Interpreting Your Report
Comments
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About a week ago I received this lovely report in my test results.
There are scattered fibroglandular elements in both breasts that
could obscure a lesion on mammography.
Tomosynthesis 3D imaging of the breast was also performed.
Current study was also evaluated with a Computer Aided Detection
(CAD) system.
There is a 1.5 cm mass with a spiculated margin in the right breast
middle depth lateral region seen on the craniocaudal view.
No other significant masses, calcifications, or other findings are
seen in either breast.
IMPRESSION: INCOMPLETE: NEEDS ADDITIONAL IMAGING EVALUATION
Spiculated mass in the right breast, malignancy is suspect.
Ultrasound is recommended.Needless to say, I have been freaked out. To anyone with some experience, does this seem like something I should be really concerned about? Any feedback would be appreciated.
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"Spiculated mass in the right breast, malignancy is suspected"
A spiculated mass is the more common presentation of IDC. This will be more definitively evaluated on compression views and ultrasound. They will likely recommend a biopsy after the follow up studies.
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Ok, thanks I will research that. I have had surgery on my right breast so I'm hoping it is related to that. It just seems they would have noted that in their notes if the thought it was related to possible scarring from a biopsy or past lumpectomy.
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Does any part of that report mention that it was compared to a priot study? and the date of that study?
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They did mention making comparison :
Comparison is made to exams dated: 11/6/2017 mammogram, 5/26/2015
mammogram, and 5/4/2011 mammogrambut that's all.
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So this must have developed some time between the 2017 exam and the current study. Keep us in the loop.
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This is the report of my breast MRI. I'm sick with worry because there seem so be so many findings and biopsies recommended. I had a clear 3D mammo and US of L breast in May.
Any advice on interpretation is welcome! Thank you..
Study Result MRI BREAST BILATERAL W WO CONTRAST IMPRESSION:
Multiple areas of enhancement are demonstrated in both breasts for which MR targeted ultrasound is recommended. The areas are as follows:
Right breast:
1. 6 mm area of mass-like enhancement at 9:30 to 10:00 at an anterior to mid depth.
2. 3 subcentimeter areas of non-mass enhancement at 6:30 to 7:00 at a mid to posterior depth, in the central aspect at an anterior to mid depth and in the central aspect at a posterior depth.
Left breast:
1. 3 areas of non-mass enhancement are demonstrated in the central aspect of the breast as described above.
2. A 3 mm focus of enhancement is demonstrated at 3:00 in an immediate retroareolar location.
Ultrasound-guided core biopsy is recommended on any sonographic correlates. If there are no sonographic correlates, MR guided core biopsy should be performed. (The most suspicious areas of enhancement are at 9:30 to 10:00 in the right breast and 3:00 in an immediate retroareolar location in the left breast.)
CATEGORY RIGHT 4: Suspicious. CATEGORY LEFT 4: Suspicious.
RECOMMENDATION: Bilateral MR targeted ultrasound.
END OF IMPRESSION:
INDICATION: 42-year-old female with BRCA2 gene mutation. Family history of triple-negative breast cancer in maternal aunt.
TECHNIQUE: Multisequence, multiplanar MRI examination of both breasts without and with gadolinium enhancement. Study performed on a 1.5 Tesla MRI unit. Computer-assisted detection algorithm was employed.
CONTRAST: 5.6mL of GADOBUTROL 2 MMOL/2 ML (1 MMOL/ML) INTRAVENOUS SOLUTION administered INTRAVENOUS
COMPARISON: Recent mammogram of 5/16/2019.
AMOUNT OF FIBROGLANDULAR TISSUE: c. Heterogeneous fibroglandular tissue.
BACKGROUND PARENCHYMAL ENHANCEMENT: Moderate
BILATERAL BREAST FINDINGS: Multiple scattered cysts and solid nodules are demonstrated in both breasts and likely represent a combination of cysts and fibroadenomata.
FINDINGS:
RIGHT BREAST: A 6 mm area of mass-like enhancement is demonstrated in the upper outer quadrant of the right breast at about 9:30 to 10:00 at an anterior to mid depth. The findings best seen on sagittal enhanced image 350. This finding is not well seen in the axial plane. MR targeted ultrasound is recommended in further evaluation. If there is a sonographic correlate ultrasound-guided core biopsy should be performed.
