Interpreting Your Report
Comments
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I had my biopsy on Wednesday and just got word that I have an intraductal papilloma. I am so relieved! My doctor wants me to see a breast surgeon for evaluation to see if it should be removed or just followed up on in 6 months. I will sleep so much better tonight!
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DJmammo,
Thank you. That certainly puts my mind at ease.
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Hi all. I am awaiting biopsy results but was wondering if anyone could comment on the questions below. Sorry for the long windedness in advanced.
Currently age 53. At Age 44 had History in 2010 of IDC 0.6cm and DCIS 1.5cm ER-/PR+ (weak) HER2+ But 0 nodes.
Treated with 4xTC plus Herceptin (11 doses due to LVEF going from 60% to 46% but no symptoms. I have mild cardiomyopathy but won't get into that here)
Fast forward 8.5 years to Feb 2019, Birads 3 mammo and ultrasound. Radiologist thinks fatty cyst. Same Breast but not near original. Original upper right and this once close to nipple. Both he and Breast surgeon recommended 6 month follow up.
Got follow up mammo and US two weeks ago and results much changed and (a different ) radiologist recommended biopsy. Breast surgeon still does not think it is cancer but did order for biopsy which I had Wednesday, 2 days ago and waiting on results.
I stupidly got the radiology reports thinking would reassure me because from reading this site, I know benign is supposed to look a certain way and know about Birads 3 vs 4 but these reports did the opposite and I am freaking out.
Questions:
- Has anyone had a second US that changed so much and it NOT be cancer. I could use some reassurance if possible.
- how does it go from hyperechoic to hypoechoic?
February Mammo was Birads 0 so not copying. Here was February US:
Feb 22:
"There is a subcutaneous hyperechoic nodule appears to contain calcifications measuring 0.5x0.4x0.5cm When comparing to Mammogram, there may be some curvilinear calcifications in this area. This could represent an early lipid cyst. I would recommend a six month mammogram and ultrasound follow up for further evaluation.
Birads 3 Hyperechoic nodule in the right Breast which has a likely benign appearance as described above. "
Here is August mammo and US. It seems so different and ominous to me!
Aug 19:
Mammo:
“Impression: focal asymmetry with microcalcifications and slight architectural distortion in the upper outer right breast for which biopsy is recommended.
Birads 4
The previously described tiny focal asymmetry in the upper outer right breast is again noted and now appears to be associated with slight architectural distortion. There are also associated microcalcofocations. Targeted Ultrasound in this location reveals a small spicilated lesion just deep to a well-circumscribed vascular lesion, for which biopsy is recommended. "
Ultrasound Aug 19:
"Targeted ultrasound examination of the right breast was performed with attention to the Mammographic area of concern in the upper periareolar and retroareolar breast.
Within the 9:00 retroareolar breast, there is a lobulated 7x5xx5 mm lesion which has a hypoechoic periphery and Echogenic center, as well as vascularity. This potentially could represent a lymph node although the findings were non specific and this has enlarged since the prior exam previously 5x4x5mm. Just deep to this there is a very subtle hypoechoic spiculated lesion measuring 4x3x3mm which is new since prior study. This contains punctuate calcification. "
I had core biopsy of both. They are basically like a snowman with 2 balls sitting on each other with the top one black and has vascularity and the bottom one not black and fuzzier.
3. aren't lymph nodes under arm or in middle of chest. What is one doing next to and under the nipple
4.If it is a lymph node and cancer does that mean it could spread to distant places (if not already?)
Thanks for reading this long winded notes.
Eileen
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Since it has already been biopsied you will have a definitive answer, worth more than an long distance opinion from me which is set to expire in a few days when the path report is available.
The very small spiculated mass that contains small calcifications sounds very suspicious. Also intramammary lymph nodes are very common. If it comes back as a cancer sentinel node sampling will tell you if the horse is out of the barn. Not sure how to answer your other questions as written.
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thank you. Guess I will know in a few days.
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just an update. My biopsy can back positive for cancer. Hormone negative. Waiting on the rest. Back to specialist on Friday. Here I go again. Thought I said goodbye to breast cancer 9 years ago.
Best wishes to all that you get a B9.
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Newlife4me, we are here for you
Please keep us posted and know we're thinking of you!0 -
moving into recurrence board now. This site is invaluable. Used it 2010 and now I am back. Good place to find all the info. Best wishes to all.
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Would you be able to help me interrupt my MRI results? I can't for the life of me understand why the size of my lesion increased (doubled) from 5.1cm on the US/mamo to 8.6 on the MRI. Is this common?
