Interpreting Your Report
Comments
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Hello everyone, newbie to this forum. I have a MRI guided biopsy scheduled Oct 9th.
My report was called into me by my doc medical assistant and really didn't go into detail. I can only assume that is because it could be nothing or something. I'm trying not to stress but any insight on the report would be great! I am going to copy the full report below. Thanks so much and have a beautiful Saturday
09/03/2019 MRI BREAST W/O AND/OR W CONTRAST BILATERAL
Reason For Exam:RIGHT BREAST LESIONS.
Data: 44-year-old patient with abnormal ultrasound.
Risk Factors:No known genetic mutation.
Family History: Great aunt, grandmother's sister.
Lmp: 8/25/2019.
Bilateral breast MRI, technique: 1.5T.
Multiplanar MRI imaging of both breasts was performed with a dedicated breast coil, before and after administration of18 cc of gadolinium contrast (ProHance), using the standard breast protocol. Computer aided detection was used to aid in interpretation.
Comparison with prior MRIs: No priors.
Correlation With Mammograms: 8/14/2019.
Correlation With Ultrasound: 8/14/2019.
General Breast Composition: Heterogeneously dense.
Background Parenchymal Enhancement: Mild.
Findings:
Left Breast:
Review of the dynamic contrast-enhanced series demonstrates no evidence for abnormal mass or nonmasslike enhancement of the left breast. The T2-weighted series shows no areas of abnormal signal intensity. No evidence for skin thickening or nipple retraction.
Right Breast:
Abnormal segmental clumped nonmass-like enhancement is observed of the anterior, mid and posterior upper outer quadrant of the right breast. No abnormal mass or nonmass-like enhancement of the remaining three quadrants of the right breast. The T2-weighted series shows no areas of abnormal signal intensity. No evidence for skin thickening or nipple retraction.
Lymph nodes: No internal mammary or suspicious axillary lymphadenopathy is identified.
Nonbreast findings: No significant abnormalities
Impression:
Left Breast:
No MRI evidence for malignancy of the left breast.
Right Breast:
Abnormal segmental clumped nonmass-like enhancement of the upper outer quadrant of the right breast.
Recommendation:Biopsy of the upper outer quadrant right breast nonmass-like enhancement by MRI guidance. This may be performed at Tower Northside facility if desired.
BI-RADS CATEGORY 4 - Suspicious Abnormality; biopsy should be considered0 -
djmammo
Thank you for your response! I'm keeping the positive vibes going
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Yes when I get the report hopefully tomorrow
That was just the results of the XRay of the mass the was removed
Thank you so much for all that you do!!
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Report says
Biopsy site changes present
Focal sclerosing adenosis
Nonproliferative Fibrocystic changes
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thank you so much!!
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Biopsy site changes are identified in several sections. There is no evidence for residual papilloma. No in Situ or invasive neoplasm is identified. In addition to small foci of sclerosing adenosis widespread dense fibrous stroma, slightly dilated ducts, rare epithelial-associated calcifications, aprocrine metaplasia and part of a small Fibroadenomatoid nodule are seen
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djmammo, does the size of a tumor differ between plain x-ray, CT, PET and MRI?
I have a tumor in my left femur. It was measured at 1.7 cm on PET and MRI in the spring.
Just had a plain x-ray of my hip and the report says it's 2.3 cm. Does that necessarily mean it's grown, or just that the x-ray measurements are different because it's a different "view" of the tumor?
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Apples and oranges. The ways in which these modalities acquire an image are all different, and "see" different aspects of the abnormality. One is based on how easily x-rays can pass through the target, one determines the metabolic activity of the cells in the target by how much radioactive sugar it takes up, and the other evaluates how atoms behave in the target when subjected to a strong magnetic field. They all supply a different puzzle piece to discover what the abnormality it is and how it might behave in the future.
Bone is a bit out of my current area of expertise but I do recall that some of what you see on imaging of bone masses is the bone's reaction to the presence of the tumor that may not actually represent active tumor. This can be a thickening of the bone around the tumor seen as increased density on x-ray (sclerosis), edema surrounding the tumor seen as increased T2 signal on MRI, etc.
To determine growth, comparison of two images obtained with the same modality would be the most accurate.
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I have a biopsy tomorrow and just got my mammogram report and wanted to see what your thoughts are:
Impression
Impression:
Intraductal mass versus debris in the subareolar left breast at 6:00, in this patient with nipple discharge.
Recommendations:
Ultrasound-guided core biopsy of the left breast.
The results and recommendations were discussed with the patient. We will assist in scheduling the biopsy.
