Interpreting Your Report
Comments
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thank you djmammo! (i posted my MRI results prior but I didnt see this part till later in the day. thank you for helping! crossing fingers...
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Mahalo djmammo,
I don't see records from 2 years ago, but I am not going to stress about that. I've been on Island for a little over 4 years, so they probably have them.
NancyB 🎶0 -
I received the following MRI results with a score of BIRADS-0. Should I be concerned? I have not yet spoken to my breast surgeon regarding these results.
There is a 1.3 cm x 1.4 cm oval enhancing in the right axilla. The abnormality is best seen on the post contrast axial slice 109.
There is non-mass like enhancement in the right breast at 8-9 o'clock posterior depth 12.5 cm from the nipple which spans an area measuring up to 2.5 cm in greatest (AP) diameter. The abnormality is best seen on the post contrast axial slices 81-96.
There is a 1.9 cm x 2.8 cm focal area of enhancement with lobulated margins in the right breast at 8 o'clock anterior depth 3.7 cm from the nipple. The abnormality is best seen on the post contrast axial slice 109.
There are a few enhancing foci clustered within the middle depth of the left breast at 12 o'clock. The largest focus measures approximately 0.6 cm (best seen on the post contrast axial slice 72).
There is a 1.6 cm x 1.3 cm focus of enhancement with an irregular margin in the left breast at 12 o'clock posterior depth. The abnormality is best seen on the post contrast axial slice 99.
No suspicious findings to account for the patient's bloody left nipple discharge and left breast pain were seen.
IMPRESSION: INCOMPLETE: NEEDS ADDITIONAL IMAGING EVALUATION
The 1.3 cm x 1.4 cm round mass in the right axilla may represent a lymph node. A second look ultrasound is recommended with same day biopsy of suspicious sonographic correlate if identified. If no correlate finding is seen, a 6 month follow up MRI will likely be indicated. If no correlate finding is seen, a 6 month follow up MRI will likely be indicated.
The 2.5 cm area of non-mass like enhancement in the right breast at 8-9 o'clock posterior depth needs additional evaluation.
A second look ultrasound is recommended with same day biopsy of suspicious sonographic correlate if identified. If no correlate finding is seen, a 6 month follow up MRI will likely be indicated.
The 1.9 cm x 2.8 cm focal area of enhancement with lobulated margins in the right breast at 8 o'clock anterior depth needs additional evaluation. A second look ultrasound is recommended with same day biopsy of suspicious sonographic correlate if identified. If no correlate finding is seen, a 6 month follow up MRI will likely be indicated.
The 1.6 cm x 1.3 cm focus of enhancement with an irregular margin in the left breast at 12 o'clock posterior depth needs additional evaluation. A second look ultrasound is recommended with same day biopsy of suspicious sonographic correlate if identified. If no correlate finding is seen, a 6 month follow up MRI will likely be indicated.
The few enhancing foci clustered within the middle depth of the left breast at 12 o'clock needs additional evaluation. A second look ultrasound is recommended with same day biopsy of suspicious sonographic correlate if identified. If no correlate finding is seen, a 6 month follow up MRI will likely be indicated.
No suspicious findings to account for the patient's bloody left nipple discharge and left breast pain were seen. Clinical correlation/surgical follow up recommended.0 -
Djmammo,
Hoping you can help me interpret my Path report. I'm scheduled for an excisional biopsy this Monday.
Top of report states:
A. Right Breast,4;00 3CMFN, Core Biopsies
-Fragments of Intraductal Papilloma
-Fibrocystic changes
Clinical Value:
Your Value
Abnormal mammogram/US Breast
It goes on to talk about the gross description of the multiple cores than the Microscopic Description. Under which, it basically states that microscopic examination was performed and the findings support the final diagnosis. It also mentioned the Immunohistochemical stains (CK5 and p63) were used.
At the end of the report it stated:
NOTE: Intradepartmental review and concurrence with diagnosis.
