Interpreting Your Report
Comments
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thank you. Here’s what was said after the biopsy 6 months ago and below that the original report that came back suspicious
Pathology has been provided for the two biopsied lesions in the left breast.
Pathology for the anterior lesion marked specimen
#1, marked with a rod-shaped clip reveals benign breast tissue. Pathology for
the posterior lesion marked specimen #2 marked with a barbell-shaped clip also
reveals benign breast tissue with pregnancy like changes.
No definitive diagnosis was demonstrated at either site. It is uncertain
whether there is concordance of pathologic and imaging findings. Biopsy may be
reflective particularly given the multiplicity of the initial findings and lack
of a dominant or high risk suspicious enhancing MRI abnormality. Short interval
MRI follow-up however, in 4-6 months is recommended to assess further stability
and this will help determine whether any additional pathologic sampling will be
needed.
Patient will follow-up with Dr.
FINAL ASSESSMENT: CATEGORY 3 PROBABLY BENIGN FINDING, RECOMMEND SHORT INTERVAL
MRI FOLLOWUP
2019 3:29 PM CLINICAL HISTORY: High risk patient, family history of breast cancer including a mother with premenopausal cancer, mammographically dense breasts.
COMMENT: A bilateral breast MRI was obtained utilizing a breast coil. Axial and
sagittal T1 and T2-weighted imaging was obtained on a 1.5 Tesla GE magnet. Fat
saturation technique was utilized. For the enhanced component the patient
received intravenous Gadavist contrast material. Following contrast
administration, serial enhanced dynamic sagittal imaging was obtained through
both breasts at incremental time intervals. Subtraction images were generated.
The study was reviewed on a PACS workstation with the benefit of computer
assisted detection.
There are no previous breast MRI studies for comparison. There are previous
mammograms with the most recent of February 2019 and another study of June 2015.
Breasts are partly fatty with patchy and confluent areas of parenchyma
throughout. There is mild background enhancement.
In the right breast there is no suspicious enhancing mass or suspicious regional
enhancement.
In the left breast at the upper outer aspect there is a nodule with peripheral
enhancement. It is well marginated. It is markedly T2 bright suggesting a
benign process. It measures close to 8 mm and appears to correspond with the
nodular density demonstrated on the recent mammograms. This was likely present
on the mammogram of 2015. Appearance as well as lack of change suggests a
benign process.
In the anterior to central depth upper outer left breast there is a focal area
of enhancement, somewhat elongated or bandlike. This is best demonstrated at
sagittal location -88.17 and corresponding axial location 2.27. This is
indeterminate and biopsy is recommended. In the slightly more central depth
more medial left breast there are additional focal areas of enhancement. This
includes an abnormality central to posterior depth at the -70.17 sagittal
location and corresponding 14.27 axial location. Slightly more lateral at the
same axial plane there is additional enhancement at sagittal location -78.17 and
again axial location 14.27. There is also a tiny nodular enhancement at the
-80.17 sagittal location corresponding with axial location 4.67. Biopsy of one
of these additional areas is recommended suggested of the most prominent which
is at the posterior upper outer breast at the -78.17 location. If these are
benign then other abnormalities can be followed in short interval with MRI to
assess further stability.
There is no bulky or suspicious adenopathy bilaterally.
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IMPRESSION:
There is a markedly T2 bright nodule in the posterior depth left upper outer
breast thought to correspond with a mammographic nodule thought to date back to
2015 mammograms. Appearance and the stability suggests a benign process.
Continuing imaging follow-up is advised in short interval to assess further
stability.
There are multiple enhancing abnormalities which are small and scattered within
the left breast and biopsy is recommended of the two most prominent to exclude
malignancy. This includes that located at the sagittal location -86.17 and
another located at the axial location 14.27. If these are benign than the
others can be followed in short interval to assess further stability.
See comment.
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djmammo - UPDATE RE: Post on 10/26
"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. BIRADS CODE: 3 - PB6 - Probable Benign"
Had my appointment with breast surgeon. He moved me from BIRADS 3 to BIRADS 4b regarding that particular concern. Size and wider than tall confirmed. He stated: It has characteristics fairly similar to benign fibroadenoma. It's edges are a little bit ragged though and not entirely classic for fibroadenoma, it is somewhat indeterminate. He did do a UltraSound Core Biopsy (2 samples) and I should get the results tomorrow.
