Interpreting Your Report
Comments
-
The two statements basically say the same thing. One was probably the prelim report and the second the final report, that's pretty standard.
Regardless of the presence of DCIS or malignancy, all papillomas are routinely removed. See my post labeled "Humor at Breast Imaging Seminar" for details regarding papillomas.
0 -
Thank you so much!!
0 -
Hi,
My final pathology report from my BMX says "suspicion of lymphovascular invasion". On the same repot, I had ITCs in one of my lymph nodes. Why is that a "suspicion" if I had cancer cells in my lymph node? They can't teleport as far as I know, so I'm assuming they travelled via the lymph or the vascular system.
Is there another factor to this?
Thanks!
0 -
In a pathology lab each item is processed and reported separately. If there is only a 'suggestion' of LV invasion in a given specimen you cannot cheat and say its 'obvious' just because you know its in the node you sectioned earlier that day. If a mammogram is looks normal, but I know there is a cancer present because I saw it on an MRI I would still have to call that mammogram normal.
Tumor cells get to the nodes through the lymphatics but if enough tumor cells find their way into the venous channels they could travel and set up housekeeping elsewhere.
0 -
Ok thank you!
0 -
In January 2018 I was diagnosed with Stage 1 IDC ER/PR+
I had a lumpectomy and reduction, 33 rounds of radiation and Tamoxifen
Flash forward to now:I am waiting on biopsy but according to US I have 7 mm taller than wide mass with indistinct margins. It is an oval mass, Hypoechoic with internal echoes. There is no increase in vascularity.
0 -
I forgot the question! My BIRAD is 4 but doesn't specify ABC. Which do you think? What are the odds of it being malignant?
0 -
In January 2018 I was diagnosed with Stage 1 IDC ER/PR+
I had a lumpectomy and reduction, 33 rounds of radiation and Tamoxifen
Flash forward to now:I am waiting on biopsy but according to US I have 7 mm taller than wide mass with indistinct margins. It is an oval mass, Hypoechoic with internal echoes. There is no increase in vascularity.
My BIRAD was 4 but doesn’t indicate ABC. What does it sound like?
Does this sound malignant. Trying to psych myself up to do this again.
0 -
Which breast had the prior surgery and which breast has the new finding?
Because of your history every new finding will be viewed with more suspicion than someone who does not have your history. The findings you cite are suspicious but it would help to see the entire report.
Not everyone uses the #s after B4. Again those are for MSQA internal statistics, not to convey to the patient the odds of something being cancer.
0 -
Thank you for the reply. The cancer was in my right breast at 9:00 and this is in my right breast at 3:00.
0 -
If a pathology report contains a addendum from the radiologist does that mean it’s “discordant”?
0 -
The radiologist dictates an addendum to the biopsy report when the path report is available. They compare those results with the impression of the report that recommended the biopsy. If they are the same or similar enough the results are deemed concordant. If they differ benign vs malig, then they are discordant.
The pathologist often dictates a prelim report followed by a final report which may be dictated as an addendum. The pathologist however does not decide concordance or discordance with imaging and a radiologist would not addend a path report and vice versa. You can only add on to your own report.
0 -
Hi djmammo,
I discovered a lump on my breast a couple of months ago. To be honest, I haven't been diligent about self breast exams until recently so who knows how long it's actually been there. I am 35 years old with little family history of BC (paternal aunt died of BC but had a rare genetic mutation that required a boatload of hormone therapy in the 50's which likely caused the cancer). The lump seems to wax and wane, and when I am lying down it feels more like an area of thickness than anything else.
I have a bit of time before my biopsy and I am suffering with a lot of anxiety. The breast surgeon and radiologist have both been incredibly vague which doesn't help. I am hoping you will help me make sense of my diagnostic mammo/US report. It may be worth mentioning that during the 2nd ultrasound, which the radiologist was present for, he had a hard time actually seeing the "vague hypoechoic tissue" and said he would see it and then disappear. Not sure what this means. Also, is there a difference between a lesion and a true mass?FINDINGS:
Mammogram:
Tissue Density: The breasts are extremely dense, which lowers the sensitivity of mammography.Right breast:
Initially focal ultrasound was performed at the patient's palpable area of concern along the 12 o'clock to 2 o'clock axis of the right breast. Along the 2 o'clock axis approximately 3 cm from the nipple, there is a 0.5 x 0.5 x 0.4 cm cyst with a single thin septation. Also along the 12 o'clock axis approximately 3 cm nipple, ultrasound demonstrated a small echogenic shadowing calcification.At this point mammography was performed. There is a rectangular palpable marker overlying the middle to posterior third of the central upper right breast. There is some dense asymmetry near the marker. There are a few benign-appearing microcalcifications scattered in the right breast. No architectural distortion. No skin thickening, nipple retraction, or adenopathy. Initially the patient was sent home with a B3 diagnosis, but upon re-review, the patient was requested to come back for additional imaging with spot compression compression views.