An 8 mm area of non-mass enhancement is demonstrated at approximately 6:30 to 7:00 in the right breast at a mid to posterior depth. This is best seen on axial enhanced image 52 and sagittal enhanced image 343. MR targeted ultrasound is recommended in further evaluation. If there is a sonographic correlate ultrasound-guided core biopsy should be performed.
Two non-mass areas of enhancement are demonstrated in the central aspect of the right breast one at an anterior to mid depth measuring 9 mm and the other at a posterior depth measuring 7 mm. Both findings are best seen on sagittal enhanced image 338. The findings are not well seen on the axial enhanced image. MR targeted ultrasound is recommended in further evaluation the findings.
No abnormal axillary or internal mammary lymph nodes demonstrated.
LEFT BREAST: Three areas of non-mass enhancement are demonstrated in the central aspect of the left breast on sagittal enhanced image 259. One is at about 6:00, is linear and measures approximately 6 mm. A second area is in the central aspect of the breast at a mid to posterior depth and measures 13 mm. The third area is linear and in the central posterior aspect of the breast and measures 4 mm. These findings are not well seen on the axial enhanced images. MR targeted ultrasound is recommended in further evaluation.
A 3 mm focus of enhancement is demonstrated at about 3:00 in a retroareolar location. This is best seen on axial enhanced image 82 and sagittal enhanced image 251. MR targeted ultrasound is recommended in further evaluate lesion.
No abnormal axillary or internal mammary lymph nodes.
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All these findings are very non-specific and could easily be benign. There is no description of a "suspicious irregular enhancing mass" as is the case for IDC. Some of the areas may turn out to have atypical cells or early DCIS but none of the words used suggests an invasive cancer. I would be interested to know if there were any suspicious calcifications on your most recent mammogram.
If nothing is seen in these areas on US that's good in that cancers usually show up on US if large enough but if nothing shows up they will want to biopsy the described areas in the MRI unit.
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Thank you so much DJMammo. I appreciate your help interpretating that. It was a bit overwhelming when I initially saw it. Especially with having a BIRADS 1 in May 2019 and no findings. So no mention of calcifications in that report. Below is the report from one year ago. I'm not sure if the simple cyst can appear as enhancement on the MRI since they are around the same position. 9:00 and 9:30.
MAMMOGRAM DIAGNOSTIC RIGHT WITH CAD AND DIGITAL TOMOSYNTHESIS, TARGETED RIGHT BREAST ULTRASOUNDIMPRESSION:
RIGHT CATEGORY BI-RADS: Category 3 - Probably Benign
Focal asymmetry in the retroareolar plane of the right breast at posterior third depth, most likely benign fibroglandular tissue. A simple cyst is noted in the 9:00 1B position.
RECOMMENDATION:Right diagnostic mammogram in six months.
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Update:for anyone who has had similar abnormal mammogram. I went to my diagnostic mamogram/ultrasound today. They skipped the diagnostic mammogram and did ultra sound. Radiologist stated they are very concerned I have cancer. I have 2 masses on my right breast that are small and one lymph node that is enlarged. I will be going in tomorrow for 2 separate biopsies. One for larger mass in breast and one for lymph node. I will update when I get results which should be in 3 to 5 days after tomrrow.
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I am very thankful to have found this forum. I completed genetic testing 5 years ago and have a CHEK2 mutation that is listed as VUS. I have lost all my close maternal relatives to breast cancer. My mother was diagnosed at age 49, my grandmother at 55 and my maternal aunt at 60. I do not have any genetic information for them, except that my mother's cancer was estrogen and progesterone negative. I am 49 years old.
I have been having mammograms on a yearly basis since I turned 40. Last year I had my first 3d mammogram. All mammograms have been normal. My doctor has a protocol for high risk patients to have a look via mammogram or MRI every six months. I had my first screening MRI on Nov. 13th that led to being scheduled for a diagnostic mammogram and ultrasound which will happen tomorrow. I have not spoken to my doctor directly about my MRI report as I have just been told I need to get the diagnostics completed first. The results of my MRI came less than 24 hours of my screening and then everything has happened in slow motion trying to get the orders and tests scheduled. I am including my MRI report below and any insights would be appreciated.