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I've come across a fair amount of info on the subject but the numbers vary a bit. Here is what I found most often
Maximum dose by weight for lidocaine without epi is 4.5 mg/kg body weight. (range 3-5mg/kg)
1% lidocaine contains 10mg lidocaine per cc (cc=ml) not to exceed a total of 300mg. (1kg = 2.2lbs)
I will leave the math to you.
see these articles:
https://wikem.org/wiki/Local_anesthetic_systemic_toxicity
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I was so stunned while I was at the doctor, that I could not really listen to what she said. I just received my reports and tried to interpret them myself, but could use some help:
1.) SCREENING MAMMOGRAM:
The following mammographic views were obtained: bilateral digital craniocaudal with tomosynthesis and bilateral digital mediolateral oblique with tomosynthesis.
There are scattered areas of fibroglandular density.
There is an area of asymmetry seen in the CC view only seen in the posterior third lateral of the left breast located 11 centimeters from the nipple.
BI-RADS Assessment Category 0
2.) DIAGNOSTIC MAMMOGRAM:
The following mammographic views were obtained: left digital craniocaudal spot compression; left digital craniocaudal spot compression with tomosynthesis; left digital mediolateral oblique spot compression; left digital mediolateral oblique spot compression with tomosynthesis; left digital mediolateral; left digital mediolateral with tomosynthesis.
There are scattered areas of fibroglandular density.
On the present examination, there is a focal asymmetry measuring 8 millimeters in the posterior third of the left breast upper outer quadrant at 2 o'clock located 12 centimeters from the nipple.
3.) ULTRASOUND:
High-resolution real-time ultrasound scanning was performed.
The finding in question is not seen on ultrasound.
BI-RADS Assessment Category 4: Suspicious abnormality.
4.) Mammo Stereotactic has been scheduled
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I had a clear mammogram in June and then requested an ABUS in October due to dense breasts, there was a finding on the ABUS and then I was recalled for a diagnostic HHUS. I am scheduled for core biopsy next week but I am just looking to understand the ultrasound report and if there is reason to be concerned or could this just be a precautionary?
Within the right breast 8 o'clock vector(s), 1-2 cm from nipple, there is a densely shadowing irregular hypoechoic lesion measuring 4 x 6 x 6 millimeters. No evidence of right axillary lymphadenopathy. Patient to be booked for ultrasound guided biopsy. BIRADS 4
Thanks
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perfect thank you, I will post once I receive the results from the biopsy.
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Thank you for your response. My question is that since I did not hear what the doctor was saying at the mammo/ultrasound appointment, but I now have the reports . . . . I am wondering what they mean? Is their write-up concerning?
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The reports as posted dont mention whether or not there were prior studies available and if they were compared with the present one. An area of asymmetry is a white spot that is seen on one side and not in the other in the same location. They did not use the word mass which is good. The ultrasound showed nothing which for the most part is very encouraging as an 8mm cancer should be visible on US. There are some masses, mostly benign ones, that can be of an identical shade of grey as the surrounding normal breast tissue (called isoechoic) which can be very hard to see/invisible on US, They want to biopsy this finding guided by the mammo since its not seen on US so it will be done by stereotactic technique. With some machines the biopsies are done lying on your stomach, some machines have you sitting up for the biopsy but the concept is the same.
See this link for stereo bx info: https://www.radiologyinfo.org/en/info.cfm?pg=breastbixr
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Hi there. djmammo thank you in advance! You are doing an invaluable service helping the members of this community. I am getting ready to schedule both an MRI and a mammogram as 6 months ago I was the lucky recipient of a BIRADS 3. I can tell you I did have a 3 week post op seroma. This current one I am certain was caused by accident. I was in exercise class in Mar or the beginning of Apr and dropped a weight on it, or something happened. Anyway, when I got these results I ended up reading a whole study on Birads. I wanted to understand the use of the word, "probably" This thing is still in there. It annoys me so I started charging it rent! My questions are, will I most likely stay at a 3 and for how long? I recall reading something like 2 yrs.? Have you seen this before so long after surgery? Wonder what my chances are of having it miraculously resolve? My BS called it "unremarkable" I am happy to know what it is, would like to know what I should anticipate for future tests. Thank you.
