Interpreting Your Report
Comments
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I called the office and they said the measurements are length x width x height
So I guess mine are taller than wider.
Guess I will ask the doctor for more clarification tomorrow morning when they do the biopsy
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Hi Djmammo,
Recently received the following report:
HISTORY: Patient was recalled for additional imaging of mass and asymmetries in the left breast on
screening breast ultrasound and screening mammogram dated 7/16/2019. History of invasive ductal
carcinoma and ductal carcinoma in situ status post breast conservation therapy in 2014. History of
stereotactic guided biopsy of the left breast marked with a bow shaped biopsy clip on 1/23/2018 and
outside pathology report of benign breast tissue with fat necrosis.
COMPARISON: Multiple prior mammograms dating back to 7/17/2017, ultrasound breast 7/17/2019,
6/30/2016
TECHNIQUE: LEFT diagnostic digital mammogram with tomosynthesis was performed.
Directed ultrasound of the LEFT breast was performed by a trained sonographer.
BREAST PARENCHYMAL COMPOSITION: B - Scattered areas of fibroglandular density
FINDINGS:
MAMMOGRAM FINDINGS:
There are changes of breast conservation therapy in the left breast. A bow shaped biopsy clip is
noted in the upper outer left breast at posterior depth at the site of previous biopsy. The
questioned asymmetry in the outer left breast does not persist.
On additional imaging, the questioned calcifications in the left axilla does not persist,
representing artifact.
SONOGRAM FINDINGS:
Directed ultrasound of LEFT breast was performed to evaluate the previously described mass on
screening ultrasound and the mammographic findings. In the left breast at the 12 o'clock position 4
cm from the nipple near the lumpectomy site, there is a 1.3 x 0.4 x 1.2 cm parallel oval
heterogeneously hypoechoic mass and irregular margins. Mild peripheral vascularity is noted.The report seems to contain both favorable and non-favorable terms. The assessment was BIRADS 4 and a biopsy was recommended. Wondering if the report is more or less favorable? Biopsy scheduled for next week.
TIA!
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A new mass in someone with a hx of breast ca near the site of surgery will always be biopsied regardless of its appearance as your pretest probability is now much higher than before your diagnosis. Parallel is usually a good sign but the architecture in the area has been disturbed by the surgery and its usual significance may not apply.
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Thanks for the reply. Fingers crossed
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djmammo, these are the results of my diagnostic unilateral mammo and us.
Breast History:
Lifetime Risk: 5.50%
Had BC?: No
Family History: None.
PROCEDURE: MG TOMO DIAGNOSTIC UNILATERAL
INDICATIONS: Fibroadenosis of unspecified breast.
BREAST COMPOSITION: Scattered areas of fibroglandular density.
FINDINGS: CC and MLO spot tomo views and straight lateral view of the left breast were obtained and correlated with prior screening study. The partially obscured nodality in the posterior one-third inner upper left breast persists on spot views and appears to correspond to a solid, well-circumscribed mass on ultrasound. This likely represents a benign fibroadenoma. Ultrasound-guided core biopsy can be performed for histopathological correlation to ascertain benignity. Please see ultrasound report for detail.
The nodular density in the central left breast appears to compress on spot views and does not correlate with any focal solid or cystic mass on ultrasound. This likely represents benign fibroglandular tissue.
ASSESSMENT: SUSPICIOUS. BIRADS-4A.
RECOMMENDATION: Ultrasound-guided core biopsy of left breast lesion at 10 o'clock, 6 cm from nipple.
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PROCEDURE: Ultrasound Breast Unilateral Left
COMPARISON: None
INDICATIONS: Left breast fibroadenosis
FINDINGS: Sonographic evaluation of the left breast shows a well-circumscribed hypoechoic lesion at 10 o'clock, 6 cm from nipple. The lesion shows mild posterior acoustic shadowing. The lesion corresonds to the mammographic abnormality and is wider than tall with ultrasound morphological findings suggestive of a benign fibroadenoma. An ultrasound-guided core biopsy, however, is recommended for histopathological correlation to ascertain benignity.
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I had a routine mammogram a few weeks ago that was BIRADS 0, leading to these further tests due to heterogeneously dense breast tissue. Based on the language used in this report, it seems they are fairly certain that it's just fibroadenoma. The only thing that worries me is the hypoechoic, mild posterior acoustic shadowing (although as I understand it, fibroadenoma can cause that?). Does wider than tall suggest benign lesion?
I have read the statistics associated with BIRADS 4A and I feel that there is no need to go into too much panic yet. I am in the process of scheduling a biopsy.
Thanks for taking the time to help all of us who are worried.
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Sounds like a routine report for a common finding. Anything newly discovered even if it looks benign is always biopsied.
Regarding the features that bother you, read my recent post entitled How to Read a Mammogram Part II .