Impression
RIGHT BREAST: Linear nonmass enhancement with persistent kinetics in the central retroareolar region. Further evaluation with diagnostic mammogram and ultrasound is recommended. If there is no correlate for this finding, MRI guided biopsy is advised.
LEFT BREAST: Enhancing foci in the anterior and central retroareolar region with high T2 signal favored to represent fibrocystic changes.
Low level nonmass enhancement in the anterior breast at the 6:00 to 7:00 position which may represent asymmetric background enhancement.
Further evaluation of the above findings with diagnostic mammogram and ultrasound is recommended. If there are no suspicious findings on mammogram or ultrasound, follow-up MRI may be performed.
ASSESSMENT:
BI-RADS CATEGORY (4A) Suspicious (low).
RECOMMENDATIONS:
Bilateral Diagnostic 3D mammogram (Tomosynthesis)
Bilateral Diagnostic breast ultrasound
A result letter will be sent to the patient.
Electronically Signed 11/13/2019 5:48 PMNarrative
MRI-BREAST BIL W/WO CON
INDICATION FOR EXAMINATION: Z15.01: Genetic susceptibility to malignant neoplasm of breast
Z80.3: Family history of malignant neoplasm of breast
Z91.89: Other specified personal risk factors, not elsewhere classified
HISTORY: This is a 49-year-old female with increased risk for breast cancer and a family history of breast cancer in her mother at the age of 49 and maternal grandmother at age 55.
COMPARISON: Bilateral mammogram dated 10/9/2018
TECHNIQUE:
Multiplanar T1 and T2 weighted images were obtained prior to and post uneventful intravenous injection of 18 ml Multihance. The color-flow dynamics, maximum intensity projection and time intensity curves are reviewed. The images were obtained using a dedicated breast coil on a 1.5 Tesla or greater magnet.
FINDINGS:
There is moderate background enhancement bilaterally.
BREAST COMPOSITION:
Scattered fibroglandular tissue.
There is no evidence of abnormally enlarged lymph nodes within the axillae or along the internal mammary chains.
RIGHT BREAST: Small cysts are visualized within both breasts. There is linear nonmass enhancement measuring 1.6 cm with persistent kinetics in the central retroareolar region at the 12:00 position middle third (axial image 64 and sagittal image 77). There is no evidence of abnormal chest wall, pectoralis or axillary enhancement.
LEFT BREAST: There is focal low level nonmass enhancement in the anterior lower inner quadrant at the 6:00 to 7:00 position (axial images 33 through 39 and sagittal images 182 and 183). This finding may represent asymmetric background enhancement.
There is a 7 mm enhancing mass in the retroareolar region on axial image 50 and sagittal image 186. Slightly posterior to it in the central retroareolar region is focal nonmass enhancement measuring approximately 1 cm with high T2 signal. These findings are favored to represent fibrocystic changes. There is no evidence of abnormal chest wall, pectoralis or axillary enhancement.0 -
, I'm new here. I finally found this site after trying to find people to talk to about this and I'm so thankful I have. I've been reading posts for a few days now and it's helped a lot. I'm 26 years old and found a lump in my left breast on nov 23rd. I went to my gynecologist and he said it's probably a cyst but we will do an ultrasound to be sure. I went for ultrasound the next day and when I saw it I knew it looked bad. The tech wasn't pleased with it either and she asked when I was getting my mammogram. I told her I wasn't scheduled for one and she said okay and left the room. She came back in and said our radiologist has ordered you a mammogram and I said okay so then I went for my mammogram right after that. The tech said that the radiologist wasn't in today that he was getting off a flight but they sent my scans to him because it couldn't wait over the holiday. They gave me his personal number to call him when I got home. I called and he said it could be cancer or it could Be a Fibroadenoma. Definitely needs a biopsy. My gynecologist called me Monday and is getting me an appointment with a breast surgeon. He said we need to get it out. I'd like help interpreting my report and I'm curious if they will remove it then biopsy it or will they want to biopsy it first before they remove it? Hoping I can get an appointment for next week but we haven't heard back yet. I know hypervascular and lobulated are both not good. If anyone has any insight I'd appreciate it. Or anything similar. Maybe Djmammo can comment and clear it up a little.
