Interpreting Your Report

Jrine890709

Can you explain to me why my history would factor into them wanting to do the biopsy since the adjectives they used are basically benign? Sorry, I am just confused and was in shock that they saw something on my left aode since I originally went in for the swelling and itchiness in my right that I have been experiencing for the past couple of weeks.

djmammo

Jrine890709

The reason is there is a large overlap in the features of benign and malignant things in breast imaging and none of us want to miss a cancer, especially in someone with a higher pre-test probability of having it.

Symptoms do not affect the side on which we may find an abnormality.

Jrine890709

Thank you! It’s all just a little overwhelming

djmammo

Jrine890709

You will get used to it. This will not be the last such biopsy that will be recommended/performed, such is the fate of the BRCA+ patient with relatives who have had gyn cancers.

If you haven't started already, you will likely be put on a regimen of yearly mri alternating with yearly mammo, offset by 6 mos. Its currently the best way to catch something early and ins should pay for it. They may also pay for a prophylactic mastectomy should that be offered to you, you may have to call the ins company and ask .

The best advice I can offer is this: each time a biopsy is recommended, ask them if they think its an actual cancer or if they are just "covering themselves" as a way of opening up an honest conversation with your docs as to what is really necessary and what is not .

Jrine890709

I will definitely ask them. This was my first mammogram and ultrasound, the GP I saw only ordered them because I kept insisting that something didn’t feel right with my right one

Sherri000

djmammo

As I mentioned previously I was waiting for an addendum after biopsy as my samples were sent off for staining. I have the addendum finally. Any insights are appreciated. I have an appointment with an oncologist tomorrow and a lumpectomy scheduled for the end of next month. Also I am 46, almost 47.

Addendum Interpretation

BREAST RIGHT US BX - LESION - 10-11 O'CLOCK - 14G - TOPHAT

--Immunohistochemistry for CK5/6 and Estrogen receptor (ER) performed on A1 and A4:

-Shows a pattern of decreased CK5 6 and increased ER expression in the atypical areas, consistent with the diagnosis of atypical ductal hyperplasia (ADH).

--Immunohistochemistry for pankeratin and myoepithelial markers (P 63, smooth muscle myosin, calponin) performed on A1 and A4:

-Shows focal loss of the myoepithelial layer (slide A1, less than 1mm total), which is concerning for a possible microinvasive carcinoma.
--The small quantity and unusually bland appearance of the atypical glands that lack a myoepithelial layer limits the interpretation. Additional sampling is encouraged for a more definitive interpretation. See comment.

COMMENT:
The typical management of ADH is surgical excision of the mammographically abnormal tissue in order to further assess for the possibility of a more severe lesion. In some cases, more conservative management including close follow-up and/or hormonal blockade can be considered.

--In this case, the presence of rare small glands that lack a myoepithelial layer and the relatively young patient age strengthens the recommendation for additional surgical sampling of the abnormal breast tissue.
--Correlation with the clinical and radiographic findings is necessary for definitive assessment and management.

djmammo

Sherri000

The details in this report are mainly for the pathologist where you had your biopsy done . The short answer is they will remove that area and examine it in more detail than can be done with just the needle biopsy material to make sure there is just ADH present since there was an extremely small area suspicious for something more, but not enough evidence to know for sure .

(Technically what you are having done is an excisional biopsy . The term lumpectomy is reserved for the removal of a known cancer)

Miranda5579

Hi all. (Especially djmammo). I’m new to this site and new at being the patient. I’m an RN with a strong cardiology and minimal oncology background. Please offer some positive insight in regards to my radiology report. Bx is scheduled for 7/17. Thanks!

Imaging

Result Information

Date and Time: Exam End: 7/12/2019 8:47 AM

7/12/2019 10:58 AM - Radiology, Oru In

Impression

IMPRESSION: INCOMPLETE: NEEDS ADDITIONAL IMAGING EVALUATION

The 0.6 cm irregular focal asymmetry in the left breast is indeterminate.

An ultrasound is recommended.

ULTRASOUND OF LEFT BREAST AND AXILLA: 7/12/2019

RESULT:

Comparison is made to exams dated: 2/4/2014 mammogram - and 3/11/2014 mammogram -

Color flow and real-time ultrasound of the left breast axilla were

performed. Gray scale images of the real-time examination were reviewed.