Final Assessment BI-RADS (4A): Low suspicion for malignancy
Electronically Signed by: Nneka Jimoh, MDNarrative
Clinical History: 45-year-old with single duct spontaneous thin yellow left nipple discharge for the past 3 weeks.
Comparison: Mammogram 4/23/2010
Density: There are scattered areas of fibroglandular density
Technique: Low-dose tomosynthesis 3D views were obtained in combination with 2D images.
This mammogram was scanned by computer aided detection system.
Mammographic Findings:
There are no dominant masses, suspicious calcifications or architectural distortion within either breast.
Sonographic Findings:
A targeted ultrasound of the entire subareolar left breast was performed. This demonstrates ductal ectasia. There is also a tubular hypoechoic mass measuring 0.9 x 0.3 x 0.4 cm best seen at the 6:00 position. This could represent a duct filled with
debris versus intraductal mass as it could be connected to a subareolar duct anteriorly on real-time scanning.0 -
Thanks, djmammo, you are so helpful! Due to the complexity of my case and the fact that they can’t seem to tell what this tumor is, the orthopedic oncologist is going to present all of my past imaging at radiology conference
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Djammo I have a biopsy tomorrow and just got my mammogram report and wanted to see what your thoughts are on what this could be originally they said no possibility of malignancy but this seems worrisome
ImpressionImpression:
Narrative
Intraductal mass versus debris in the subareolar left breast at 6:00, in this patient with nipple discharge.
Recommendations:
Ultrasound-guided core biopsy of the left breast.
The results and recommendations were discussed with the patient. We will assist in scheduling the biopsy.
Final Assessment BI-RADS (4A): Low suspicion for malignancy
Electronically Signed by: Nneka Jimoh, MDClinical History: 45-year-old with single duct spontaneous thin yellow left nipple discharge for the past 3 weeks.
Comparison: Mammogram 4/23/2010
Density: There are scattered areas of fibroglandular density
Technique: Low-dose tomosynthesis 3D views were obtained in combination with 2D images.
This mammogram was scanned by computer aided detection system.
Mammographic Findings:
There are no dominant masses, suspicious calcifications or architectural distortion within either breast.
Sonographic Findings:
A targeted ultrasound of the entire subareolar left breast was performed. This demonstrates ductal ectasia. There is also a tubular hypoechoic mass measuring 0.9 x 0.3 x 0.4 cm best seen at the 6:00 position. This could represent a duct filled withdebris versus intraductal mass as it could be connected to a subareolar duct anteriorly on real-time scanning.
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I have had a diagnostic mammogram and an ultrasound for unilateral, single duct, spontaneous bloody nipple discharge. The mammogram was negative and the ultrasound showed a suspicious mass, but a core needle biopsy failed to explain the persistent discharge. My doctor then ordered a ductogram, and I have concerns about the results. I have been referred to a breast surgeon for consultation and probable surgery, but in the meantime my mind keeps going to all the "what-ifs."
The report states that it is abnormal galactography of the right breast. Multiple filling defects are seen within ectatic and dilated ducts beginning approximately 2 cm posterior to the nipple in the retroareolar right breast and continuing up to 5 cm posterior to the nipple within the retroareolar right breast. There is at least one abnormally truncated dilated duct approximately 2.3 cm posterior to the nipple. Normal branching and caliber of the ducts is seen more posterior/deep to these locations.
My questions are:
Do multiple filling defects as described above have a greater chance of being cancer?
Can an older (age 68) postmenopausal woman have papillomatosis? I have read it usually occurs in younger women.
What does a truncated dilated duct indicate?
I know the only definitive answer will come with a pathology report, but I am hoping you can shed some light on the possibilities of what all this could likely mean. It is so hard not to think about it.
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Far and away papillomas would be the most likely cause for fixed filling defects in the ducts. And as they have a small malignant potential they are always removed as a precaution even if the biopsy comes back benign.
Do multiple filling defects as described above have a greater chance of being cancer?
The short answer is 'not necessarily'. Statistically, I guess each one has a very small chance of being a problem and I guess you could combine all those probabilities but someone other than me would have to "do the math".
Can an older (age 68) postmenopausal woman have papillomatosis? I have read it usually occurs in younger women.
Yes. Key word is 'usually'.
What does a truncated dilated duct indicate?
It means the duct is blocked and expanded, likely due to the presence of a papilloma, causing an abrupt cut off of the contrast in the image.
A few possibilities for follow up here, depending on your docs' routines. I believe a duct excision will ultimately be recommended but it may be proceeded by an MRI to see how many ducts are affected that were not examined on ductography, and to see if it is present in the other breast as well. They might opt for an ultrasound just to see if those things in the ducts are visible that way, and could be biopsied before surgery.