Side note: ever since I found it I've had a deep feeling that it was cancer. Idk why I just can't shake that. So I won't be surprised if it is. Although hopefully it's an adenoma. But don't worry about scaring me with your opinions. I have bad anxiety and knowing as much information as I can helps it so much. When people aren't straight forward with me it makes my anxiety worse.
Ultrasound
Indications: left breast mass at 3:00
Findings: there is a 28x42 mm lobulated, hypoechoic mass with enhanced through transmission a few centimeters from the nipple at 3:00. There is some hypervascularity peripherally on color Doppler.
Impression: incomplete, need additional imaging evaluation.
Recommendation: mammography unilateral left with cc spot compression, MLO spot compression.
Mammogram
This is her 1st mammogram.
No prior biopsy. Great aunt developed breast cancer in her 60s.
Indications: left breast lump at 3:00 5 days ago.
Findings: there is a 30mm left breast lobulated mass 6 cm posterior to the nipple at 3:00 that corresponds to the findings on the ultrasound today. There is a 30 mm lobe tissue extending medially. There are no Microcalcifications within the mass or in other areas of either breast. There are no other suspicious areas.
Summary: suspicious finding, moderate suspicion for malignancy. BI-RADS 4b.
Recommendation: consider biopsy.
Note: She asked me about the findings and I told her it could be cancer or an adenoma
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The mammo and US will help determine what these findings mean. Non-mass enhancement is fairly non-specific and could go either way. Linear non-mass enhancement though leans more toward DCIS but not always. The 7mm enhancing mass does not seem to be specifically addressed as regards enhancement kinetics but if it is high T2 with a benign kinetic curve, it may be a FA but the ultrasound is better for evaluating this.
Let us know what the next round of imaging shows
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There is no mention of the size and appearance of the lymph nodes. Also no mention of the borders of this mass whether smooth or irregular and this is important in making a diagnosis via imaging however increased through transmission is a feature of benign masses. Benign masses can be mildly lobulated and they can show some blood flow.
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You will obviously need a biopsy so do not let me sway you from proceeding with it.
At your age it would be odd for this to be malignant. The differential diagnosis of the findings you presented above would include a Giant Fibroadenoma, and a phyllodes tumor, and these would be at the top of the list with any kind of frank malignancy lower on that list. Also at this size one would want to know if the lymph nodes on that side are enlarged and if they were, that would increase suspicion for malignancy.
The recommendation will be to remove it no matter what the final path is. An FA this big is assumed to be fast growing, and a phyllodes tumor has a small malignant potential. The standard of care is to biopsy first so don't skip that step. Find a surgeon who knows how to achieve a good cosmetic result post op. Keep us in the loop.
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thank you so much for all that information djmammo. I thought it odd that there were a lot of things that weren’t mentioned as well. I will have to look up what a phyllodes tumor i
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about the borders... if you’re asking if it was smooth line the outline of a circle then no, it was not. It was wavy and looked like it kinda of just spread and didn’t really have a definite border to me. They also did not check the lymph nodes
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DJMammo, thank you for your response. I had my follow-up today and basically I have to have biopsies completed due to family history. If the MRI does not show enhancement when I go in there will not be a biopsy on my right breast. However, they are definitely doing a US guided biopsy on the right and will place a marker. Below are further results.
US-BREAST BILATERAL LIMITED, MA-MAMMO DIAGNOSTIC TOMO BILATERAL
HISTORY: 49-year-old female with a strong family history of breast cancer. Recent MRI demonstrates nonmass enhancement of the right breast and enhancing foci of the anterior left breast.
DATE OF SERVICE: 12/4/2019 10:06 AM
COMPARISONS: MRI dated 11/13/2019 and mammograms dated 10/9/2018 through 11/12/2014
MAMMOGRAM
TECHNIQUE: Bilateral 2-D and 3-D tomosynthesis images of the breast were obtained in the CC and MLO projections with spot compression views of the right breast. Computer aided detection (CAD) was used to assist in the interpretation of the 2D mammogram.
BREAST COMPOSITION:
The breast tissue is composed of scattered fibroglandular densities.
FINDINGS:
There is no new, dominant mass, developing asymmetry, evidence of architectural distortion, or suspicious microcalcifications within either breast. There is no concerning interval mammographic change.
ULTRASOUND
TECHNIQUE: Real-time grayscale and color images of both breasts were performed, targeting the areas of interest.