June 2019:
LEFT BREAST
In the interval, in the upper inner quadrant, there is susceptibility artifact consistent with postbiopsy changes. There is a fluid fluid level seen on T2-weighted images consistent with seroma/hematoma.
In the 10:00 axis on the superior medial aspect of the hematoma/seroma, there is progressive enhancement, postcontrast image #132 and sagittal imaging #118. This measures 1.0 x 0.7 x 0.4 cm (AP by TV by SI). Although this could represent postsurgical
changes, as this corresponds to the only area of enhancement within the left breast, this is probably benign and six-month follow-up MRI is recommended. No corresponding abnormality is seen on mammography of December 2018 and given the seroma, this area
is not likely to be identified with ultrasound.
In the remainder of the left breast, there are is no additional dominant mass, area of architectural distortion or abnormal enhancement to suggest malignancy.
There is no adenopathy.
RIGHT BREAST
There are postsurgical changes in the middle third position of the upper outer quadrant consistent with the surgical excision.
In the remainder of the right breast, there is no dominant mass, area of architectural distortion or abnormal enhancement to suggest malignancy.
There is no adenopathy.
IMPRESSION:
Left breast assessment:
Probably benign. 1 cm focal area of enhancement on the periphery of the seroma cavity, likely corresponding to postsurgical changes, yet follow-up MRI is recommended for this probably benign finding.
Right breast assessment:
Benign. No findings suspicious for malignancy. Annual mammography is recommended
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Thank you soooooo much, djmammo! You truly are doing an invaluable service!
To answer your question . . . . . . . . yes, there were prior studies used for comparison in stating the Findings:
"Prior imaging studies performed at The Breast Care Center on 11/02/2012, 01/03/2018, 11/05/2019 and 11/08/2019, and at The Mammography Center on 02/03/2015 and 03/29/2016 were reviewed."
Sorry for omitting this information; I was trying to keep my post from being so long.
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In my experience it is very common to see enhancement along the rim of the surgical cavity on a post op MRI. How long that might last or what effect additional blunt trauma might have on it is less certain. If it is just post op enhancement it should fade with time. B3 things like masses are usually followed for 2 years unless the patient gets fed up and asks for a biopsy in the meantime. I'm not sure why they think the seroma would obscure this area on an US.
Loosely translated "probably" means they are 98% sure that its nothing to worry about. Maybe it should be "most likely benign".
Fluid collections in the breast can be drained under US but can recur depending upon how long its been there and if the inside surface has epithelialized. Sometimes after they drain them they inject something like alcohol to keep the lining cells from producing more fluid. If it recurs after that it could be excised surgically if still bothersome.
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djmammo, I had my latest mammo (3D & 2D) on Nov 1. My last two were in 2017 (digital), and 2014. I am 47 yrs old, postmenopausal, hysterectomy in 2008 which left me with only my left ovary. Prev history of scattered fibro glandular density. I was called back in 2014 for additional views and US. My mammo then disclosed the area and also an enlarged lymph node in the axillary area. The area on ultrasound was believed to be a benign cyst. Forward to today, in my other breast, a 'new asymmetrical density is found. Seen on MLO and questionable correlate in CC view. Nothing suspicious seen in L breast.' I go for spot compression views and US on Tuesday Nov 19. He gave no description about size, appearance etc. Location seems to be about 11:00. My question(s) is, is it more concerning when it is seen on both views? Also, being postmenopausal, is that more concerning? A biopsy was not mentioned on report, so does that mean they will only do one if it's as suspicious on spot compression? Are screening reports always this vague?? I'm trying not to be worried, but it's hard not to be! Thank you for any insight!
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Hello djmammo:
Can you please shed light on my diagnostic mammogram report? I am lost if I have to wait 6 months or see a breast specialist, please advise, I would greatly appreciate it, thank you!
EXAMINATION: MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS LEFT, US BREAST COMPLETE LEFT 11/6/2019
Computer-assisted detection was utilized in the interpretation of this exam.