I understand papillomas are typically not cancerous but that because of a small chance of something else being found so an excisional biopsy is recommended. However, I read an article on the American Cancer Society that if fragments of a papilloma are found on biopsy that is more concerning vs finding confirmation of a papilloma after the excisional biopsy.
Did I understand that correctly? My "mass" what the radiologist called it is 10mm in size confirmed on Mammo and US.
Any feedback regarding my questions about the "fragments" found on core Biopsy would be greatly appreciated! Thank you!
FYI, I also have a small black mole on the side of my nipple (I've maybe had it for a year) and it seems to be slightly darkening around the edge of the nipple. Areolas look normal. No dimpling or anything. Right breast. Kicking myself that I didn't get that spot checked out sooner. Hopefully it's nothing...The surgeon is also taking a sample of that area, as well, during the excisional biopsy procedure. Have you heard of or seen anything like that on a nipple? Thanks again!
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Image guided core biopsies can only give us fragments of a 10mm lesion to examine. They do not usually remove an entire lesion unless it is very very small.
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djmammo, would you mind telling me if you agree that not enough information was given? Also, am I correct in that fibroadenoma can not be positively identified/diagnosed without a biopsy? Thank you.
59 yrs old. As background, I have Hidradenitis Suppurativa (3 cysts and 2 fistulas removed/repaired this year so far >1cm and <2cm), Right Clear Cell Renal Cell Carcinoma with partial Di Vinci Robotic surgery ( 2.5cm Grade 2 Stage 1) almost 2 years ago and am Multigoiter with Endo Dr watching a suspicious .07mm cyst (TI RAD Score of 4) for possible Thyroid cancer. I literally have more cysts than I know about both inside and outside my body from head to toe / front and back.
Spontaneous left nipple discharge off and on for 5 years. Was milky and over the last 2-3 years changed color. Brownish and thin. Went to PCP. She found several 'lumps' in both breasts, but one in the left breast 6:00 position had her concerned. I had Mammo Bil Diag w/Tomo/CAD, Breast Unilateral Limited* on 10/22/2019. I believe that the Rad Dr did absolutely not give enough information in his report for me to make an informed decision regarding my next step and did not address my discharge issue. He gave me a Bi-Rad 3. My PCP wanted to just 'follow things for the next 6 months." I have taken matters into my own hands and have an appointment Nov 11th with the breast surgeon. Having already been down the Cancer road and maybe looking at it again with my Thyroid, I don't do well with "MAYBE, POSSIBLY, PROBABLY" I need 100%.
FINDINGS:
This exam was performed on digital equipment and in addition to being interpreted by a Board Certified Radiologist.
MLO and CC views of bilateral breasts were obtained. As part of the interpretive process, the mammographic images were analyzed with a computer-aided detection system. Tomosynthesis imaging was obtained and reviewed as part of this examination.
There are scattered areas of fibroglandular density. There are focal areas of nodularity noted within the slightly upper outer left breast, lower outer left breast, and inner left breast. These demonstrate well-defined margins on tomo synthesis images. No suspicious focal lesion is noted within the right breast.
There is no architectural distortion or skin thickening.
The background parenchymal activity is symmetric. Benign calcifications are noted bilaterally.
Ultrasound imaging of the left breast demonstrates a small hypoechoic focus at the 6:00 region of the left breast 4 cm from the nipple measuring 0.3 x 0.4 x 0.5 cm. This most likely represents a small cyst with debris. Within the 3:00 region there is a hypoechoic nodule with sharp well-defined margins measuring 1 .0 x 0.5 x 0.7 cm. This is wider than tall. Imaging features are most consistent with fibroadenoma. Within the 4:00 region of the left breast there is a anechoic focus measuring 0.5 x 0.3 x 0.4 cm consistent with a cluster of cysts. A similar focus is noted at the 9:00 region measuring 0.8 x 0.4 x 0.7 cm suggestive of a cyst.
ORDER # 1022-0035 US/Breast Unilateral Limited*
IMPRESSION:
Probably benign. Multiple areas of nodularity are noted within the left breast on mammographic evaluation. These appear to correlate with probable cysts as well as a suspected fibroadenoma as described above.