FINDINGS:
Right breast: No solid or cystic mass is demonstrated. There is mild ductal ectasia within the subareolar region, without evidence of an intraductal mass. There is no sonographic correlate to the nonmass enhancement within the central retroareolar region on the prior MRI.
Left breast: At the 6:00 position, 1 cm from the nipple, there is an oval, parallel, mixed echogenicity mass, without internal vascular flow, measuring approximately 9 x 3 x 8 mm. Small cystic foci are present within this mass and finding may represent a focus of fibrocystic change and is felt to be a correlate to the focus of enhancement at approximately the 6:00 position within the anterior breast on the recent MRI. This lesion has a low level of suspicion. Ultrasound-guided biopsy is recommended for confirmation of benignity.
At the 9:00 position, subareolar location, there is a small, oval, mixed echogenicity mass, with parallel orientation and fairly well-circumscribed margins, measuring approximately 5 x 2 x 6 mm. Anechoic foci are present within this mass and finding likely represents a focus of additional fibrocystic change. Six-month follow-up ultrasound is recommended if the ultrasound guided biopsy of the 6:00 mass is benign.
No additional suspicious masses are demonstrated.
ASSESSMENT:
BI-RADS CATEGORY (4) suspicious. Biopsy should be considered.
RECOMMENDATIONS:
Right MRI guided breast biopsy. Biopsy of the nonmass enhancement as recommended on the prior MRI.
Left: Ultrasound-guided breast biopsy of the 6:00 subareolar mass.
Left: Follow-up diagnostic breast ultrasound in 6 months targeting the 9:00 subareolar mass if biopsy is benign. Otherwise, additional biopsy may be required.
Results and recommendations were discussed with the patient at the time of the exam.0 -
Sounds reasonable. Let us know how it goes.
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I had breast cancer in 2018. In August of this year, they found a very suspicious mass Bi-Rad 4c. They did biopsy and it was found to be benign but wanted to follow up in 3 months.
They just did follow up U/S and it states that they can’t find the original spot or clip but that a new one appeared. What do you make of this?
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Hi, I have been dealing with some breast issues since the beginning of summer. I just turned 40 and I am absolutely terrified of the potential outcome and the need for another surgery. My previous attempt with a lumpectomy was swiftly aborted due to a reaction during surgery, I almost didn't make it. Needless to say I'm still walking around with my original radial scar and now something new. I'm set to get an MRI guided biopsy in two weeks.
My questions are it appears I will have to have two areas sampled, am I reading that correctly?
What does it mean when stated "mild level of background enhancement mean"?
Overall what do you make of my report? I'm pretty much in freak out mode but know I have to roll with whatever is handed to me.Much thanks in advance!
IMPRESSION: Region of nonmasslike enhancement and architectural distortion associated with the biopsy proven radial scar in the upper outer quadrant of the left breast.
Second area of nonmasslike enhancement in the lateral left breast.
RECOMMENDATION: MRI guided biopsy of the area of nonmasslike enhancement in the lateral left breast at approximately the 9:00 position.
If surveillance is being considered for the radial scar in the upper outer quadrant of the left breast then further evaluation with biopsy of the nonmasslike enhancement in the upper outer quadrant of the left breast is also suggested.
BI-RADS category 4: Suspicious
NarrativeINDICATION: Left breast Radial scar. Patient was unable to undergo surgical excision due to an allergic reaction during surgery.
COMPARISON: Diagnostic evaluation dated 7/26/2019
TECHNIQUE: Bilateral breast MRI was performed on a 1.5 Tesla magnet. Sagittal T1-weighted, sagittal fat-saturated T2 weighted, sagittal fat-saturated T1-weighted both pre and in four phases post the administration of Gadavist images, as well as axial
delayed post contrast images, were obtained through both breasts.
POST-PROCESSING: Additional subtraction images were generated from the pre and post contrast images to further increase lesion conspicuity and to evaluate lesion enhancement kinetic curves.
CAD software was utilized in the interpretation of this study.
FINDINGS:
The breast tissue is composed of scattered fibroglandular tissue.
There is a mild level of background enhancement.
LEFT: The biopsy proven radial scar is visualized in the upper outer quadrant of the left breast there is associated architectural distortion and a region of enhancement spanning approximately 48 x 24 x 37 mm. The savi scout is present along the
inferior central aspect of this enhancement and is associated with the distortion. There is predominantly progressive enhancement kinetics associated with this region of enhancement.
