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Interpreting Your Report

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  • lorimsn
    lorimsn Member Posts: 5
    edited February 2018
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    djmammo,

    Thanks so much for replying to my post. So, it sounds like this will be a coin flip for me. I will be anxious to get the results on Tuesday or Wednesday and I will share them here. I have also not had any evaluation of the nipple abnormality as of yet and the other physicians have indicated that the breast surgeon will most likely want to biopsy that area as well. Is an obstructing lesion indicative of DCIS? I am also not clear whether the debris in the ducts are suggestive of anything. I should have mentioned before, I am 55 years old.

    The discomfort from the biopsy is some better today. There is still a good deal of swelling. The core biopsy was over 48 hours ago. Is the swelling and discomfort normal at this point? I am still using the ice pack.

  • momto3sons
    momto3sons Member Posts: 68
    edited February 2018
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    @lorimsn - my core biopsy was on Tuesday, and I used an ice pack for a couple of days. I’m still a bit sore at times, but I think it’s because they had to go close to the chest wall for the biopsy.

    I hope your biopsy comes back benign

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018
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    lorimsn

    I cant imagine the lump visible on your nipple has anything to do with DCIS. It arises from the lining of the duct and I have never seen it present as a cutaneous lump outside the breast. I have seen skin cancers on the nipple though and I have also seen a papilloma on a stalk that grew inside the nipple and extended out from a duct. That will need to be biopsied. Debris is a common finding in ducts on US in your age group. As far as discomfort is concerned it varies from patient to patient and can certainly last a few days. Is there a hard lump like a hematoma present? If you are taking NSAIDS like aspirin or motrin they can cause bleeding which will form a hematoma which can be tender.

  • brandiaw
    brandiaw Member Posts: 3
    edited February 2018
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    I am going back for a diagnostic but have been trying to understand the following test results. Can you help? I am 41 and had a 3D mammogram. This was my first mammogram. I'm really nervous.


    IMPRESSION:

    Grouped microcalcifications 6 o'clock right breast mid depth. Precautionary diagnostic evaluation is recommended. The patient will be contacted regarding the need for additional imaging.

    BI-RADS 0: INCOMPLETE - NEED ADDITIONAL IMAGING EVALUATION. Right breast diagnostic mammogram and possible bilateral breast ultrasound recommended.

  • lorimsn
    lorimsn Member Posts: 5
    edited February 2018
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    momto3boys,

    Thank you so much. I hope that your biopsy turned out ok. The waiting is the hardest part. All the best to you and thanks again for the advice.

  • momallthetime
    momallthetime Member Posts: 1,375
    edited February 2018
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    My daughter is 30yrs old, she went for her 6 mos mamo due to strong fam History, mamo was unimpressive, she has very dense breasts, and due to History also she had an MRI done.

    MRI results: Within the retroareolar left breast extending from the nipple-areolar posteriorly approx 4.0cm, linear enhancement with two associated sites of focal heterogeneous non mass enhancement are noted. The focal enhancement measures 0.5 and 0.3 cm. This represents an interval MRI change.

    MRI guided biopsy will be done tomorrow very early.

    Could someone explain, are there any indications of it being not benign maybe? The retroareolar seems to be a difficult spot to get to? Would that be a more painful type of biopsy? Thank you for your help.
  • lorimsn
    lorimsn Member Posts: 5
    edited February 2018
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    Thanks again djmammo. I am not using any NSAIDS. It does not feel hard, just firm on the lateral side of the breast. Thank you for the great news on the nipple lump. It was just concerning that both doctors so far indicated a need for biopsy of that area and the US report indicated the need for surgical consult. I feel more reassured now.

  • momto3sons
    momto3sons Member Posts: 68
    edited February 2018
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    Thanks lorimsn! My biopsy came back as benign, but I have a radial scar and ADH that needs to be removed. I have my follow up appointment tomorrow morning

  • astyanax66
    astyanax66 Member Posts: 223
    edited February 2018
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    Hi lorimsn,

    Hope your pain from biopsy is better. I'd never used an ice pack, and it helped a lot. Lesson learned. :)

    Mine was close to the chest wall as well. Still waiting for steri strips to come of. Have a good week


  • lorimsn
    lorimsn Member Posts: 5
    edited February 2018
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    Hi astyanax66,

    The pain is a lot better today. The ice pack was the only thing that helped me. I have an appointment with the breast surgeon tomorrow and should also get my biopsy results tomorrow. I hope you have a great week also.



