Interpreting Your Report
Comments
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Can you explain the difference between between lymph node positive invasion, micro invasion, and lateral extention? Is there a difference?
Thanks so much
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"Lymph node positive invasion" I assume is a wordy way of expressing that a cancer has spread to the lymph nodes as evidenced by the presence of cancer cells within the lymph node at microscopy.
I am not a pathologist, but when I see the term microinvasion/microinvasive in a report it usually refers to the primary breast cancer itself and not to involvement the lymph nodes though I have heard the term micrometastasisto the lymph nodes.
The term "lateral extension" meaning "extending in a direction away from the midline" is a fairly non-specific term. In what context was it used?
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As I have often said, never feel bad when you don't understand the meaning of the terminology used in your reports as they are not written for you nor intended for you to read. They are not routinely sent to patients unless they request them. They are written for your doctors who do understand all the terminology as they are, well doctors. If you Google all the terms out of context, you can get a false impression of what that report actually says.
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LlamaMom1,
Try not to worry. I know that is easier said than done. I had asymmetry on my mammo, followed by ill defined hypoechoic tissue on ultrasound and a palpable hard lump. Djmammo is absolutely correct when he says not to google suspicious terms because it will all be out of context. My biopsy revealed 100% benign results. Hang in there, and STOP GOOGLING! I’ll send you good juju!
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LlamaMom1
I also completely understand the fear. It is scary stuff! When I went for my diagnostic mammo/US I felt like I was given zero information by the radiologist. When I went back for the biopsy, I made sure before the procedure to ask questions and demand answers (in a nice way). I was quite frank with the radiologist and said " I am really anxious and feel like I have been kept in the dark about what may be going on with my body. Can you please talk me through exactly what you are doing and exactly what you see on ultrasound in terms that I can understand?" It worked. Remember to be your own advocate. Most radiologists will respect you for this and will be transparent, honest and hopefully reassuring. Good luck!
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Hello @djmammo Newbie here. Had a mammogram and ultrasound the other day. Biopsy scheduled. Can you help me interpret this Ultrasound report please? Is there any area of concern?
BREAST LIMITED/TARGETED RT
CLINICAL INDICATION: PALP LUMP RT BREAST. ALSO, F/U ABN MAMMO. NO PRIORS.COMPARISON: Today's mammogram TECHNIQUE: Multiple real time gray scale images were obtained of the right breast in a targeted fashion.
FINDINGS: 9:00 area of mammogram abnormality shows smooth-walled wider than tall hypoechoic nodule 1.7 x 1.1 x 1.3 cm. Probable benign fibroadenoma.
Right breast 2:00 in area of palpable concern shows irregular hypoechoic mass shadowing. Some minimal internal color flow demonstrated as well. This measures 0.9 x 0.7 x 0.5 cm.
No suspicious axillary adenopathy seen. Overall findings are identified within a background of dense parenchymal tissue.
IMPRESSION: 1. Suspicious hypoechoic mass seen right breast 2:00 in area of palpable concern. Recommend tissue sampling utilizing ultrasound guidance.
2. Probable benign fibroadenoma right breast 9:00 requiring short-term follow-up in 6 months with targeted sonogram.
BI-RADS CATEGORY 4 - Suspicious Abnormality; biopsy should be considered.
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"Is there any area of concern?"
Yes, the description of finding #1 in the body of the report is very suspicious and is the reason for the B4 rating and the biopsy recommendation.
After the path comes back, they will likely recommend an MRI to evaluate the rest of both breasts and the lymph nodes.
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Thank you for replying. What if path comes back normal? Will they still order MRI
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thank you for your help. Will post when I get my results.
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Hello,
this is my first post here. I am from Hungary, my English is not the best, therefore excuse me for the mistakes.
I'm having breast pain in the left breast since last spring. I had last summer my first mammogram and ultrasound at age 37. They found an irregular lesion (7 mm) at 12'o clock, 3,5 cm from the nipple in the left breast. The lesion was hypoechoic on ultrasound and high dense on mammogram (tomosynthesis). They ordered a FNA (fine needle aspiration), because the radiologist was not sure if it is carcinoma or not. The result was fibroadenoma or a mastopathic area (dissociated myoephitel cells and ductus epithelial cells).
One year later, I had yesterday my next mammogram (tomosynthesis) and ultrasound. The lesion is still there, still 7 mm, taller than wide and irregular. The pain is not gone. I am not sure what to do next. Should I force a core biopsy? FNA is not the best method, because it is like to pick a needle into a haystack (as a doctor said). Or should I go to a breast surgeon to remove it? I do not want to controll it every 6 months or every year until it become malignant.
Thank you for your help.
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My recent US results lack detail like others I've had.