For a duct excision, on the morning of the surgery we would repeat the ductogram with a blue dye mixed in with the contrast so that in surgery they can see which duct is affected visually.
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Thanks, djmammo. My oncologist said she would not recommend an invasive bone biopsy unless they highly suspect malignancy. They seem to be taking a very nonchalant approach to this.
Oh, one other question. What are pseudoarticulations? Those are noted as being seen on my lumbar spine and hip X-rays.
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djmammo,
Thank you so much for answering my questions! I also appreciate the information on possible follow up. I have wondered if the same thing could potentially be happening in the opposite breast. Perhaps this should be further explored depending on the final diagnosis of the abnormality in my right breast. I will mention this to the breast surgeon at my appointment. Again, thanks for your response.
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Sorry, djmammo, one other question. What does "nonspecific inguinal lymph nodes" mean on an MRI?
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I’m new and trying to get input on my report. Blah, I hate Dr. Google. I wasn’t worried but my primary called me to schedule a review of this before signing the biopsy. Boo hiss. This sent me straight into panic mode. I keep repeating it’s only a BI-RADS 4.
I tried to find similar results of others on here but didn’t see the same terminology. Alas, I’m not trained or educated in the slightest about this. Thanks if you got this far!
Narrative
MA-MAMMO ADDITIONAL VIEWS TOMO RT, US-BREAST RT COMPLETE
INDICATION FOR EXAMINATION: R92.8: Other abnormal and inconclusive findings on diagnostic imaging of breast.
DATE OF SERVICE: 9/17/2019 1:52 PM
COMPARISONS: 9/3/2019 through 6/5/2017
MAMMOGRAM
TECHNIQUE: 2-D and 3-D tomosynthesis images of the right breast were obtained. Computer aided detection (CAD) was used to assist in the interpretation of the 2D mammogram.
BREAST COMPOSITION:
The breast tissue is heterogeneously dense, this may lower the sensitivity of mammography.
FINDINGS:
There is a persistent isodense 7 mm mass with obscured margins at the 7:00 position of the right breast (CC slice 12, MLO slice 18). In retrospect, this may have been present on the prior exam from 2017.
ULTRASOUND
TECHNIQUE: Real-time grayscale and color images were obtained and are reviewed. The breast(s) was/were scanned in its/their entirety including all 4 quadrants and the axillary, supraclavicular and parasternal region(s).
FINDINGS:
At the 12:00 position 2 cm from the nipple, there is a 6 mm anechoic cyst. There is an additional 5 mm anechoic cyst seen at the 1:00 position 2 cm from the nipple.
At the 8:00 position 7 cm from the nipple, there is an irregular hypoechoic mass with microlobulated margins measuring 9 x 4 x 7 mm. It is unclear if this corresponds with the mammographic finding, however given the likelihood lobulated margins, ultrasound-guided biopsy is recommended. Correlation with clip location on the postprocedural mammogram is recommended.
At the 9:00 position 14 cm from the nipple, there is redemonstration of an oval hypoechoic mass measuring 8 x 7 x 9 mm, not significantly changed him back to 7/16/2017.
The parasternal and infraclavicular regions are unremarkable. No abnormal axillary lymph nodes are identified.
ASSESSMENT:
BI-RADS CATEGORY (4) suspicious. Biopsy should be considered.
RECOMMENDATIONS:
Right Ultrasound-guided breast biopsy of the hypoechoic mass at the 8:00 position.0 -
Hello. I have a biopsy scheduled for Monday. I have high anxiety and was ill today after this mammogram. Would you kindly let me know what this means? The radiographer showed me the area of concern and said it didn’t have straight lines but lines coming out. He was very robotic.
IMPRESSION:
The asymmetry in the lateral right breast persists on spot compression CC
view and CC view and is still not well appreciated on the ML views. There is
also no discernible sonographic correlate to this area. Therefore, further
evaluation with tomosynthesis guided stereotactic biopsy is recommended.
This result was discussed with the patient's time of interpretation including
the recommendation for right breast stereotactic biopsy.
BI-RADS: 4: Suspicious
Recommendation: Tissue diagnosis.
Recommendation Laterality: RightEXAM: MAMMO SPECIAL VIEWS WITH TOMO RIGHT, US BREAST LIMITED UNILATERAL RIGHT,
09/26/2019 09:59 AM (accession 5159972E), 09/26/2019 10:10 AM (accession
5159973E)
CLINICAL INDICATIONS: 43-year-old female who is being recalled for an asymmetry in the lateral middle third of the right breast.