  • momto3sons
    momto3sons Member Posts: 68
    edited February 2018
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    I received my pathology report - DJMammo, can you shed light on any of it?


    FINAL PATHOLOGY DIAGNOSIS:

    Right breast (9: 00, 7 cm from nipple), MRI guided biopsy: Solitary focus of

    atypical ductal hyperplasia (2 mm) in a background

    of breast parenchyma showing complex sclerosing lesion with extensive

    sclerosing adenosis, radial scar, apocrine metaplasia,

    columnar cell change and small duct ectasia.

    Microcalcifications associated with many small ducts associated with

    sclerosing adenosis.

    No evidence of invasive carcinoma.

    Comment: Immunostains E-cadherin, HMWCK, P63, SMMS-1, estrogen receptor and

    Ki-67 are performed on sections of paraffin

    blocks A1 and A2. Immunostains P63 and SMMS-1 highlights the myoepithelial

    cells, confirming the above findings of extensive

    areas of sclerosing adenosis and radial scar. The immunostains E-cadherin,

    estrogen receptor and HMWCK are positive; and

    negative for CK 5/6 in a solitary focus of atypical ductal hyperplasia. The

    immunomorphology supports the a

    bove findings. There is

    no evidence of invasive carcinoma.

    All immunostain controls show appropriate reactivity.



    I'm having an excisional biopsy on 2/22/18.

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018
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    momto3sons

    The significant findings are the ADH and the radial scar both of which will have to be removed. There is no cancer mentioned.

    The stains described in the second half of the report were used to confirm the above findings.


  • momto3sons
    momto3sons Member Posts: 68
    edited February 2018
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    Thank you! My doctor sort of read over the details with me, but not entirely.

    I'm scheduled for an excisional biopsy later this month.

  • bear741
    bear741 Member Posts: 4
    edited February 2018
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    Hi djmammo,

    Thanks for all your help here! I have mammogram/ultrasound results that I'd love help understanding -- some words seem bad but others good. I'm going to get a biopsy but it's taking a while to refer out and get scheduled and so I'm wondering how worried I should be in the meantime, and whether I should try to hurry along the process. I'm 28 and this was my first mammogram.

    DENSITY:

    The breast is heterogeneously dense, which may obscure small masses.

    MAMMOGRAPHIC FINDINGS:

    The densest portion of the breast is anteriorly in the upper outer quadrant, corresponding to the palpable firm tissue. There are pleomorphic calcifications seen in this area, without a definite mammographic mass. The calcifications appear to extend more posterior and superior to the palpable mass.

    There is no skin thickening or nipple retraction.

    LIMITED LEFT BREAST ULTRASOUND:

    The study was targeted to the upper outer quadrant. At the site of firm tissue anteriorly at about 1:00, 2 cm from the nipple, is an irregular hypoechoic mass which is parallel. The margin is lobulated and angular. It measures approximately 2.4 x 1.2 x 1.5 cm. There is a combined pattern of posterior shadowing and enhancement. Minimal internal vascularity is seen.

    IMPRESSION:

    Irregular mass at 1:00, 2 cm from the nipple. The pleomorphic calcifications extend posteriorly, superiorly and laterally from the mass.

    Biopsy is suggested.

    Breast MRI may be indicated to evaluate the extent of the mass, and to evaluate the right breast.

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018
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    bear741

    The term 'pleomorphic' is of concern as a description of the calcifications, as is the description of the mass. If the calcifications are directly related to the location of the mass, that causes additional concern.

    Since the mass is not visible on the mammo, the biopsy will likely be done under ultrasound. In cases like these when biopsied under ultrasound we would x-ray the little core samples to make sure that calcifications were present in the sample along with portions of the mass so that both are evaluated. Let us know how it goes.