There is a second area of nonmasslike enhancement in the lateral breast at approximately the 9:00 position measuring approximately 13 mm best seen on image 32 of the subtraction series that demonstrates primarily plateau enhancement kinetics.
RIGHT: there are no abnormal areas of enhancement suspicious for malignancy.
Review of the axial delayed post contrast images does not demonstrate any suspicious axillary or internal mammary adenopathy.0 -
Just an update, I had my core Biopsy completed two weeks ago and it came back as a fibroadenoma but the radiologists does not agree and has requested to have the core biopsy specimen sent to a breast pathology expert as she says that my ultrasound findings had concerning qualities that do not correspond with a fibroadenoma, so as it sits right now still waiting, there may be a second biopsy in the future either a core or excision depending on recommendations.
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“What does it mean when stated "mild level of background enhancement mean"?
This is the MR equivalent of density on a mammogram.
One biopsy if you will eventually have the RS and surrounding area removed. Two biopsies if you intend on watching the RS instead
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Can you please review this result from my recent MRI screening? I am 38 with strong family history of premenopausal breast cancer. I have had three previous biopsies that were benign (cyst, fibroadenoma and another that was the result of lactational changes). How worried should I be about these findings? I noticed it says the study is sub-optimal due to motion artifact. I am always careful to stay very still. Would that be caused by my movement or something else? Could that skew the results? Thank you!
IMPRESSION: SUSPICIOUS FINDING - BIOPSY SHOULD BE CONSIDERED
Normal right breast MRI.
The 8 mm lobular mass in the left breast is suspicious of malignancy. A
second look ultrasound is recommended. If no sonographic correlate is
identified, MRI guided biopsy is recommended.MRI BI-RADS: 4 Suspicious finding - Biopsy should be considered
DATE OF EXAM: Nov 27 2019 8:59AM
AKM 0773 - MRI BREAST WO/W IVCON BIL / ACCESSION # 119472690
PROCEDURE REASON: multiple diagnoses
* * * * Physician Interpretation * * * *#119472690 - MRI BREAST WO/W IVCON BIL
BREAST MRI OF BOTH BREASTS: 11/27/2019
HISTORY: High risk of breast cancer. Family history of breast cancer.RESULT:
No prior exams were available for comparison.
Interpretation of this MRI was correlated with available mammograms,
ultrasounds, previous MRI scans, and clinical information. Informed
consent was obtained from the patient. 14 cc of gadolinium contrast was
injected. Axial T1, T2, and pre and post contrast T1 images were
obtained with a dedicated breast coil. Pre and post contrast images were
obtained for 4 frames. Post processing was performed including color
parametric mapping. The study is sub-optimal due to motion artifact.
Bilateral background breast enhancement is mild.
There is an 8 mm lobular mass in the left breast at 10 o'clock middle
depth 3 cm from the nipple. This shows heterogeneous enhancement and
slow initial rise and delayed plateau type vascular enhancement. This
can best be seen on Dynacad subtraction image 417 (TP3) and on AGFA high
res post contrast series 7 image 57.
No masses or areas of abnormal contrast enhancement were seen in the
right breast. No other findings are seen in the left breast. There are
no abnormalities seen in the axillary nodes region.0 -
They compared it to a prior MRI but did not specifically say it was new since prior though I will assume it is. I will also assume they meant lobulated (shape) and not lobular (histology).
The enhancement pattern they describe is not the type usually associated with a cancer, plus they did not us the terms spiculated or irregular in the description, so thats good.
Let us know what the US shows.
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djmammo, just wanted to let you know that I was diagnosed with IDC today. Back on Nov. 27 when you suggested that was what my mammogram was pointing to, I was mad at you (irational, I know). But since then I learned as much as I could about IDC and when I was given the news today it was not as upsetting as it could of been. Thanks for the help!
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I was looking for encouragement after receiving my mammo and ultrasound report. But I think this info has made me so much more anxious since reviewing it. Hoping for some words of encouragement or stories of how having so many “less favorable” words on the report didn’t result in a malignant mass. My biopsy is scheduled for tmrw but I basically have so much anxiety to start with that this news has put me over the top. TIA.
BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM WITH TOMOSYNTHESIS AND DIAGNOSTIC BILATERAL BREAST ULTRASOUND
CLINICAL HISTORY: 1.5 cm palpable lump on the left at 9:00 2 inches from the nipple
TECHNIQUE: 2-D 3-D CC, MLO views of both breasts, implant excluded views
COMPARISON: No priors
MAMMOGRAM FINDINGS: There are scattered fibroglandular densities. There is a lobulated mass within the lower inner quadrant of the right breast.
Otherwise there are no worrisome masses, areas of distortion or suspicious microcalcifications in either breast.
ULTRASOUND FINDINGS: Targeted ultrasound was performed by myself as well as the technologist. At the site of the patient's palpable lump on the left at 5:30 4 cm from the nipple is 0.8 x 0.5 x 0.7 cm parallel oval hypoechoic lesion is identified. This correlates with the previously seen mass in 2014 and is not significantly changed given imaging technique.
Targeted imaging on the right at the 5:30 position 4 cm from the nipple did demonstrate a 1.2 x 0.5 x 0.9 cm hypoechoic mass with a few microlobulated and ill-defined margins. There is suggestion of intraductal extent on a few of the transverse images. Evaluation with color Doppler demonstrate internal flow. This correlates nicely with the mammographic finding.
IMPRESSION:
1. Suspicious right breast mass at 5:30.
2. Stable palpable mass on the left is considered benign.
ACR BI-RADS CATEGORY: 4, SUSPICIOUS
RECOMMENDATION: Ultrasound-guided core needle biopsy is recommended for the suspicious mass on the right..
CAD was utilized.
The standard false-negative rate of mammography is between 10% and 25%.
Complex patterns or increased breast density will markedly elevate the false-negative rate of mammography.
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DJ Mammo,
So, I had an ultrasound last week to follow up with my MRI. I spoke to the radiologist because there were so many areas, she came in to view the images herself during the scan. (She said I have very "busy" breasts.) She asked me to then schedule another MRI, in a different view, and she would then finalize her report. I did the MRI today. She said nothing jumps out at her as being cancer, but she would like me to have 2 MR guided biopsy's in each breast, just to be sure. She said since I have the BRCA 2 mutation, cancers sometimes hide. After seeing my report on my patient portal, I can't help but worry about the terms "hypoechoic" and "complex cystic lesion with blood flow."
What are your thoughts? (I also posted the second MRI report) Sorry it's so long.
Study Result US BREAST COMPLETE BILATERAL WITHOUT MAMMOGRAM IMPRESSION:
There are 2 sonographic findings in the right breast which appear to correspond to areas of enhancement seen on MRI. These findings are at 11:00 2B and 7:00 2C. Core biopsy of these areas is recommended.
No sonographic correlate is demonstrated for the enhancing focus at 3:00 in a retroareolar location in the left breast. This would not be amenable to MR guided core biopsy due to its anterior and superficial location. It may however be possible to place a clip in this region under MR guidance.
The axially acquired MRI shows 4 mm enhancing masses in the upper outer quadrant of the right breast in the upper inner quadrant of the left breast. No sonographic correlates were identified to account for these findings.
In summary, there are three areas of suspicious enhancement in the right breast, two of which show sonographic correlates. And two areas of suspicious enhancement in the left breast, neither of which show sonographic correlates. MR guided core biopsy is recommended for 2 areas in the right breast (which ever of the 3 areas are most worrisome at the time of biopsy), likely the 4 mm mass in the upper outer quadrant and the non-mass enhancement at 6:30 to 7:00. MR guided core biopsy is recommended for the 4 mm enhancing mass in the upper inner quadrant. Also possible MR guided clip placement in the 3 mm area of enhancement at 3:00 in the retroareolar region.
CATEGORY 4: Suspicious
RECOMMENDATION: MR guided core biopsies as described above.
END OF IMPRESSION:
INDICATION: Multiple areas of enhancement in both breasts on MRI.
TECHNIQUE: Real-time ultrasound images of all four quadrants of both breasts and retroareolar regions were obtained. Permanently recorded images were obtained and stored.
COMPARISON: Breast MRI of 11/27/2019 and a repeat dynamic breast MRI acquired in the axial plane on 12/12/2019 .