Six-month follow-up left breast mammogram and ultrasound are recommended to monitor stability and assure benign nature of these lesions.
BIRADS CODE: 3 - PB6 - Probable Benign: Recommend 6 month follow-up.
ORDER # 1022-0027 MAM/Mammo Bil Diag w/Tomo/CAD
IMPRESSION:
Probably benign. Multiple areas of nodularity are noted within the left breast on mammographic evaluation. These appear to correlate with probable cysts as well as a suspected fibroadenoma as described above.
Six-month follow-up left breast mammogram and ultrasound are recommended to monitor stability and assure benign nature of these lesions.
BIRADS CODE: 3 - PB6 - Probable Benign: Recommend 6 month follow-up.
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I am a data driven person - I want all the info - but so far it's like pulling teeth.
History - Mother died of breast cancer 20+ years ago at the age of 59, diagnosed at age 54 - I know nothing about the type she had. She had a mastectomy, and that was it - they wanted her to take tamoxifen, but she refused. It came back 5 years later and she died. Me - 10 years ago, at age 43, I had a rare type of Ovarian cancer (granulosa cell). Complete hysterectomy and chemo. Since then, I have a blood test once a year and it's been clear. Just had it in September and it was normal. In 2015 I noticed bleeding from a nipple. Went in and it was an intraductal papilloma in my upper left breast and was removed. They left a marker behind and sent it off to pathology and it was benign. Have had yearly mammograms since then. They have called me back once, but it turned out to just be bunched up tissue on the right breast. Left breast has always been "unremarkable".
Fast forward to early September I went in for my yearly mammogram. They wanted to compare the prior images. That took 2 weeks. Then they wanted me to come in for a diagnostic and ultrasound. That was finally scheduled for 10/22. At some point, I started feeling a lump in my left breast. At the diagnostic appointment they really didn't give me any information other than "scary enough to do a biopsy". I didn't know what to ask at the time. They just said they would schedule a biopsy - which was supposed to be 11/11 - but I managed to get it moved up to 10/29. My doctor has never called me about any of this. The last time I talked to her was my physical and she wrote the order for the annual screening mammogram.
On Friday I received my report (I had to go up there and get it, as I was going to change facilities to get the biopsy done sooner). I'm thinking this report is not all that great... Seems the mass has several indicators leaning toward malignant, but it's silent on other indicators. Also, the mass is in the same region as the marker, so I was wondering if maybe it's just scar tissue or something from the marker???
Here is the full text:
Findings.
There are scattered fibroglandular densities.
There is a BB marker in the superior left breast, in the region of palpable abnormality as indicated by the patient. There is a underlying focal asymmetry. This corresponds to the abnormality seen on the recent screening mammogram. The asymmetry measures approximately 14 mm. No associated microcalcifications are noted.
Targeted ultrasound of the left breast was performed. There is a irregular hypoechoic mass with angulated margins at 12:00, 9cm from the nipple. This mass appears taller than wide. There is a echogenic rind. This mass measures approximately 1.0 x 0.5 cm. There is no internal vascularity. Imaging features warrant tissue sampling. Evaluation of the left axilla demonstrates enlarged fat containing lymph nodes. No suspicious lymphadenopathy is noted.
BIRADS 4 - Suspicious Abnormality
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Since the time I was in my teens I had been told I had fibrocystic breasts(I am now 31). back in May I went to the dr for a small lump feeling in my right breast. I was sent for an US and they noticed a tiny cyst and told me to come back in three months. They only did US in the one area I mentioned not the whole breast. When I had my follow up back in beginning of sept I saw a different radiologist and she's asked I feel i could still feel the lump. I mentioned that my breasts always feel lumpy so I had a general lumpy feeling. She decided to go ahead and do a mammogram followed by an ultrasound. She became very locked in on area during the ultrasound and mentioned that's that i had fibrodeonma and said I should do see a breast surgeon(rated birads 3). The breast surgeon was not to overly concerned and suggested get another ultrasound in a month(oct.)The radiologist (from October apt)last week said she she noticed something else on the mammogram and showed on US i have three areas in total to investigate. And now is saying birads 4. I am going back to breast surgeon on Thursday to get some more clarity and then will likely have a biospy on Friday. I am just looking for advice in the meantime on how to interpret the report. Is it saying I have dense breast category b or the birads is a 4b. Does this sound like it might be just another fibrodeonma or something more? I am confused by the language since is says likely a fibrodeonma and it's says the margins are slightly indeterminate in the impression area which makes it sound not as serious. However the rating of the birads 4 makes is sound like they are pretty suspicious?