  • bear741
    bear741 Member Posts: 4
    edited February 2018
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    Thank you so much for the quick reply! I will try to get the biopsy to happen ASAP. And will return with results.

  • brandiaw
    brandiaw Member Posts: 3
    edited February 2018
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    Hi djmammo,

    I am currently waiting on biopsy results. Hopefully I will get them today. I am so stressed out about this especially since the radiologist really didn't divulge any information on how my diagnosis was looking after the diagnostic mammogram, ultrasound, and biopsy. The only thing she said was it's 50/50. I feel like I'm in the dark and someone needs to turn the lights on. I am 41 years old, mother of 3 (2 in college one in elementary) and wife. Can you look at my screening results and let me know if I should continue to worry?

    EXAMINATION: MAMMO BREAST SCREEN TOMOSYNTHESIS BILATERAL 1/30/2018

    Computer-assisted detection was utilized in the interpretation of this exam.

    COMPARISONS: None. Baseline imaging.

    INDICATION: 41 year-old female who presents for annual evaluation. Saline implants placed 5 years ago. Family history of a paternal grandmother and maternal aunt with breast cancer at ages 55 respectively.

    FINDINGS:

    There is scattered fatty and fibroglandular tissue. There are no suspicious mammographic findings in the left breast.

    Benign postsurgical type calcifications are noted in the periareolar region consistent with a history of implants. However, additional grouped microcalcifications are present in the 6 o'clock position right breast mid depth.

    Bilateral saline implants are present. The presence of implants obscures evaluation of the posterior parenchyma.

    IMPRESSION:

    Grouped microcalcifications 6 o'clock right breast mid depth. Precautionary diagnostic evaluation is recommended. The patient will be contacted regarding the need for additional imaging.

    BI-RADS 0: INCOMPLETE - NEED ADDITIONAL IMAGING EVALUATION. Right breast diagnostic mammogram and possible bilateral breast ultrasound recommended.

    Thank you for any incite you may have.


    UPDATE: RESULTS CAME BACK BENIGN BUT WILL HAVE TO GO BACK IN 6 MONTHS.

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018
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    brandiaw

    This report is from the screening and many are intentionally vague, the diagnostic report is the important one but really moot at this point if the biopsy results were benign. A 6 month follow up at this point is merely routine.

  • brandiaw
    brandiaw Member Posts: 3
    edited February 2018
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    Thank you for responding. I truly appreciate it.

  • Hadiya
    Hadiya Member Posts: 1
    edited February 2018
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    Hi Nikki444, I wondered how you are doing. Any news yet? Thinking of you and sending prayers ~

  • Nikki444
    Nikki444 Member Posts: 4
    edited February 2018
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    Hadiya.. I have US guided biopsy of both breasts scheduled for Monday 2/12. I’m pretty much a ball of nerves. Thanks for asking

  • momallthetime
    momallthetime Member Posts: 1,375
    edited February 2018
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    Nikki44 crossing fingers and toes.

    I wanted to update you : The result of the MRI guided core biopsy came in as B9. Densely fibrotic with dilated ducts. She is scheduled for a follow up MRI in 6 months.

    Thank you for your help and caring.

  • andie5087
    andie5087 Member Posts: 1
    edited February 2018
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    Djmammo -

    I am hoping you can shed some light on my report. After reviewing some other reports on this board, mine seems to be very vague and lacking in information. Please let me know if you can shed any light on my Mammogram and US results. I am scheduled for a core biopsy on Thursday, 2/15.


    EXAMINATION:
    Bilateral Diagnostic Digital Mammography and Limited Bilateral Breast Ultrasound



    EXAM DATE:
    2/12/2018 2



    TECHNIQUE:
    Bilateral diagnostic mammography, producing direct digital images, all views. Bilateral limited breast ultrasound utilizing 18 MHz transducer.



    COMPARISON:
    None. Baseline study



    INDICATION:
    Palpable concern reported by patient and her physician upper outer quadrant of both breasts. Family history of breast cancer (paternal aunt).