And regional non-mass enhancement means mostly DCIS? How do I read this?
Unfortunately, no one really walked me through these results, so I'm left to google every other word
Your help is appreciated!
LEFT BREAST: There is a vitamin E marker overlying the upper outer posterior left breast. There is focal susceptibility in the upper outer posterior left breast from a biopsy clip. There is an 8.6 x 5.3 x 4.8 cm area of regional non-mass enhancement in the upper outer left breast, which extends posteriorly to the chest wall and corresponds to the site of biopsy-proven malignancy. The anterior extent of non-mass enhancement is located on series 9/image 87 and series 20/image 55. There are mixed kinetics with areas of rapid initial and washout delayed phase enhancement. There is an indeterminate 1.3 x 0.6 x 1.4 cm oval circumscribed enhancing mass in the central posterior left breast 9.3 cm posterior to the nipple with rapid initial and persistent delayed phase enhancement (series 9/image 111, series 20/image 54). There is an indeterminate 0.6 x 0.4 x 0.5 cm area of clumped non-mass enhancement in the central posterior left breast 7.4 cm posterior to the nipple with rapid initial and persistent delayed phase enhancement, which is located approximately the 1.0 cm anterior to the 1.3 cm mass (series 9/image 114, series 20/image 57). Additional scattered foci of enhancement in the left breast are favored to represent background parenchymal enhancement. The left axilla is within normal limits.
EXTRAMAMMARY FINDINGS: None
IMPRESSION/RECOMMENDATIONS: 8.6 cm regional non-mass enhancement in the upper outer left breast, which corresponds to the biopsy-proven invasive and in situ carcinoma with ductal and lobular features and extends posteriorly to the chest wall. Surgical management is recommended. MRI guided biopsy of the anterior extent of non-mass enhancement could be performed, if clinically indicated.
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VMB, please stay off Google. It's like comparing apples to oranges. djmmamo will be by shortly.
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A few quick comments about breast mri reports. The detail in the body of the report is for the benefit of the next radiologist involved in the case. Unlike mammo and US reports, is full of very specific jargon that only radiologists understand. Its not for you nor for your other doctors. The impression, recommendation and Birads are for you and your doctor, and its your doctor's responsibility to tell you what the study showed in terms easy to understand. Also BrMRI is never read in a vacuum, that is the reader has the mammogram, US, biopsy imaging, and path report at hand when making a decision on the MRI findings.
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"I can't for the life of me understand why the size of my lesion increased (doubled) from 5.1cm on the US/mamo to 8.6 on the MRI."
Thats because they are two completely different imaging modalities based upon vastly different principles of physics to obtain an image. They do not see the same things. The Mammo and US tell us what and abnormality looks like (anatomic) and the MRI gives us an idea of the behavior of the abnormality (physiology). Your findings didnt change size, but the MRI gives us a more accurate depiction of the true size of the area involved.
"And regional non-mass enhancement means mostly DCIS? How do I read this?"
NME can be seen in many conditions, and since yours was already biopsied we know its probably all DCIS. Same can be said for clumped NME though this is usually more suspicious for DCIS. The recommendation for biopsy of the anterior aspect of this NME is not unusual. When there is a large area of NME samples are often taken at its margins to determine if all the NME represents the same histology.
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Is this the entire report? The right breast is not addressed and the enhancing nodule described in the body of this report is not mentioned in the impression.
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Thank you so much for your reply. Full report is now below.
I read this entire thread... all 54 pages. And just want to say how kind and helpful you are to these women. You are an angel.
- The right breast area of concern was actually fibroadenoma (phew! I had it biopsied), so now the plan is for a unilateral mastectomy
- My left breast biopsy showed both DCIS and IDC, but they classified it as just invasive carcinoma with ductal and lobular features. I'm told that they are not able to distinguish exactly how much IDC there is and how much DCIS...
There is no mention in either of my 2 mammo, 2 US or MRI of lymph nodes, except for the sentence that reads "the left axilla is within normal limits" -- what does that mean exactly? I'm terrified that this has spread. Trying to break ties with Dr. Google for now...The breasts have extremely fibroglandular tissue. The background parenchymal enhancement is mild.
RIGHT BREAST: There is a 0.9 x 0.6 x 0.6 cm oval circumscribed enhancing dermal lesion overlying the upper inner posterior right breast with mixed kinetics with areas of rapid initial and persistent and plateau delayed phase enhancement (series 9/image 41, series 29/image 26). Scattered foci of enhancement in the right breast are favored to represent background parenchymal enhancement.
The right axilla is within normal limits.