COMPARISONS: 10/18/2019 and 7/13/2018
INDICATION: Left breast asymmetry seen on screening mammogram
FINDINGS:
MAMMOGRAM:
The breast parenchyma is heterogeneously dense. This limits the overall sensitivity of mammography, possibly obscuring the detection of small masses.
Full field and spot compression 3-D Tomosynthesis imaging demonstrates an asymmetry with possible distortion in the far posterior slightly medial central left breast best observed on the MLO and lateral views. This partially effaces on the spot
compression exams. No definitive correlate is observed on the cc views. No associated calcifications.ULTRASOUND:
High resolution gray scale sonography includes imaging of all four quadrants and the retroareolar tissues. This demonstrates dense left breast parenchyma with a few scattered subcentimeter sized cysts. There is an incidentally noted 0.6 x 0.6 x 0.4 cm
complex cystic mass at the 10 to 11:00 position subareolar region.Benign-appearing lymph nodes are identified in the evaluated left axilla.
There is no sonographic abnormality to correlate with the mammographic asymmetry in the far posterior medial left breast at approximately the 10:00 position overlying the pectoralis muscle.
IMPRESSION:
Partially effacing asymmetry in the far posterior medial left breast 10:00 position at the level of the pectoralis muscle without sonographic correlate. Short interval reevaluation with 3-D Tomosynthesis diagnostic left breast mammogram and spot
compression 3-D imaging is recommended.6 mm complex cystic mass 10-11 o'clock subareolar left breast observed sonographically. Reevaluation with targeted ultrasound in 6 months is recommended.
BI-RADS Category 3: PROBABLY BENIGN.
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djmammo, here is 2017 report0 -
djmammo, this is all I have of the 2014 on hand at the moment 0 -
djmammo, here is 11-2019 report0 -
If a mass is real, it usually becomes more conspicuous on the compression views and its usually seen on both views if the mass is far enough away from the chest wall in order to be included in the picture. Ultrasound of the area of interest is usually the tie breaker. If no mass is seen on that we look again in 6 months as a routine.
The description of that tiny cyst may not be accurate. There is a difference between a complex and a complicated cyst in our jargon, and i am not sure this thing is large enough to make that distinction and the description is not complete enough for me to remark on that finding. It must not have bothered the reader if they recommended a short term follow up.
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I have questions regarding the relating of current to previous findings but they will likely be answered in the report of the diagnostic exam.
Yes screening reports can be vague, sometimes intentionally, but the bottom line is if you want someone to come back for more imaging and you have 75 more screeners to read before noon it almost doesn't matter how much detail is in the report as long as a reason is given and the patient comes back. When the pt comes back for the diagnostic all the priors can be reviewed and compared and all the measurements and details can be attended to, but for the person batch reading screeners alone in a tiny dark office that kind of complete report is really taking time away from getting to the next screening exam.
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djmammo,
Thank you for your reply. Can you please shed some light on what you question regarding the relation of the previous/current Mammogram so that I may inquire about it if nothing is mentioned at my appt tomorrow morning?
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When there is a finding on present study and there are priors we always want to know if its new or old, and if old has it changed. So ask "was it there before?". Thats all i was referring to.
Keeping in mind the goal of the rad reading screenings, they may not have taken the time to review all your priors, usually the most recent prior and one from 2 or more years ago come up automatically for comparison. If the finding on the current study is not obvious on those priors its assumed to be new and you get called back. The rad reading your diagnostic study will have time to work it all out. Sometimes someting looks new and if you go back far enough sometimes you can find that study taken at exactly the same angle and there it is. Let us know if they find anything.
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Djmammo, thank you, and yes I'll be sure to post my results. Last night I decided to see if I could feel anything in the area they were talking about and noticed I have what seems to be an enlarged, hard lymph node in the crease of that armpit (lying down, arm above my head). Still holding on to benign, I know it could all still be nothing!!
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Djmammo, thank you for taking a look at my report. Is anything in this concerning to you? The radiologist told me it would have been visible on US if it was a lymph node or cyst.
