ndy
If the breasts are extremely dense it is not at all unusual for it to be seen in only one view. This is the reason for most recalls across the board. Another cause is the mass’s location. If very far back in the breast it may not always be in the field of imaging. This can change with weight gain/loss
An US will answer the question.
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Both the known fibroadenoma and the asymmetry are in the top posterior area. I know the Fibroadenoma is hard to get to because I've had to have diagnostic screenings of that one (it is on the inner side). I am hoping it's just been out of the picture field on that one view.
Thank you for your help.
EDIT 6/22: I had the diagnostic today and they verified that the "new" asymmetry was the fibroademona I've had for many years.
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Hello. I am 34 with no family history of BC. My PCF ordered a mammogram due to unexplained swollen lymph nodes in my left underarm. They would come and go and have been gone for about 2 weeks. I thought getting a mammogram unnecessary but had one done anyway and then I got a call back. Here are the results.
EXAM: SCREENING MAMMO 3D - BILATERAL
COMPARISON: None.
HISTORY: Annual screening mammography. No complaints.
TECHNIQUE: Standard bilateral mammographic views were obtained.
Additional 3-D tomographic mammography was also obtained. Current study was also evaluated with a Computer Aided Detection (CAD) system.
FINDINGS:
The tissue density of both breasts are heterogenously dense, which may obscure small masses.
There is an asymmetry within the medial anterior one third depth right breast seen only on cc view. No suspicious calcifications or other significant findings.
In the left breast no suspicious masses, calcifications, or other significant findings.
IMPRESSION:
1. Right breast asymmetry.
2. There is no mammographic evidence of malignancy in the left breast.
RECOMMENDATION:
1. Recommend right diagnostic mammogram and possible limited breast ultrasound for further evaluation.
I have a follow up scheduled but looking for peace of mind in the meantime. Seems so vague to me but I also dont understand the language. Also, why with dense breast tissue would the opt for another mammogram and not just do an ultrasound.
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Well the problem I see here is that you have a finding on physical exam yet had a screening mammogram. Screening reports are intentionally vague plus there is no mention of lymph nodes which are usually seen on Mammo and happen to be of interest to you.
This should have been ordered as a diagnostic study with ultrasound to follow. You would have seen the nodes in question and since they already had an order for the US they could have looked in the area of the asymmetric density on the right and the lymph nodes on the left and would also have saved you an additional trip to the center.
Let us know what the follow up study shows.
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Hi DJmammo,
My mom was diagnosed with breast cancer at the age of 45 and I'm approaching 40 so I went in for a routine exam . Mammo was clean but revealed I had dense breasts and the ultrasound revealed a hypoechoic mass at the 8 o'clock location of my left breast 3cm from the nipple. A target u/s confirmed this and I was given a birads 0 but marked “probably benign" with the recommendation of an aspiration or CNB. The radiologists explained to me at the time that it looks like a complex cyst. I had my CNB and my doctor called me to tell me it was benign but wanted me to remove the entire lesion for further testing. The pathology report did not say explicitly it was benign but stated the following: "Complex sclerosing lesion with focal papillary features. Microcalcifications are present". What does this mean and should I be concerned? I am still waiting for my results from my excisional biopsy. Many thanks for your help
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Since you have already had the excision, I am not sure what I can add.
I am not a pathologist so here is an article that you should find helpful: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361064/
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Here are the results of the study. I am thinking everything is ok. Plan is follow up breast exam in 3 months and follow up diagnostic mammo in 6. The tech measured something when she was doing the ultrasound and then radiologists came in and couldn't 100% duplicate her findings. He feels like it is dilated ducts but couldn't be 100% sure. Also mentioned my age (34) and stated that really I shouldn't have had a mammo until at earliest 40. I explained the initial enlarged lymph nodes that have since gone away and he didn't seem concerned, in fact made it seem like a silly reason to come in. My husband and I both left feeling like we didn't have an answer. The report makes it a little clearer for me but still unsure. Can another radiologists look at the scans and form a second opinion or should I just wait 6 month and go somewhere else?
TECHNIQUE: Right diagnostic mammographic views were obtained. Additional 3-D tomographic mammography was also obtained.
FINDINGS: The breast tissue density is heterogenously dense, which may obscure small masses.
With additional spot compression, there is a persistent right breast asymmetry medial to the nipple in the anterior depth that changes in configuration slightly. No suspicious calcifications.
Targeted right breast ultrasound was performed from the 2-4 o'clock positions. Mild duct ectasia is seen medial to the nipple. Dilated ducts might account for the mammographic finding although this is difficult to say with absolute certainty. No suspicious solid masses are seen.
IMPRESSION:
Persistent probably benign right breast asymmetry. This may correspond to areas of duct ectasia on targeted ultrasound.
RECOMMENDATION:
6 month follow-up diagnostic right breast mammogram is recommended to ensure stability.
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Well if it looked like a cancer they would tell you and biopsy it. There is no mass described, spiculated or otherwise so thats good. Ductal ectasia just means dilated ducts and we don't always see what is causing that. If there was bloody nipple discharge and dilated ducts that would be a different story, they would then be looking inside those ducts for a tiny mass.
If you get copies of all your exams and the corresponding reports you can call other hospitals in your area (especially if its a university hospital) and tell them you want your studies reviewed by a radiologist and they can either accommodate you or tell you where else to try for a second opinion.
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djmammo,
First I just want to say thank you for being available for us to ask questions about our reports. The insight you provide truly helps through this process!
A little history, I first had a diagnostic mammogram and ultrasound 4 weeks ago due to spontaneous bloody discharge, my subjective feeling of thickening and my doctor feeling a lump in my right breast during a physical exam. The mammogram and ultrasound came back with normal findings and a BRADS 1 - negative rating. I was referred to a breast surgeon due to the continuous bloody discharge. She sent me for an MRI due to my symptoms and an extensive maternal family history of breast cancer. The MRI was done this last Sunday and I just got the report from the MRI and it states,
"IMPRESSION: Right breast: Heterogeneous nonmass enhancement throughout the retroareolar right breast demonstrating linear and segmental distribution raises the concern for underlying ductal carcinoma in situ, especially given the provided clinical history of bloody nipple discharge. Further evaluation with mammography may be indicated in order to determine whether suspicious calcifications have developed. In the absence of calcifications, second look right retroareolar ultrasound is recommended."
"Right breast: There is heterogenous nonmass enhancement demonstrating linear and segmental distribution throughout the right retroareolar breast demonstrating focal regions of washout kinetics. There is associated increased skin enhancement throughout the anterior aspect of the right breast."
"BIRADS 0 - needs additional imaging evaluation"
I think I generally get the concept of what a nonmass enhancement is but I was hoping you could explain the difference between linear and segmental and what washout kinetics are. I also was curious what "increased skin enhancement" means typically. Is it referencing density or is it usually a reference to the skin absorbing contrast and being enhanced on the imaging, or something completely different
I love to learn so if there is a study or other resource that explains these terms I would be happy to read it if you point me in the right direction I also was wondering if it is common to get another diagnostic mammogram or ultrasound so soon. Will it help with the imaging process to be able to look at a specific area of concern now that the MRI has pointed one out? I guess I am just wondering why they don't recommend a biopsy instead of additional imaging.
Thanks again for your time!
Carissa
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