FINDINGS:
Right breast:
There are cysts and fibrocystic changes scattered throughout the breast. A complex cystic lesion with internal blood flow is demonstrated at 11:00 2B in the right breast. This area measures 1.6 x 0.9 x 0.6 cm. This likely corresponds to an enhancing multicystic mass seen in the upper outer quadrant the right breast on MRI. Ultrasound-guided core biopsy is recommended.
At 7:00 2C in the right breast a solid hypoechoic mass is demonstrated and measures 1.1 x 2.6 x 0.5 cm. This would account for the 8mm area of enhancement at 6:30 to 7:00 on the MRI. Ultrasound-guided core biopsy is recommended.
Left breast:
Scattered cysts and fibrocystic changes are demonstrated as seen on MRI. There are no definite sonographic correlates for the 3 areas of non-mass enhancement in the central aspect of the left breast or the 3 mm focus of enhancement at 3:00 in a retroareolar location.
This is the second MRI report:
MRI BREAST BILATERAL W WO CONTRAST
IMPRESSION:
There are two 4 mm enhancing masses, one in each of the breasts for which MR guided core biopsy is recommended.
The 3 mm area of enhancement in the retroareolar region at 3:00 in the left breast is again seen. This would not be amenable to MR guided core biopsy but it may be possible to place a clip within this area under MR guidance.
Please note that the areas of enhancement seen at 7 and 11:00 in the right breast on the MRI of 11/27/2019 are not as apparent on the initial dynamic axial images. MR guided biopsy of at least one of these areas is recommended.
CATEGORY RIGHT 4: Suspicious. CATEGORY LEFT 4: Suspicious.
RECOMMENDATION: Bilateral MR guided core biopsies, possible MR guided clip placement on the left.
END OF IMPRESSION:
INDICATION: 42-year-old female with BRCA2 gene mutation. Screening study. Multiple areas of enhancement are demonstrated in both breasts on the initial breast MRI of 11/27/2019. After performing complete bilateral breast ultrasound on 12/5/2019, it was felt that this patient may benefit from axial acquired dynamic breast imaging.
TECHNIQUE: Multisequence, multiplanar MRI examination of both breasts without and with gadolinium enhancement. Study performed on a 1.5 Tesla MRI unit. Computer-assisted detection algorithm was employed.
CONTRAST: 5.6mL of GADOBUTROL 2 MMOL/2 ML (1 MMOL/ML) INTRAVENOUS SOLUTION administered INTRAVENOUS
COMPARISON: Breast MRI of 11/27/2019 and bilateral breast ultrasound of 12/5/2019.
AMOUNT OF FIBROGLANDULAR TISSUE: c. Heterogeneous fibroglandular tissue.
BACKGROUND PARENCHYMAL ENHANCEMENT: Moderate
BILATERAL BREAST FINDINGS: Multiple scattered cysts and solid nodules are demonstrated in both breasts and likely represent a combination of cysts and fibroadenomata.
FINDINGS:
RIGHT BREAST: There is a 4 mm enhancing mass in the upper outer quadrant of the right breast on axial enhanced image 334. There was no definite sonographic correlate on the ultrasound of 12/5/2019. MR guided core biopsy of this area is recommended.
The previously seen areas of enhancement at 11:00 and 7:00 are again demonstrated but not well seen on the initial enhanced image. These findings, more apparent on the delayed sequences.
No other suspicious areas of enhancement are demonstrated within the right breast on this examination.
There are no abnormal axillary or internal mammary lymph nodes demonstrated.
LEFT BREAST: There is a 4 mm enhancing mass in the upper inner quadrant of the left breast on axial enhanced image 334. There was no definite sonographic correlate on the ultrasound of 12/5/2019. MR guided core biopsy is recommended.
The 3 mm area of enhancement demonstrated at 3:00 in a retroareolar location on the prior MRI is again demonstrated on this study. This would not be amenable to MR guided core biopsy but it may be possible to place a clip within this area at the time of MR core biopsies.
There is no suspicious enhancement to suggest malignancy.
No abnormal axillary or internal mammary lymph nodes.
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I had the MRI guided biopsy today. The area of concern was a little bit larger. She took five samples. I am sore but doing ok. For those awaiting this test I was prescribed an ativan to take right before we started. It really helped.
Tomorrow is the US guided biopsy.
Results next Wednesday. I will let you know. Thank you for your support.
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