There is 3.2 cm x 1.6 cm x 1.5 cm irregular lesion with an indistinct

margin in the left breast at 2 o'clock posterior depth 8 cm from the

nipple. This irregular lesion is of mixed echogenicity. This correlates

as palpated and with mammography findings. There is an adjacent node .

It is difficult to tell if there are two nodes or a focal lobulation. I

recommend biopsing the ?lobulation. It is marked biopsy #2.

No abnormalities were seen sonographically in the left axilla.

IMPRESSION: SUSPICIOUS OF MALIGNANCY

The 3.2 cm x 1.6 cm x 1.5 cm irregular lesion in the left breast is at an

intermediate suspicion for malignancy. An ultrasound guided biopsy is

recommended.

Thanks! (FYI- BIRADS 4b)

Verdana

DJMammo,

Yes, it's that one.

My doctor called me back in for a follow up, so I contacted a breast surgeon I'd previously seen and she also looked at the report. When I asked why she recommended F/U, she said she wanted to do an examination for 'clinical correlation' and then probably a second ultrasound. Not sure why you'd need a second ultrasound?! The people at the breast clinic (radiographer/radiologist) had seemed reassured by the images, so it seems a bit strange and I'm not sure whether or not to worry. The breast surgeon's email said 'the ultrasound itself isn't worrying, but I need to follow up for clinical exam.'

djmammo

Miranda5579

The description of the mass makes the conclusion a reasonable one. They will likely want to biopsy the adjacent node as well .

After the biopsy if the path is positive an MRI is usually performed to look for any additional areas of concern followed by a lumpectomy . Further treatment would be determined after testing is completed on the lumpectomy specimen .

djmammo

Verdana

Surgeons want to examine patients after the scans to make sure that what they are feeling is what is seen on imaging . If the location and size don't match, the evaluation continues .

When a patient comes in with a lump everyone can feel and the imaging suggests a benign etiology a follow up is done to make sure we didn't miss anything and/or that what we saw is stable over time .

This redundancy is your safety net .

Miranda5579

Thank-you so much for the quick response. I’m officially in the “go with the flow” mode. No more googling. I just want this over so I can move on!

gaelle79

Hi all

I'm new here and I'm really grateful that I found you guys. I'm a french speaker so pardon my english.

I'm 40 with no history of BC in my family.

In 2007, I felt a palpable lump in my left breast. I was 28 at the time so the doctor did a sonogram and diagnosed the lump as a fibroadenoma. The radiologist recommanded removing it but my Oby, told me to leave it alone since it could never become cancerous and wasn't causing any pain or discomfort. In 2016, I had a child and beastfeeded her for 6 months with no issue.

Last year, I started feeling a mild burning sensation in that breast, now and then (usualy a few days before my periods). So I asked for a check up. I just got the result of my mammogram. That exact same lump is described as:

- hypoechoic

- 3.0x2.5x1.5 cm (diameter was 2.2 cm when first measured in 2007)

- microlobulated

no calcification or architectural distortion, axilary lymph nodes are clear

- BI-RADS IV, biopsy in a few days.

I'm terrified right now... How likely is a 12 years old lump to be cancerous ? Can a breast cancer stay asymptomatic for that long without spreading ? Can a fibroadenoma become cancerous despite what i've been told ? What else could this be ?

Thanks for your help

djmammo

gaelle79

Did they have your study from 12 years ago to compare to the current one? Is it the same lump? Is it the same size as 12 years ago?

gaelle79

I lost the previous sonogram pictures. Only have the report. The lump had a diameter of 22mm 12 years ago and it’s now 25mm.

I think It’s the same lump. I do regular breast palpation. Always spotted that lump. The only other explanation would be that the former lump totally disappeared and a new one grew out right in the same place.

Now I really don’t understand how this lump is showing these characteristics (hypoechoic, microlobulated) that point strongly to cancer

djmammo

gaelle79

When we see that a benign appearing mass has not changed in 2 years, we no longer follow it . If this is the same mass and it has been stable over 12 years, then it is considered benign .

Those characteristics alone do not "strongly point to cancer" . There are many features that can be shared by both benign and malignant masses and these are two of them .

SazzleD

Hi djmammo.