Let us know what the biopsy shows.
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DJMammo I know this is not the correct forum but I need your expertise. Did you ever hear of a biopsy clip moving from the original site? I had a mastectomy and the clip was not found in the tissue that was removed. I had an xray a few days later and it showed that it had moved and is still in me. I now have to have a second srugery to have it removed and pray when it moved it didnt take any cancer cells with it.
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Yes it can. One needs to review all the pre-op films to see when it happened.
It can move between the biopsy and the post biopsy mammogram but that mammogram documents its final resting place in relation to the biopsy site.
Between the biopsy and the surgery if there is excessive movement of the breast and a large biopsy cavity it can migrate until such time as it heals in place.
Before surgery a wire (or other locating device) is usually placed in the breast next to the biopsy marker indicating the location of the marker for the surgeon. Did you have that done? If the wire was placed correctly and not disturbed the clip should have come out with the wire. At that point in time the marker should be pretty well healed in place and should not move. The specimen radiograoh tells us if the wire and the marker maintained their positional relationship within the breast.
I dont know that the marker can actually drag any cells with it but I assume they will get a margin of tissue around it to make sure.
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Hello and thank you in advance for your insight. How worried should I be about the following?
A 0.4 x 0.5 x 0.4 cm slightly taller than wide hypoechoic nodule with posterior shadowing at 3:30, 5 cm from the nipple is indeterminate. Recommend biopsy.
BI-RADS 4B.Thank you.
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I agree with the 4B designation. Those are worrisome features, but it is very small.
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What is a focal asymmetry behind nipple 5 to 6 cm in diameter
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I had a ultrasound of my left breast done this friday. The results showed that I have a 0.5 x 0.3 x 0.5 cm hypoechoic nodule/complicated cyst. It was rated Birads 3. It was recommended that I wait 6 mounths and have a follow up to see if any changes or altenatively I could have a guided ultrasound core biopsy. Is it better to wait or should I do the biopsy now. I had a sonogram in 2017 and this was not on it, so its new. Not sure wich is better to do . Thank you for any inpu
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Hi DJMammo - I'm not sure if you can help me with my most recent Chest CT that was ordered to check for METs and enlarged nodes due to neck swelling for 2 weeks and continuing. If so, here is the report.
I'm confused most about the "shotty nonenlarged nodes" in the Mediastinum and also about the Lung findings of "subpleural reticular opacities" and "linear atelectasis versus scarring".
What does all this mean? No one will really explain what this scan shows other to tell me it's "clear". It's frustrating.
Also, is there any reason why a doctor would not want to compare my new scan to a prior one? My MO refused to compare to my old one from 2014 saying "the current scan was clear so no need to compare".
Is this normal?
Thanks in advance for any help or insight you can give.
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I often gave patients this option on certain B3 findings. Each pt has their own tolerance level for waiting 6 months for an answer while others were very resistant to having a biopsy. It really comes down to how much confidence you have in the radiologist that made the recommendation.
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"I'm confused most about the "shotty nonenlarged nodes" in the Mediastinum and also about the Lung findings of "subpleural reticular opacities" and "linear atelectasis versus scarring"."
Don't worry about not understanding these phrases, the report was not meant for you. It is written by a radiologist to be read by the next radiologist that sees your study. I doubt that all the other physicians who read this report understand these specific radiologic terms. They read the impression then tell their patients what the study showed.
My subspecialty has been exclusively breast imaging since 2003 so I really shouldn't comment on other modalities such as this except to say the impression of that report says they didn't find anything bad. Take the win.
EDIT: also see https://community.breastcancer.org/forum/83/topics/872668?page=1#idx_3
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Thank you! I am very a very anxious person ..so I am thinking may be best to do
biopsy now. Would there be any negatives to having the biopsy now instead of latter ?
Thank you again
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ok, I tolf them when I just booked it. Shoud I be concerned about the marker they said they place in during biopsy. I mean if the biopsy comes back negative and nothing needs to be removed is it safe to have the maker left in your breast. Could it cause complications or health issues later. I am sorry for all the questions, as I noted before I am a extremly anxiouse person.
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The marker stays in and acts as a "do not disturb" sign for the next person that reads your study so they know that area has been biopsied already and is benign, even though they might not have your previous exams on hand.
Personally I have never seen a problem arise secondary to the placement of one of those markers .
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OK! Thank you sooo much for answering my questions. You have made me feel a bit calmer. Hope you have a wonderful day
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Biopsy came back benign on both masses. Looking at the report I was wondering why a surgical consult was recommended
It says : ****************************ADDENDUM**************************** Right breast 9 o'clock lesion (spiral marker), upper outer quadrant anteriorly, demonstrates fragments of intra ductal papilloma, no evidence of malignancy. Surgical consultation would be advised.