    FINDINGS:



    Breast Density:
    There are scattered areas of fibroglandular density.
    Metallic markers are placed in the skin overlying the reported palpable concerns in the upper outer aspect of each breast. No underlying mammographic abnormality is identified. Subsequent ultrasound demonstrates no abnormality in these regions as well.
    In the upper outer aspect of the right breast, closer to the nipple than the reported palpable concern, there is a focal irregular area of increased density, which is found to represent an irregular solid lesion sonographically (see below). Biopsy is
    recommended under ultrasound guidance.
    No other evidence of dominant mass or suspicious calcification is present. Digital breast tomosynthesis demonstrates no other evidence of mass, nodule or distortion. The skin, nipples and vascular pattern are unremarkable.



    ULTRASOUND FINDINGS:



    Right Breast:
    Real-time focused ultrasound of the right breast is carried out the 1
    unremarkable.
    In the 10:00 position, 3 to 4 cm from the nipple, there is an irregular serpiginous appearing hypoechoic structure measuring 2.5 x 0.8 x 1.4 cm. Biopsy under ultrasound guidance is recommended to establish histology. The surrounding breast parenchyma is
    unremarkable. Scanning the right axilla, several normal-appearing lymph nodes are identified.



    Left Breast:
    The left breast is scanned in the 1
    Lack of mammographic and/or sonographic evidence for malignancy should not preclude the biopsy of a clinically suspicious lesion.
    These findings were discussed with the patient and her mother immediately following the examination on the afternoon of 2/12/2018.



    Impression:
    1. Solid lesion in the upper outer aspect of the right breast, warranting further evaluation with biopsy to establish histology. See discussion and recommendations above.
    2. The palpable concerns in the upper outer aspect of each breast demonstrate no mammographic or sonographic correlate. See above.
    3. No other evidence of dominant mass or suspicious calcification is present in either breast.



    Recommendation:
    Biopsy Right.
    Betty Ford Breast Care patient navigator will place an order for a Right Breast Biopsy per my direction for the additional diagnostics needed to evaluate the area(s) in question as noted in my assessment and impression above. Our navigator will ensure
    the appropriate follow-up appointment is scheduled.



    Follow-Up Interval:
    NOW.



    BI-RADS Category:
    4 Suspicious Abnormality - Biopsy Is Recommended.

    Thank you for your help! :)

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018
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    Andie5087

    Pretty straight forward report. They found nothing abnormal in the areas where you and your doctor felt something on each side. There is an incidental finding of a mass that looks suspicious enough for them to recommend a biopsy. The path report from the biopsy will let you know what it is.

  • youngguy
    youngguy Member Posts: 4
    edited February 2018
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    What does it mean when the radiologist uses the term artifacts?


    Also what kind of lumps do you most of find on women over 60? Are the lumps they biopsy ever b9 at that age?

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2018
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    Y’guy

    An artifact is a technical problem with an image, not a finding in the breast. In what context was it used?

    Most breast lumps biopsied are benign at any age so the short answer to your question is Yes.

  • youngguy
    youngguy Member Posts: 4
    edited February 2018
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    Thanks.

    The Dr called and told her via the phone that there were some artifacts and they were going to do a biopsy to rule anything out.

  • momallthetime
    momallthetime Member Posts: 1,375
    edited February 2018
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    Youngguy you could ask for the written report (which they must have) and there you should be able to get a bit more details. If she has dense breasts, they should follow up(from my experience only), with an Ultrasound or even an MRI, they could see if they see also in any of those two modes of imaging, then you could have even more info. And yes, if they actually see something, of course is wise for a biopsy. But they should have those other tests also.

  • youngguy
    youngguy Member Posts: 4
    edited February 2018
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    I am going with her in the morning to see what her Dr says. Her biopsy is scheduled for Wednesday morning.

    She had a mammogram in early December because she was having breast pain. It came back fine. Had a good clinical exam in January.

    Then a couple weeks ago she felt a lump and he referred her for an ultrasound. Which came back that they needed to do a biopsy.


    Does that make any sense? lol

  • momallthetime
    momallthetime Member Posts: 1,375
    edited February 2018
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    Yes, it makes sense. You have the report? Or when you go there tom you could ask for a copy, let us know the findings then we could give you an idea what you dealing with. Good luck