COMMENT:
6:00 position, 1.5 cm from the nipple: Incidental 0.2 x 0.1 x 0.1 cm circumscribed hypoechoic avascular mass, probably a tiny cyst.
4:00 position areolar margin: Redemonstration of a 1.0 x 0.8 x 0.4 cm circumscribed wider than tall solid mass with no appreciable internal vascularity, likely a fibroadenoma.
10:00 position, 2 cm from the nipple: Newly documented 0.8 x 0.8 x 0.5 cm solid lobulated hypoechoic mass with moderate vascularity. This probably represents an additional fibroadenoma but the margins are indeterminate. Biopsy of this lesion is recommended.
11:00 position, 3 cm and the nipple: 0.4 x 0.5 x 0.3 cm circumscribed wider than tall hypoechoic solid-appearing mass with posterior through transmission and noappreciable internal vascularity, likely a small fibroadenoma.
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IMPRESSION: Three solid-appearing right breast masses all of which probably represent fibroadenomas however the 8 mm lesion at the 10:00 position of the right breasts is slightly indeterminant. Tissue sampling of this lesion is recommended. If benign, the other lesions could be safely followed in six months with repeat right mammogram and ultrasound to confirm stability.
FINAL ASSESSMENT BI-RAD CATEGORY 4 - SUSPICIOUS ABNORMALITY - BIOPSY SHOULD BE
CONSIDERED (B RIGHT) (6MOS RT; US 6 MO R) DENSE.
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Dear geneseo and Sunset5585,
Welcome to the BCO community. We are glad that you reached out here for support and information. We are certain that djmammo will be along to comment on your reports. Let us know if we can be of help.
The Mods
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"... am I correct in that fibroadenoma can not be positively identified/diagnosed without a biopsy?"
FA's can have a wide range of appearances. If the mass has enough of the findings that are associated with a benign FA then that's what we call it. Unless there are comparisons that show its stable, a 6 month follow up is routine. Many patients do request a biopsy in such cases and I usually oblige.
"... telling me if you agree that not enough information was given?"
Information in the form of adjectives describing the probable FA, or information regarding what to do next?
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I don't see a reference to the prior study in this report but the description warrants a biopsy. If this finding is new that would tend to make this more suspicious. If you had a core biopsy of the papilloma, that would not leave a visible scar. If it was a surgical excision that would leave a scar that would look suspicious on mammo but can be distinguished from a cancer on US.
"...but it's silent on other indicators."
What other indicators are you interested in?
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FA's are often found in multiples, often bilaterally too. If they all look similar and the biopsy of one is benign we assume the other are too then watch them for a while.
I've noticed they seem to run in families when multiple. Mother or sister with FA's?
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DJmammo thanks for your reply. My mom has had a few lumps/cysts looked at all benign back in her 30s-40s but nothing recently(she is now in her 60s). I am unsure if they were FA or cysts. I have many aunts/cousins and no one has ever had issues with breast cancer. I guess i am more worried since they features say hypoechoic, lobulated, with moderate vascularity with Indeterminate margins(during the scan the radiologist also did say she couldn’t tell if the blood flow was by mass or in the mass). Can a FA have these features?The nurse coordinator when I was setting up my biopsy said to me at least if it's cancer they caught it early. The radiologist made it seem more like she wanted to get a closer look to make sure it Is a Fa. I know the only way to tell is to do a biospy but based on the description what's the likihoood it's a FA vs malignant. Thank
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The terms used, 'wider than tall' and 'posterior through transmission' are features of benign masses. (malignant masses are more often described as taller than wide and demonstrate posterior shadowing)
'Hypoechoic, lobulated and vascular' are features of both benign and malignant masses and the difference comes from the degree of each i.e. how hypoechoic is it? how lobulated is it? how vascular is it?