Thank you
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Papillomas are always removed.
see this article: https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/intraductal-papillomas.html
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Hi everyone, this is my first time posting, I have been stalking this site and Google since May.
I'm a 48 year-old female with two adult children, I never breastfed and I started my menstrual around 11. I've had a partial hysterectomy 4 years ago only one ovary.
I'm having outpatient surgery on the 7th to check for papillomas and to have a possible adenoma removed just under the areola.
I didn't see the MRI report till after I spoke with my surgeon he said I had very busy breasts. I have read over this report a hundred times and I have no clue what all this means. I'm not very good with my words and expressing myself. Thought I was doing okay but the closer my surgery is the higher my anxiety is going. If anyone can explain what this report means to me I would be grateful. Is a adenoma the same thing as a fibroadenoma?
MRI BREAST W WO CONTRAST BILATERAL - Details ImpressionNEW ONSET PROVOCABLE LEFT-SIDED NIPPLE DISCHARGE ARISING FROM A LATERALLY SITUATED DUCTAL ORIFICE WITH DISCHARGE OF BROWNISH-GREEN COLORATION. NO SUSPICIOUS OR ABNORMAL MR FINDINGS ARE IDENTIFIED AT THIS LEVEL OR WITHIN THE EXPECTED DUCTAL DISTRIBUTION. NOTE, HOWEVER, IS MADE OF A SMALL FOCUS OF SUBTHRESHOLD ENHANCEMENT AT THE BASE OF THE NIPPLE IN THE PERIPHERAL UPPER INNER ASPECT WHICH IS NON-CORRELATIVE IN POSITION TO THE CLINICAL FINDING AND OF QUESTIONABLE SIGNIFICANCE. SHORT INTERVAL/THREE-MONTH SONOGRAPHIC FOLLOW-UP WOULD BE OF BENEFIT WITH DISCHARGE CHARACTER SUSPECT FOR FIBROCYSTIC RELATED TYPE PHYSIOLOGIC DISCHARGE. MULTIPLE BILATERAL SIMPLE APPEARING BREAST CYSTS ARE OF INCIDENTAL NOTE. ADDITIONAL HYPOECHOIC CIRCUMSCRIBED FINDINGS OF MID-LEVEL HYPOECHOIC SONOGRAPHIC CHARACTER, WITH MR AND SONOGRAPHIC CHARACTERISTICS MOST CONSISTENT WITH A PATTERN OF MULTIPLE FIBROADENOMAS.
Narrative
ACR BI-RADS/FDA CODES: 3-Probably Benign
RECOMMENDATIONS: 1030 - Ultrasound in 3 months
DENSITY: d
CC:MRI OF THE BREASTS WITH AND WITHOUT CONTRAST: 77059
REASON FOR EXAMINATION: High risk patient with new onset provocable left-sided bloody nipple discharge arising from a laterally situated ductal orifice in the 2-3:00 position of the left nipple without demonstrable mammographic or sonographic abnormality excepting widespread fibrocystic appearing type findings. Long-standing, greater than one year history of palpable tender thickening in the upper outer quadrant of the posterior left breast. Intermediate family history for breast cancer, two paternal aunts diagnosed at unknown ages. Calculated lifetime risk of 16.7-38.6% (average 11.8%) by the Tyrer-Cuzick risk assessment models (v8.0 and v8.0b respectively, the latter incorporating estimated inherent risk conferred by the calculated volumetric parenchymal density of 19.7%/ACR parenchymal pattern d). Z12.39, N64.52, N63, N64.4, R92.8
MRI examination of the breasts was performed using a dedicated breast coil at 3.0 Tesla prior to and following the uncomplicated intravenous administration of 0.1 mmol/kg (5.0 cc) of gadobutrol (Gadavist) via a 22-gauge right antecubital venous access site at 2 cc/sec with 30 cc saline flush. Pre-contrast axial T1-weighted, T2-weighted and STIR sequences were obtained followed by four sequential post-contrast 1 mm axial T1-weighted fat-suppressed dynamic sequences at 1 minute 38 second intervals. Post-contrast axial T1-weighted fat-suppressed subtracted, 3D MIP and T1-weighted fat-suppressed coronal and sagittal subtracted and nonsubtracted multiplanar reconstructions were also generated. CADstream software was utilized for processing post-contrast kinetic data. Correlation is made with the patient's prior bilateral mammographic examinations, the most recent of which is dated May 21, 2019 and bilateral breast ultrasound and left-sided diagnostic mammographic/DBT study of June 27, 2019.