LEFT BREAST: There is a vitamin E marker overlying the upper outer posterior left breast. There is focal susceptibility in the upper outer posterior left breast from a biopsy clip. There is an 8.6 x 5.3 x 4.8 cm area of regional non-mass enhancement in the upper outer left breast, which extends posteriorly to the chest wall and corresponds to the site of biopsy-proven malignancy. The anterior extent of non-mass enhancement is located on series 9/image 87 and series 20/image 55. There are mixed kinetics with areas of rapid initial and washout delayed phase enhancement. There is an indeterminate 1.3 x 0.6 x 1.4 cm oval circumscribed enhancing mass in the central posterior left breast 9.3 cm posterior to the nipple with rapid initial and persistent delayed phase enhancement (series 9/image 111, series 20/image 54). There is an indeterminate 0.6 x 0.4 x 0.5 cm area of clumped non-mass enhancement in the central posterior left breast 7.4 cm posterior to the nipple with rapid initial and persistent delayed phase enhancement, which is located approximately the 1.0 cm anterior to the 1.3 cm mass (series 9/image 114, series 20/image 57). Additional scattered foci of enhancement in the left breast are favored to represent background parenchymal enhancement. The left axilla is within normal limits.
EXTRAMAMMARY FINDINGS: None
IMPRESSION/RECOMMENDATIONS: 8.6 cm regional non-mass enhancement in the upper outer left breast, which corresponds to the biopsy-proven invasive and in situ carcinoma with ductal and lobular features and extends posteriorly to the chest wall. Surgical management is recommended. MRI guided biopsy of the anterior extent of non-mass enhancement could be performed, if clinically indicated.
Second look left breast ultrasound with possible ultrasound guided biopsy is recommended for the 1.4 cm mass in the central posterior left breast. If no sonographic correlate is identified, MRI guided biopsy is recommended. If the posterior mass is difficult to target due to its far posterior location adjacent to the chest wall, the 0.6 cm clumped non-mass enhancement in the inner central mid left breast could then be targeted.
Ultrasound-guided biopsy is recommended for the 1.9 cm oval mass at 10:00, 6 m from the nipple in the upper right breast seen on recent diagnostic ultrasound.
0.9 cm enhancing dermal lesion overlying the upper inner posterior right breast. Correlate with direct inspection. Clinical management is recommended.
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Hi DJmammo,
Just wanted to ask quickly, would NME present ever WITH a mass and how would that be reported on the MRI read out?
To me, it sounds like I have DCIS (with IDC per my pathology report), but I have a large palpable lump and I know DCIS isn't really felt....?
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@djmammo, I would appreciate your insight on my situation. I was diagnosed with ADH in my left breast last June. Had the lumpectomy last August and am on 6-month monitoring. First check up in March went well, they didn't find anything worrisome. Just had my 2nd follow up and the radiologist saw something in my right breast that he recommended biopsy. There are 3 spots that they are monitoring since last May. Two of the spots they cannot find (or they can no longer see this time). However, there is a small mass that he thinks is suspicious. The report shows “at 10:00, 10 CFN is a hypoechoic slightly irregular 3x3x3 mass with vague shadowing. Although it is decreased in size from previously measured at 7x4x4, its border are no longer circumscribed.". If the mass has decreased, wouldn't it be good sign since if it is cancer, it shouldn't decrease , it should increase in size?Why does he think it needs biopsy when the mass is getting smaller? There is no way that if it is cancer, it will get smaller, right?
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"the left axilla is within normal limits" -- what does that mean exactly?
It's shorthand for "there is no abnormality seen in your left arm pit". That would include the lymph nodes there. At the time of surgery they will take one or more nodes and section them looking for mets.
I'm told that they are not able to distinguish exactly how much IDC there is and how much DCIS..
They will know when they examine the mastectomy specimen.
Just wanted to ask quickly, would NME present ever WITH a mass and how would that be reported on the MRI read out?
NME means "non-mass enhancement", so no, there is no mass seen on the MRI just an area of contrast uptake in that location. If there were a solid mass they would say 'there is an enhancing mass present' and give a measurement of it.
You will know a lot more after the mastectomy.
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@djmammo. Thanks for the response. I understand that “irregular border" is one of the typical signs of concern. However, the mass is getting smaller (they have been monitoring since last May along with two other masses, but they can't find/see the other two masses this time) Since cancer doesn't get smaller, why would it be a concern regardless of its shape if it is getting smaller?