On the spot compression view, there is an approximately 16 x 19 x 17 mm area of asymmetry near the marker which is slightly denser than the other breast tissue. This may contain a very small amount of intervening fat (CC slice 37 of 62). No associated architectural distortion seen. No clear margin was identified to suggest a definite mass. Repeat real ultrasound scanning of this area as well as the right axilla were performed.
At the site of the patient's palpable abnormality along 12 o'clock axis approximately 3 cm from nipple, there is some ill-defined hypoechoic tissue which demonstrates mild posterior acoustic shadowing.This is difficult to measure and does not have clear margins but measures approximately 12 x 12 x 16 mm. On physical examination, this vague ill-defined hypoechoic area was firmer than adjacent breast tissue and corresponded to the patient's palpable abnormality. The contralateral left breast at the 12 o'clock axis at the same area was imaged for comparison and showed normal-appearing dense breast tissue. The right axilla was imaged and demonstrated a 0.5 x 1.2 x 0.9 cm benign-appearing normal-sized lymph node with an echogenic fatty hilum and a thin cortex.
Left breast:
No suspicious focal mass, architectural distortion, or concerning microcalcifications are seen. No abnormal axillary lymphadenopathy, skin thickening, or nipple retraction are seen.IMPRESSION:An ill-defined 12 x 12 x 16 mm indeterminate lesion in the central upper right breast corresponding to patient's palpable abnormality. Given the patient's age and the presentation as a palpable abnormality, this is suspicious and biopsy is recommended rather than just follow-up.
No evidence of right axillary adenopathy with a single normal sized normal-appearing right axillary lymph node seen by ultrasound.
ASSESSMENT: BI-RADS Category 4: Suspicious findings.0 -
Will someone please help me determine my risk for malignancy? Some of the terms are worrisome for me such as architectural distortion and posterior shadowing. But the US tech was unable to locate and the radiologist used the phrase “very subtle abnormality.” Thoughts? I’ve worried myself sick and Dr Googled way too much over the last 48 hours. Appt with breast specialist is not until Wed.
BREAST DENSITY: The breasts are heterogeneously dense, which may obscure small masses.
FINDINGS:
There is persistent architectural distortion in the lateral posterior right breast measuring about 2 cm.
Ultrasound was performed. There is a very subtle abnormality observed at 9:00 5 cm from the nipple. A hypoechoic mass measuring 0.5 x 0.5 x 0.7 cm is seen. There is an area of hypoechogenicity, which is indirect, measuring about 1.4cm as shown on image 7. Ligamentous distribution is interrupted and there is more shadowing from the posterior aspect of the tissue. Findings are suspicious and biopsy is recommended for definitive diagnosis.
ASSESSMENT: BI-RADS 4: Suspicious
MANAGEMENT: Biopsy is recommended
Recommend right breast biopsy 9:00 5cm from the nipple. If sonographic correlate is difficult to identify at the time of biopsy then stereotactic biopsy could be performed.
LETTER: B4/5 Biopsy recommended
0 -
Hi JustBreathe16, and LaFemmeGA,
Welcome both of you to Breastcancer.org. We're so sorry you're here and worrying, but you've come to the best place for answers, advice, and support. Someone will be by shortly to weigh in on your reports, but we wanted to say hi and send our best thoughts for nothing to worry about!
--The Mods
0 -
Personally I do not like the word "lesion". It is roughly translates to an "abnormality" that may be benign or malignant but I always feel there is an ominous connotation to it. I prefer just referring to something as a "finding" until I know what it is. A mass is a lesion but a lesion is not necessarily a mass.
On ultrasound, when evaluating a lump one can see something solid, something cystic, mixed cystic and solid or nothing. In those cases when we see "nothing" we can sometimes go back and see some very subtle disruption of the echo pattern of the breast tissue. My usual example is to picture a blanket that is made of a plaid fabric. You study the blanket until you notice an area that looks different. Its still plaid but is a subtly different plaid pattern. If that area of the US corresponds with something you and/or the patient can feel, then I always biopsy that area. It sometimes comes back normal and sometimes areas of early ADH or DCIS which in the scheme of things is better than IDC which usually presents with a distinct mass.
Let us know what the biopsy shows.
0 -
How likely is it to get a false reading on a biopsy? If they say it's benign, how sure can we be
0 -
Thanks, djmammo for explaining this in terms that I can understand. I guess now I just wonder if it’s going to be hard to biopsy since the whole area is highly moveable.
0 -
Additional information regarding my previous post is that I am 41 years old and had my first mammogram 7/23/19, so there is nothing to compare it to. Mass is not palpable and was first seen on initial screening mammogram and then two weeks later on diagnostic mammogram and ultrasound. There is no history of breast cancer (or any cancer) in the family and I feel I’m at very low risk but I just can’t shake this anxiety from the finding
0 -
In medicine we all consider the pathology report to be the last word in these cases.
There can be differences in opinion on the finer points of a particular diagnosis but distinguishing the broad difference between benign and malignant is not a problem I have ever seen.