Following contrast administration there is marked background parenchymal enhancement throughout the heterogeneously to extremely dense fibroglandular parenchymal pattern. This is symmetrically evident in both upper outer quadrants with spin-echo sequences confirming the asymmetric mammographic and sonographic distribution of parenchyma, greater at the level of palpable, intermittently tender ridge in the axillary tail of the left breast. No discrete focal abnormalities are defined. No discrete abnormalities are identified in the expected distribution of possible and potential intraductal pathology corresponding to the laterally situated ductal orifice yielding a fairly darkish brown to greenish cast discharge at the time of recent clinical exam. Note, however, is made of a 0.3 cm focus of subthreshold enhancement within a lactiferous sinus in the upper inner aspect of the right nipple though discordant with the clinical position of the apparent involved ductal orifice. Multiple
bilateral enhancing circumscribed findings are noted exhibiting relatively moderate T2 hyperintense moderate progressive enhancement in both breasts with subtle intrinsic nonenhancing septations. Corresponding to sonographically detected hypoechoic findings. Appearance is consistent with adenomatous lesions. Additionally multiple nonenhancing T2 hyperintense cystic abnormalities are also seen. No suspicious nonenhancing abnormalities are detected on either side.Axillary nodes are normal in appearance and size bilaterally. No discrete nodal structures seen within the internal mammary chain on either side. Mediastinal structures appear normal. Limited visualization the upper abdomen is unremarkable. Thyroid gland is not imaged. Visualized osseous elements appear intact.I also have a burning stabbing pain at times pretty often that comes and goes just under the areola nipple area. When the nipple discharge started it was just blood without a green tent.
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"I have read over this report a hundred times and I have no clue what all this means"
Why would any patient know what all this means? Don't feel bad, this report was not written for you. Most of the detail in the body of the report is for the next radiologist that reads your studies. The impression is for your doctor who should explain it to you and answer your questions as this is part of their function.
See this terrific article about interpreting your reports: https://www.kevinmd.com/blog/2014/09/insider-guide-reading-radiology-report.html
On your MRI there are cysts and there are fibroadenomas present. There is some "iffy" enhancement near where the discharge appears to originate but not exactly so to make sure they know whats going on they want to take another look at it soon with US.
Bottom line is the word cancer was never used, neither was the word suspicious. It was not given a B4 or a B5. Greenish-brown discharge is normal but can become bloody depending upon how often the area is examined or is squeezed in order to elicit the discharge.
Let us know what the next study/surgery shows.
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Thank you for your response, I did read the article thank you,
I've had a 3D mammogram and ultrasound at a regular diagnostic Center in May and then I was sent to a breast center by my breast surgeon mammogram and ultrasound was repeated, I'm scheduled for surgical biopsy Wednesday. I didn't ask enough questions the day of my appointment and after I received the MRI report in the mail is when my brain started going crazy.the radiologist suggested to repeat test and 3 months, is very nice and courteous it didn't really act like anything was a big deal when I spoke with him. My surgeon which is also very nice and compassionate suggested to do the biopsy to make sure and stated he thought it was just an adenoma. I can feel the area of concern, it feels to me as it's not movable, are adenomas usually movable? The nipple discharge started with a spot in bra which led me to squeeze it, it was completely bloody. From there I went to my PCP and it looked like blood she put it on a tissue and said it was definitely blood then I went to gynecologist she put it on a glass slide said it was bloody with a slight green tint. Which came back with no abnormalities. Surgeon said it was bloody with a green tent and then the radiologist said Brown with a green tent but he could barely get any out at the time.
Do benign nipple discharge normally start out with blood and turn green?
I've been having this issue for a few months now and all of a sudden I'm completely emotional. Thank you so much for your time!
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Here is information on nipple discharge, in general: https://community.breastcancer.org/forum/83/topics/857426?page=1#post_5015399
We only worry about bloody and clear discharge, and between the two I worry more about bloody especially if spontaneous and unilateral. It is usually caused by a papilloma inside the duct.
I have never been a fan of MRI for papillomas as they can be very small and hard to detect on MRI which has better contrast resolution than spatial resolution. Many times you can locate a papilloma on US if its big enough but for me the gold standard is a ductogram (aka galactogram). I have found this to be both sensitive and reliable in the right hands but I think its becoming a lost art.
When no one can demonstrate the source of the bleeding but can isolate it to a duct or set of ducts, the surgeon will excise the lot of them and that usually puts an end to the bleeding.
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Thank you for reading and helping me understand my report.
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Thank you so much
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One last question! I’m wondering why original pathology report says
Fragments of introductal papilloma
No evidence of in- Situ or invasive carcinoma
Then addendum was issued saying demonstrates fragments of intra Ductal papilloma, no evidence of malignancy. Surgical consult would be advised.
Am I making too much out of the fact that the second statement no longer says No evidence of in- Situ or invasive carcinoma? At first the nurse said I was all set- no need to remove
Then the addendum was issued
Thank you
Thank you
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