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As with most things in medicine, and especially in breast imaging, nothing is 100%. If a mass gets smaller over time and retains the same shape and margin (morphology) we assume its benign. If it suddenly develops malignant characteristics (irregular margin) we consider that suspicious regardless of a decrease in size.
Here is an excerpt from a case study where a cancer got smaller:
"Conventionally, an untreated breast malignancy usually does not decrease in size or resolve. A mass that decreases in size on mammography may lead to the conclusion that the lesion is not malignant. Our case demonstrates that this assumption is not always true. It is paramount that one evaluates the morphology of a lesion on mammography, regardless of stability or size, and correlate this with detailed knowledge of the hormonal status of the patient. The most suspicious characteristic of any lesion should guide the decision to perform a biopsy."
full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4891469/
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Thank you so much!
NME means "non-mass enhancement", so no, there is no mass seen on the MRI just an area of contrast uptake in that location. If there were a solid mass they would say 'there is an enhancing mass present' and give a measurement of it.
Given your experience (and my limited knowledge), is it possible not to have a mass when I feel a very firm, palpable one? This out of everything is what is confusing me the most.
I appreciate you.0 -
@djmammo, many thanks for the clarification and additional information. It makes a lot of sense to me now. Coincidentally, one of the authors who wrote the case report is my doctor! The presentation of the case has a lot of similarities to my situation (termination of HRT and Tamoxifene treatement, etc.). Interesting, I went to the biopsy appointment today as scheduled, and surprisingly, the radiologist who is supposed to do the biopsy (not the one who read the ultra sound imagings and rendered BIRAD 4 result - although they are from the same hopsital) felt that I could actually wait and watch it for another 6 months. So, she cancelled the biopsy today and I am now back to 6-month monitoring. A bit confusing, I have to say.
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Unfortunately there will always be inter-observer differences in radiology as its is based largely on perception, but IMO this especially affects mammographic interpretation. If you've seen one chest x-ray you've basically seen them all but every mammogram is as individual as a fingerprint so you can't rely on something deviating from a known standard appearance to make a decision.
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Hi again djmammo,
You answered my question a few days back about a CSL biopsy result being "high risk and concordant." I have a follow-up.
The radiologist, the pathologist, and the breast surgeon I've now seen all refer to this as a complex sclerosing lesion. There's no measurement on any of the mammogram reports, and the radiologist said the area looked larger on the mammo than the ultrasound (where it was measured at 5 mm).
My understanding has been that radial scars and complex sclerosing lesions are differentiated by size--but are they ever used purely interchangably? (Mine was seen as an architectural distortion on the screening and diagnostic mammograms.) I'm just wondering if mine is indeed larger than 1 cm.
I actually did ask the radiologist this question when she called with the initial biopsy result, but she was talking a million miles an hour and my head was still swimming a bit and I didn't quite get a hold of her answer, and would feel like a doofus for asking again.
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Sizing a RS/CSL is difficult on mammo and US. On Mammo it looks like a vague area of arch dist, or like a "spider web" as I refer to it. It sort of fades out as you follow it from the center to where its edge might be. It is often only seen in one view on mammo and can be very poorly seen or invisible on US which helps us differentiate it from a cancer but underestimates it size. Surgeons routinely use the largest available measurement to plan their surgery for any abnormality so i assume that is the case here. You might ask if MRI will give a better measurement, we never used it for this but maybe they have.
Also, I use the two terms interchangeably as does this very good article on the subject: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215659/
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Thanks for the great explanation. I'm on the books now for an excision in three weeks, so all will be revealed before too much longer!
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DjMammo - I have my first post-surgical, post- treatment Breast MRI in 2 weeks. My first 3D Mammo in April was stable.
Over the summer 2 of my Supraclavicular nodes on cancer side have been growing. Shown on an US my PCP ordered in July. At that time they were still within "acceptable" parameters, but barely. They now feel larger than they did at the US.
My question is this, when I have the Breast MRI, are those level 5b nodes in the FOV? Will the Radiologist see them if they are an area of concern or will they not be seen?
I'm just not sure how "wide" of an image is taken. Can you help me out a little about how far out from the breasts they can and can't see with a typical Breast MRI?
Thanks so much in advance and for continuing to be such a huge support and resource to everyone here on the boards. You are so very appreciated!!!!
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It varies from place to place but will alsways include both breasts, anterior chest wall and both axilla, and usually goes high enough to include both clavicles. At the time you go in for the scan mention that the subclavicular nodes are of clinical interest to you and your docs.
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I had a excisional biopsy this past Monday for a intraductal Papilloma
I am waiting on pathology
The online portal states under radiology report
large lobulated mass
Does this mean anything
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