One of the many cysts is described as "Complex cyst: 8 x5mm". No other descriptions.
Conclusion says no suspicious lesions seen.
My question: can a complex cyst be 'not suspicious'?
I have an appointment next week to see a breast surgeon for aspiration of another large problematic cyst. Just wanted to ask here about the complex cyst.
Thanks. (48yo)
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I have seen this problem come up over the years, and IMO the problem most often lies with the Rad reading the exam.
There is a difference between a COMPLICATED cyst and a COMPLEX cyst. These terms are not interchangable and are often confused by rads who do not read breast imaging exclusively.
A Complicated cyst is fluid filled and may contain mobile debris, has a very thin wall and may have internal septations that are very thin and uniform in appearance, and has no solid elements. These can be left alone or watched over time (B2 or B3)
A Complex cyst is fluid filled but contains solid elements, or have a thick wall or have thick internal septations and require a biopsy (B4).
Ask them if they can clarify that for you and amend the report/recommendations as necessary.
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Thanks dj.
I have the films, so I assume the breast surgeon can look for herself?
Thanks, SL
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Yes, and bring copies of the reports as well.
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Will do. Thanks for your advice dj.
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I'm a 54 year old woman looking for some help interpreting my ultrasound results.
I went for a screening mammogram a few weeks ago and was called back for an ultrasound because of breast density. I had always been in the b category but am now a c. Nothing suspicious was on the mammogram.
My ultrasound results showed a small mass in my right breast. The report says "There is a round avascular solid mass with indistinct margins measuring 6 mm seen in the posterior third of the right breast upper outer quadrant at 10 o'clock located 6 cm from the nipple. Internal echogenicity is hypoechoic. There is increased sound transmission."
The BIRADS category is 4 (with no letter after it)
From reading this forum I have some idea as to what is positive and what is negative about this report but I'd like more information. Some specific questions I have are:
1. What does increased sound transmission mean and is that good or bad?
2. I haven't seen many people report that their mass is round. Is that uncommon and where does that fit on the scale of oval being better and irregular being worse?
3. What does it mean, if anything, when there is no letter after the 4 on the BIRADS category?
I have a core biopsy scheduled for this week. I feel better and more prepared when I have information so your help is greatly appreciated!
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Blueandgold
1. What does increased sound transmission mean and is that good or bad?
This is the same as "through transmission" or "posterior enhancement" and is usually associated with benign masses.
2. I haven't seen many people report that their mass is round. Is that uncommon and where does that fit on the scale of oval being better and irregular being worse?
Overall oval masses have a higher probability of being benign but a round cyst with internal debris can look solid at US.
3. What does it mean, if anything, when there is no letter after the 4 on the BIRADS category?
The lack of a letter with B4 is common and without meaning to you in this scenario. Those letters are more an internal MQSA auditing feature for the radiologists' performance, and is not meant to convey a probability to the patient though this is a popular misconception since pt's began reading their own reports.
A mucinous carcinoma (aka colloid carcinoma) is an uncommon tumor but can present as a round mass with through transmission on Ultrasound so it is important to have your finding biopsied.
Let us know how it goes.
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Thanks djmammo! That helps clarify things for me. I just want to get this biopsy over with.
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Good luck blueandgold. I hope it's an all clear result for you.
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I had a 3D mammogram last week and received a call back for a diagnostic mammogram and ultrasound.
Is there usually a Birads for this and should it be on the report?
Also for some reason I thought there were less call backs for the 3D mammograms. So does that mean there is a higher chance that I will need a biopsy done after the diagnostic mammogram and ultrasound?
This is what my 3D mammo report said...
Exam: digital bilateral mammogram with tomosynthesis
History: screening
Comparison: 11/8/2017, 5/8/2017, 8/1/2014
Technique: CC and MLO digital mammographic views of the both breasts were obtained and 3D tomosynthesis was performed.
Computer-aided detection was utilized by the radiologist in the interpretation of this study.
Mammogram findings:
Residual areas of asymmetric dense fibroglandular tissue and diffuse benign-appearing calcifications persist bilaterally.
On the 3D CC images of the right breast, oval-shaped nodular density is seen within the medial aspect. This measures approximately 7 mm in maximal diameter and is located approximately 8-9 cm from the nipple. Also on the 3D CC views of the right breast, there is a suggestion of 3 small areas adjacent nodularity within the central to medial aspect. This grouping is centered approximately 5 cm from the nipple. These findings are not discretely visualized on the images in the MLO projection. It is recommended that the patient return for ultrasound evaluation of the medial aspect of the right breast.
On the left, there is no evidence of spiculated mass, malignant appearing microcalcification clusters, skin thickening or nipple retraction.
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It would be Bi-Rads 0 (which means incomplete without additional imaging.)