Also statistically speaking, cancers are usually single and fibroadenomas are not infrequently multiple when discovered.
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Thank you for the reply. This was a new finding. Previous mammogram last year was completely normal - "unremarkable". I've heard a lot about "shadowing" and my report didn't mention that at all - which is why I said it was silent on other indicators.
My biopsy was today, and the radiologist (different from the first ultrasound) said in his experience, he thinks it will come back as cancer - but there is still a chance that it is benign.
He said he would call me on Friday with the results - which I really appreciated, as getting information out of my primary doctor has proven difficult.
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Dear Djmammo,
Would it be normal to see an intramammary lymph node on MRI, but not on mammogram? I'm having a second look ultrasound for a what probably is an intramammary lymph node seen on MRI. As far as I know it's never been noted on a previous mammogram or previous ultrasound. Is it normal for new lymph nodes to show up? This is a new to me imaging center, they did not have old imaging for comparison. They have requested the older studies.
Thank you!
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If a lymph node or other mass is located far enough posterior in the breast (i.e. very close to the chest wall) it may not be included in the mammogram image depending upon the size and shape of your breast, when it is compressed in the mammo machine. An MRI has no such restriction and can image all the way through the chest wall. Also the MRI should be able to determine the size and internal architecture of the node but if they have any questions, US is excellent at evaluating lymph nodes and my personal favorite for this.
The old studies will be helpful as sometimes these things are alternately seen and not seen depending upon the machine used and fluctuations in patient weight over the years. They should look at all the old studies not just the one from last year.
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History:
38 Year old, had radial scar removed 7/26/19. (Family history: Mother DCIS diagnosed at 65 years old)
Starting on every six month screenings on 10/21/19 with MRI. This MRI resulted in needing an ultrasound. Report below:
Impression
1.Biopsy of RIGHT breast 1:00 nodule and LEFT breast 11:00 nodule is recommended. These correspond to the MRI findings. While these have an appearance of benign fibroadenomas, the MRI appearance and the patients high-risk for breast cancer make biopsy appropriate.
2.The MRI nodule very far posteriorly within the RIGHT breast at 3:00 may be visualized on today's study and also has an appearance of a fibroadenoma. Since this is less certain to correspond to the MRI finding continued surveillance with MRI for this lesion is recommended.
BI-RADS Category: 4A-Biopsy : Suspicious. Low suspicion for malignancy. Biopsy should be performed In the absence of clinical contraindication.
Recommendation Laterality: Bilateral
Narrative:
ULTRASOUND BILATERAL BREAST: 10/28/2019 11:17 AM
HISTORY:bilateral abnormal MRI - Z91.89 - At high risk for breast cancer - N64.89 - Radial scar of breast - R92.8 - Abnormal magnetic resonance imaging of breast, bilateral.
COMPARISON: MRI 10/21/2019, surgical specimen 7/26/2019, needle localization 7/19/2019, outside mammogram 4/29/2019, 4/12/2019
TECHNIQUE: Gray scale and Doppler images.
FINDINGS:
PHYSICAL EXAM: Deferred
RIGHT BREAST:
MRI nodule #1: A correlate nodule is found to be MRI finding located at 1:00, 5 cm from the nipple. This measures 5 x 9 x 10 mm by ultrasound and has macrolobulated borders with no posterior acoustic shadowing. This is wider than tall. This has imaging appearance of fibroadenoma. Given patient's high-risk for malignancy and imaging appearance on MRI biopsy is recommended.