I hope you're well! I'm currently living in Indonesia and recently discovered a lump in my right breast. The procedure so far here has been super efficient. I did have to push my GP for a referral to a specialist, but since then everything has moved really swiftly. I found the lump on the 6th of July and am scheduled to have it removed on the 28th. In my last visit to the oncologist following up on the ultrasound, I wasn't given a great deal of information other than being informed of the need to remove the mass. I have copies of my scans and the report from the radiologist, which I've used Google translate to interpret as follows... (nothing suspect was found in the left breast)

MAMMAE DEXTRA.

The 'kutis' and 'subkutis' does not thicken.

There is no retraction of papillae.

Echoctrusture background loose homogeneous fibroglandular tissue. The appearance of hypoechoic lesions in the oval boundary shape as circumscribed edges is irregularly mucrolobulated and spiculated, wider than taller, parallel orientation to the skin, with posterior shadowing, and posterior enhancement, not visible calcification, at 9 / 5cm (0.80 x 0.48 x 1.22 cm) )

In CDS there is no intralesional vascularization. Does not look calcified.

The lactiferous duct does not widen.

Impression: The solid mass of dexterous mammary oval boundary forms circumscribed irregularly microlobulated and spiculated edges. Suspicious abnormality (Birads US 4C).

I was wondering if anyone could help with interpreting this result. The doctors here are reluctant to give as much information as those in the West, I'm mainly wondering why removal is the next step versus a biopsy as I had expected, perhaps becsuse the mass is small. Don't get me wrong, since I became aware of it, it has proven to be a bit painful and I'll be glad to have it removed! Just curious to know if I should be concerned about longer term treatment following the procedure.

Thank you!

djmammo

Sarahdot

The description is suspicious but regardless of the translation Birads 4c has the following connotation:

"But, when we see a mammogram with a classification of bi-rads 4C, the positive predictive value of breast cancer jumps up to around 79%. So, this means that category 4C indicates a high risk for breast cancer. A birads 4a has 13% chance of malignancy." May 7, 2019 (from https://breast-cancer.ca/bi-rads/)

In the US the standard of care is image guided biopsy first so that surgery can be better planned, and be limited to one surgery rather than one for diagnosis and one for margins and/or nodes. Not sure what the protocol is over there.

SazzleD

Thank you so much for your swift reply, djmammo. The oncologist mentioned that he would take around a cm of tissue around the mass too, so hopefully if it does turn out to be something to worry about, I'll have clear margins and not have to go though another op. Fingers firmly crossed! Thanks again.

Kims911

When the ultrasound report mentions shadowing on Hypoechoic mass is that more concerning

djmammo

Kims911

The short answer is yes, most of the time. Is your report posted elsewhere in the forum?

Kims911

I tried to post it but I am getting error that I am unable to post attachments at this time?

Kims911

I retyped it from the report thank you so much

Diagnostic Mammogram

There is persistence with asymmetries in the right breast medially and laterally necessitating ultrasound

Ultrasound findings

Demonstrate a Hypoechoic nodule with shadowing at 230 measuring 0.8 x 0.5 x 0.6 cm

There is also a Hypoechoic mass at 9:00 measuring 1.6 x 0.9 x 1.5 cm

There are also minimally complex cysts at 8:00

There are some lymph nodes in the right azilla

Impression

There are two suspicious areas in the right breast necessitating ultrasound guided biopsy

One at 9:00 measuring 1.6 cm and the other at 2:30 measuring 0.8 cm with some shadowing

Final assessment BI- Rads IV suspicious findings.

I can feel the mass at 9:00 if that matters

Feels like a small hard pea

Does not move

Feels like it might be attached to tissue or something if that makes sense

Kims911

I recorded the conversation immediately following the ultrasound

Kims911

djmammo

Kims911

They don't offer a lot of detail but what they do say would warrant a biopsy. The nodes are incompletely described. Let us know how the biopsy goes.

Kims911

Thank you

Biopsies are on Tuesday

Thanks for taking a look

Kims911

Can you tell me from the measurements if they are taller than wider? I’m not sure which number is height and which is width

Thanks again

djmammo

Kims911

There is no convention that I am aware of for the order of the measurements so there is really no way to tell unless it is stated in so many words in the report.

Kims911

ok thank you so much