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djmammo, you rule. :-) Thank you for all of the time you put in here.
Can you explain a phrase to me? It's from a biopsy for an architectural distortion seen on screening mammo, diagnostic mammo, and ultrasound. The biopsy addendum to the US biopsy procedure report says "The pathology revealed fragments of a complex sclerosing lesion with elastotic stroma," followed by:
"The result is high risk and concordant with the imaging findings."
I was called by the radiologist the morning after the biopsy and told that the area biopsied is benign, but I've still been referred to a breast surgeon. (?)
From the reports:
Impression
Architectural distortion with probable corresponding mass in the right breast 2:00 radian on ultrasound. Ultrasound-guided biopsy recommended.BI-RADS Category: Overall Assessment: 4 - Suspicious
Mammogram breast composition: There are scattered areas of fibroglandular density. Architectural distortion in the upper inner right breast persists on additional images. A circumscribed mass in the upper outer right breast is stable. Benign-appearing calcifications are stable. No suspicious calcifications or masses have developed in either breast.
Targeted ultrasound was performed. In the right breast 2:00 radian, 2 cm from the nipple there is a hypoechoic 0.5 x 0.2 cm mass only seen on the transverse images at the expected site of architectural distortion.
Ultrasound-guided biopsy is recommended.
(Neither screening nor diagnostic mammo report show any measurements, though the radiologist said that the area was much harder to see on US.)
Should add that I'm 53 and post-menopausal since hysterectomy in 2014, no HRT.
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That is the typical result after biopsy of a radial scar (complex sclerosing lesion). It is technically benign but some can eventually turn on you (high risk lesion). The Rad that read your imaging thought thats what is was going to be (concordant with imaging). On US they are typically less well seen than a cancer as your report indicates.
They are always removed.
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"Also for some reason I thought there were less call backs for the 3D mammograms. So does that mean there is a higher chance that I will need a biopsy done after the diagnostic mammogram and ultrasound?"
With "3D" there is a higher chance the finding is real, and not overlapping tissue. It doesn't mean it is more likely suspicious. The ultrasound will tell the story.
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Hi, I'm new here and just wondered if you could help me out. I got call back for abnormal screening mammo.
The screening mammo showed: "two new tiny groups of microcalcifications" in the lateral left breast and left upper about mid breast. A "7 mm nodule in left lateral breast 2:00-3:00 mid depth". Focal asymmetry in the right upper slightly inner breast.
The DX mammo showed: Left- "on magnification views, the microcalcifications in the superior breast are coarse to amorphous". Right- :the mammographic area of concern is reproduced in the superior right breast. Based on tomographic images from the screening mammogram, this is at the 10-11:00 position".
The US showed: Left- "at the 3:00 position 6 cm from the nipple at the mammographic area of concern there is a 0.7×0.3×0.5 oval hypoechoic mass with flow on color Doppler". Right- "at 10:00 position 10 cm from the nipple there is a 1.1×0.4×0.6 cm oval hypoechoic avascular mass". BIRADS 3, Follow up 6 months. Both masses are suspected fibroadenomas.
My questions are:
Are amorphous micricalcifications considered a "bad" finding?
Is blood flow in a mass considered a "bad" finding?
In the left breast, is the mass near where the microcalcifications were seen based on the location descriptions given?
Are fibroadenomas typical in a postmenopausal woman (surgical, x12 years...no hormone replacement therapy)?
I should mention, the comparisons were from dx studies done in 2012 which were all normal, including breast MRI (was getting work up for unusual bruising/rash and burning sensation on right breast...turned out some kind if inflammatory response from rib fractures).
I'm wondering if the 6 month follow up is prudent or if I should push to see breast specialist based on these findings.
Thanks in advance!
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Are amorphous microcalcifications considered a "bad" finding?
Not as good as "smooth and round" but better than "branching" or "pleomorphic"
Is blood flow in a mass considered a "bad" finding?
Not always, benign masses can have blood flow
In the left breast, is the mass near where the microcalcifications were seen based on the location descriptions given?
Hard to say from the above but whether a mass contains calcifications or not is an important and basic finding and if they were related that fact should have been included in the report
Are fibroadenomas typical in a postmenopausal woman (surgical, x12 years...no hormone replacement therapy)?
They are seen in all age groups
I'm wondering if the 6 month follow up is prudent or if I should push to see breast specialist based on these findings.
That recommendation is based on the rad's opinion that these findings are benign. Your imaging was interpreted by a breast imaging specialist. If you go to a "surgical breast specialist" they will go over the results generated by the radiologist and may offer you a surgical solution which may include an open biopsy for something that is more likely benign than not. If you are uncomfortable with waiting 6 mo ask the breast center if you can have these biopsied there where they can do image guided biopsies that leave no scars.
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