MRI BREAST W WO CONTRAST BILATERAL
Impression
1. Left enhancing 1.8 cm breast mass with associated biopsy clip, compatible with history biopsy-proven PASH. Please note no prior mammograms or ultrasounds were provided for review.
2. Early enhancing 0.8 cm upper inner right breast mass at 1:00, 4 cm from the nipple, which could represent an intramammary lymph node. Second look ultrasound is recommended. If this cannot be confirmed by ultrasound, MRI guided biopsy is recommended.
ACR Bi-RADS 4: Suspicious findings. Tissue diagnosis should be performed in the absence of clinical contraindication.
Findings:
BREAST COMPOSITION: Extreme fibroglandular tissue
RIGHT BREAST: There is mild background parenchymal enhancement. There is a sub pectoral saline implant present. There is an early enhancing 0.8 cm oval circumscribed mass (axial series 6, image 111 and sagittal series 11, image 65) in the upper inner right breast at 1:00, 4cm from the nipple. This has a questionable reniform appearance and exhibits mild T2 intensity. Additional sub centimeter T2 hyperintence non enhancing cysts are present. There is no axillary lymphadenopathy.
BREAST US RIGHT LIMITED - DETAILS
Impression
No corresponding sonographic abnormality in right breast at 1:00, 4 cm from the nipple. MRI guided biopsy of the right breast mass is recommended.
COMPARISON: Prior breast imaging dating back to 2018 review. MRI breast dated 10/21/19.
I'm scheduled for MRI biopsy next Friday. Is the only approach for mri biopsy lateral? Can the dr only access the breast from the side? Is there any indication of what this mass might be? Another PASH tumor or a fibroadenoma?
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djmammo, below are my results to diag mammo and US. I did specifically ask if it was seen on the two prior and she said no. Some questions I have for you, if you don't mind, how does a lymph node just appear at the age of 47? Or has it just been hiding somehow? The US tech said the small cysts were clustered together. Is that normal? Are these new cysts, and is it normal to still be getting them postmenopausal? One more question, it says in the US report that the cysts do 'not likely correspond with the mammographic abnormality.' So does that mean they didn't see it on US, or is what they found at the 10:00 position the correlation, because they don't confirm that with that description either. My doctor sent along a personal note with the results and said to make sure I put this follow up on my 2020 calendar, as she 'doesn't want anything to fall thru the cracks on this one'. Thankful for it to all be over with for now!!
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Djmammo, thank you for your reply! I truly appreciate it and you are making a difference for all of us here! Sending you blessings!
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Is the only approach for mri biopsy lateral? Can the dr only access the breast from the side?
That is the case with most MRI machines that i am familiar with.
Is there any indication of what this mass might be? Another PASH tumor or a fibroadenoma?
PASH usually does not look like a discrete nodule. Fibroadenoma has a pretty familiar appearance on MRI + US I have to suppose they would include that in the differential if that was a possibility.
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How does a lymph node just appear at the age of 47? Or has it just been hiding somehow?
*Probably hiding
The US tech said the small cysts were clustered together. Is that normal?
*Yes
Are these new cysts, and is it normal to still be getting them postmenopausal?
*I have seen this before.
It says in the US report that the cysts do 'not likely correspond with the mammographic abnormality.' So does that mean they didn't see it on US, or is what they found at the 10:00 position the correlation, because they don't confirm that with that description either.
*Its usually a matter of location and size when deciding whether or not a finding correlates.
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@djmammo You are the best for doing this!
I just had a 3 month follow-up US. Report is here:
COMPARISON: 9/6/2019FINDINGS: At the 3:30 clock position, 2 to 3 cm from the nipple there is a 2.1 x 0.8 x 1.3cm hyperechoic mass with a 7 x 5 x 3 mm central hypoechoic area. Previously this measured 2.2 x 1.9 x 1.1 cm. No internal blood flow is seen on color Doppler. A second lesion at the 4 clock position, 8 cm from the nipple measures 5 x 3 x 5 mm, compared to 5 x 3 x 5 mm previously.IMPRESSION: 2 right breast masses, one stable and one smaller. Six-month follow-up right breast ultrasound is recommended.
The central hypoechoic area is new. My last US said the whole thing was hyperechoic. Is 6 months an okay time to wait for follow-up or should I push for further testing?
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