COMPARISON: Prior mammograms dated 8/20/2018 and 9/20/2019
TECHNIQUE:
2-D ML, CC, and spot compression CC views were obtained of the right breast.
3-D digital tomosynthesis images were also acquired in the same projections.
Computer aided detection was utilized.
FINDINGS:
The breast has scattered areas of fibroglandular density. The asymmetry in the
lateral posterior third of the right breast persists on the spot compression
tomosynthysis views. It is still not well appreciated on the ML view. There are no additional suspicious masses, calcifications, or architectural
distortions. The patient was then sent to ultrasound for further evaluation of the asymmetry.
ULTRASOUND TECHNIQUE:
Multiple real-time gray-scale images of the right breast in the 7-10 o'clock
axis are performed. Color Doppler was used to assess vascular flow.
ULTRASOUND FINDINGS:
There is no evidence of mass lesions, architectural distortion, or abnormal
blood flow.Thank you. I’m overwhelmed.
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No reason for panic mode at this point.
There are 2 little nodules described on the US, one of which will correspond to the mammo finding which has not changed in 2 years, the other will be the one that gets biopsied.
The one that will be biopsied is not completely described IMO. There is no mention of the presence or absence of posterior shadowing which helps me predict between favorable and less favorable histology. I will for now assume it there were more scary findings present they would have mentioned them as that is what we are trained to do.
On the prior US that showed one of the 2 nodules, it would be interesting to see if the area of the other nodule was scanned back then, as it would help us to know if it is really new since prior exam.
After the bx they will take another mammo which will show the marker clip. They will look to see if it corresponds to the mammo finding they described. They will decide what's next depending upon where that clip is.
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First, odd that you had a male mammogram tech, secondly techs are not trained nor qualified to interpret your imaging, you can disregard what they say. They are not supposed to offer opinions.
Although this finding is likely new since the prior study, the odds of it being something bad go down if it is only seen in one view, and the odds go down even further if the US shows no abnormality in that area.
So no reason to panic at this point. If what the tech told you was the reason for your high anxiety I would mention his comments to the radiologist next time you see them.
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Hi. It was the radiologist that came in and said that (aka, Mr. Robot). Not sure why I wrote radiographer.
Thanks for looking at my post!
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Thank you @djmammo
I was hoping they would find that in previous scans as well. Not sure why they didn't mention the shadowing? It's very vague to me. I went over my previous tests but the areas don't line up. This one noted 7, 8, 9 o clock positions. I'm trying not to stress because I looked further on here and seems most ladies with similar reports were clear. Thank you again for reading
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djmammo,
I ended up switching to an accredited breast clinic this last month due to my last BS and radiologist not agreeing and having very different opinions on what further diagnostic steps should be taken. I found this breast clinic using links to accreditation websites you previously have provided on this site, so thank you for that! The difference is amazing, and I feel very confident in the team I now have. I was initially scheduled for a ductal excision and likely excisional biopsy for next week. But they just called back and after receiving and reviewing the images I already had, not just the written reports, they want to do another MRI with their 3T machine. The intent would be to then try for an MRI guided biopsy depending on what is still seen on the newest MRI. I was told if I was upgraded my surgical plan would be significantly different, so my planned surgery will be postponed until these next steps are completed.
After I got off the phone I realized I had two questions, and I'm hoping you might be able to help me with them. What is the main difference in using a 3T machine versus the 1.5T I had done 3 months ago. What generally is hoped to be gained by using this machine?
My second question is about skin enhancement. During my appointment I noticed the surgeons PA circled on my MRI report where it said there was "associated skin enhancement throughout the anterior aspect of the right breast". I was hoping you could give me an idea of what benign processes could cause skin enhancement on breast MRI.
Carissa
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I have been a bit spoiled having had a 3T MRI at my last practice and there is a big difference in image quality in my opinion. After that experience I wont read a breast MRI from a 1.5T unit.
Enhancement in MRI is based on the blood supply in the area of interest. If the skin is not thickened in that area, and there is no adjacent abnormality in the breast tissue underneath, it may be an infectious or inflammatory process in the skin itself. It would be odd to have a skin cancer there and not see anything odd. If there is something visible or palpable in the skin in that area that may help tell them what it is.
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Thank you so much for your quick response!! Now I'm hopeful the new images will provide better information to help figure out what is going on.
The information about skin enhancement really helped me. I did have heterogenous nonmass enhancement in a segmental and linear distribution throughout the retroareolar area on the same breast, and all the focus has been on that so far. With the new interest in the skin enhancement it made me curious what it could mean, and I'm trying really hard not to use Dr. Google!!
It really does seem I'm at the right place now, and hopefully with have definitive answers soon
Carissa
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