0 -
Around 75% of pt's who develop breast cancer have no family history. Here is a tool to calculate your overall risk: https://bcrisktool.cancer.gov/
Is that the exact wording of the report? Its not clear to me how many abnormalities they see. They describe a mass of one size and an area of hypoechogenicity (darker area on the screen) of another size. Not sure if they are related or not.
That being said.....
For the most part if there has been no surgery, arch dist is caused by either a cancer or a complex sclerosing lesion (radial scar) and, in general, on US a cancer is usually a more well-defined an abnormality than the radial scar which can appear as a vague area of shadowing rather than a distinct mass. If they can't find it on US on the day of the biopsy a stereo is a perfectly legit method to biopsy it. Though the radial scar is considered benign, it is always removed owing to a small malignant potential.
Let us know how it goes.
0 -
Thank you djmammo for your insight. That is the exact wording from the report. I’m unsure if they are separate abnormalities. I was under the impression that it was all related to one area of concern.
Also- it states under management BI-RADS 4 but then what does “LETTER B4/5” mean?
I’m feeling more and more as if the chances are that this is malignant. I have spent time researching my insurance benefits and different healthcare options. I’m feeling as though I would be in early stages with the mass being so small? But I don’t know. One month ago my back grew stiff and then overnight my right arm went numb and felt lifeless. I’ve had incredible numbness, tingling and soreness from my back to my neck, to my pec and underam and it radiates down my arm to my hand. Lots of muscle spasms in the area, too. I attributed it to a back sprain (although I was not aware of a sprain occurring, but two days prior I had played a mad game of Air hockey with my son) and two weeks later went to the dr and got a steroid shot which did nothing to help with the pain. Now, four weeks from onset, I feel the pain is better and more tolerable, but is definitely still there. I don’t think it’s related to the mass but the anxiety of waiting for my consult with the breast specialist has my mind racing in circles.
0 -
djmammo, what do you think of this picture of my cyst. Sorry, I took a pic of my computer screen, but it doesn't affect the look of what I'm being told is a cyst in the upper right outer area, near armpit. Just wanted to know what you think. Thank you in advance for your feedback. It's taller than wide, but they don't mention that in the results.0 -
(reposting here on suggestion of the moderators)
Hi everyone,
I'm a little confused about tests I had this week and wondering if anyone has any insight or has been in a similar position.
I'm 39 with a family history of breast and ovarian cancer (older grandmothers) so I've had two preventative and normal mammograms and US due to dense breasts over the last few years (last OK mammo/US was Nov '18). I felt a lump in my upper right breast this past week, saw my GP and went in for a diagnostic mammogram a few days later coupled with US. The radiologist said that there is new tissue showing on the mammogram, but while both she and the US tech could feel the lump they could not see anything on the US. They would have done a US guided biopsy right there but because they couldn't see it I now have to meet with a breast surgeon and have a stereotactic biopsy.
Has anyone had something show on the mammogram and not US? Would this indicate it's normal tissue? I'm confused, the radiologist seemed stumped and I'm a wreck waiting to meet with the breast surgeon next week.
0 -
Thankfully, my biopsy was benign! No recurrence!!
The pathology report states the following:
"fibrofatty breast tissue with foreign body type giant cells and reactive changes"
Anybody understand what that means? Will be seeing doc for f/u on Wednesday but am hoping to formulate some concise questions.
Many thanks!
0 -
"what does "LETTER B4/5" mean?"
There are standard "lay letters" that are sent out to patients with the bottom line of their report in non-medical terms.They correspond to the Birads numbers. What you posted is an internal note indicating which lay letter should go out with your report.
0 -
Had my core biopsy on Monday. The very experienced radiologist suspected it was dense stromal fibrosis but wanted to go ahead with the biopsy to be safe. Results came in
Fibroadenomous change and dense stromal fibrosis. No mention of ADH. Several samples were taken ranging from .9-1.6cm long. I’m taking this all as good news but would love more information on what exactly fibroadenomous change means. My guess is a fibroadenoma with some funky stuff mixed in that makes it look weird on ultrasound? Any info/insight would be much appreciated. Thanks djmammo!!
0 -
Justbreathe16: Hopefully that is all good news for you!
I had my consult with the breast specialist today and they did another ultrasound. I was told it is “probably cancerous.” She was very candid with me but was so kind and empathetic. I have an ultrasound guided core needle biopsy scheduled for Tuesday 8/20 and and follow up for results scheduled for Wednesday 8/28. Until then...
0 -
Great news. Likely a fibroadenoma at an early stage but that's academic at this point.
Focal stromal fibrosis can look just like a cancer on US. If I see that in a path report I know I hit the intended target of my biopsy.
0 -
LafemmeGA:
Hang in there! And remember that nothing is known for certain until the path report comes back. My ultrasound looked quite suspicious. And, if you are worried about the biopsy, try not to be. I found it to be much less intense than I made it out to be in my head. Do try to plan nothing for the whole day and keep ice on it (30 min on, 30 min off) for the first day. That made a world of difference. I’ll be thinking about you!
0