MRI and nodule #2: A correlate nodule is potentially seen at 3:00 within the RIGHT breast far posteriorly near the pectoralis muscle. This measures 5 x 11 mm in diameter and is macrolobulated with no posterior acoustic shadowing. This is less well seen than nodule 1 described above. Although possible for biopsy this would be technically more difficult given its deep location adjacent to muscle. This also showed slightly less concerning imaging findings on MRI and therefore continued surveillance is recommended with MRI since this ultrasound finding may or may not correspond to the MRI finding.
LEFT BREAST:
MRI nodule #3: A macrolobulated hypoechoic nodule measuring 6 x 11 x 11 mm is present without posterior shadowing at 11:00, 3 cm from the nipple. This likely corresponds to the MRI finding. This appears fairly readily amenable to percutaneous biopsy.___
I don't understand how this can be Birads 4 and also low suspicion for malignancy.
I had a bad experience with breast seed localization procedure and am having a terrible time with anxiety about starting this process all over again where another surgery may be needed. I am wondering if waiting and watching is a okay as I go back for another mammogram in May. I am also wondering how quickly fibroadenomas pop up and if every six months from now on I am going to need follow ups and biopsies. Is that even possible?
Since these three spots apparently were not seen on my mammo in April of 2019 but seen in MRI on 10/21/19, will they even show up well on my next mammogram? Is that why they would rather biopsy now and not wait a year?
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"I don't understand how this can be Birads 4 and also low suspicion for malignancy"
You cannot have a biopsy without a B4. The ACR and the ins companies require it. The other choices are routine imaging or 6 mo follow up.
If the nodule is too far back to see on mammo, and it is an FA, t will have to be followed by US or MRI or removed.
Once it is biopsied and is found to be benign it is followed to assess its rate of growth since if it grows very fast they are usually removed. This can be done at US if overall measurement can be accurately made, as seeing internal details dont matter in its management at that point.
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I had the ultrasound guided biopsy today only on the right breast for the item previously indicated at 8 o’clock. The other MRI findings were not located in ultrasound. Is this good news? I will receive results on 11/1.
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djmammo I'm just not sure that the information given by the Rad Dr is enough in regarding what to do next. This is my 1st mammogram and have nothing to compare it to. I've got a Hx of cancer, and to 'maybe' have it again is very scary. BIRADS 3 is right in the middle. Thank you for responding to my previous message.
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There are basically only two choices, wait the 6 months or biopsy it. I assume you do not fully trust the report of your imaging or you wouldn't feel the need for additional information so I would discuss it all with the doc you know best, perhaps your oncologist, then do what you feel most comfortable.
I am not sure if the combination of all your current conditions adds up to any particular known syndrome but there may be associations between some of them (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674048/) . If this puts you in a higher risk category for breast cancer, that may help you make your decision. Again talk it over with a doc you trust.
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Thank you djmammo. Your thoughts are very much appreciated.
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Thanks!
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I am currently waiting for biopsy results. After my diagnostic mammogram the tech showed me the area of concern a cluster of mirco calcifications behind my nipple. When I went for my biopsy earlier this week there was a mix up with my appointment time so I ended up starting late. I was told to plan 2 hours and yet I was less than an hour. During the biospy I was told that there were 3 clusters scattered through out my right breast and that they would be taking samples from a cluster on the outer left side of my breast. I asked why not the same one that was noted as concerning and was told that they all looked the same and that the dr was not concerned.
So my questions:
If this cluster is clear then the others are as well? Which leads me to ask if this cluster shows cancer then the others do as well? I am so confused. Why a diagnostic mammogram on one area yet do the biopsy from a different area.
I realize I am low risk with a 4A but I have cancer, lots of cancer in my family so I am very scared.
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If there are multiple identical findings, either masses or calcifications, the convention is to biopsy the one easiest to sample (shortest distance, easiest method, least discomfort etc) and assume that its path result represents all of them. And by identical I mean IDENTICAL not "fairly similar". If they were dissimilar they would all be biopsied.
If benign, the ones not biopsied are followed at intervals. If malignant an MRI is performed which will document that the ones not sampled are also malignant by MRI criteria and by comparison to the one sampled.
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