Interpreting Your Report
Comments
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Thank you for your response. And thank you for all that you do for this community. I am proud to say, because of some of your posts, I haven't googled!
Anyway, initially, she was only going to do US guided biopsy of the 2 areas on the right breast, but after further review she DID decide she wanted to biopsy the areas on the left breast as well that didn't show up on US. Therefore, she recommended MR guided biopsy's of all areas, both breasts, that way it can all be done at once. I am scheduled on December 30th. Hopefully results do not take too long. I am going to try not to worry too much until then because I know it is out of my control right now and worrying will not help me.
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Hi! I am really nervous, I am 43, this is my first mammo and my paternal great grandmother had breast cancer with a mastectomy. I was adopted, so that is all the info I have. I have had breast pain for about 2 months and my breast feel lumpy. I had a hysterectomy 3 yrs ago and kept one ovary. I assume some of the breast pain is hormone changes, I was advised to take evening primrose oil by my PA at the breast health center I went to. (She said I had fibrocystic breast) She wanted a 3d mammo and ultrasound, I still have pain on the bottom side of my left breast after a couple months. I went to the waiting room after the mammo and was asked to come back for more pictures before going for my ultrasound. The dr came in and said she didn't think the microcalcifications were cancer but also couldn't rule it out. I am a little nervous but from what I know from researching on here it sounds like it is pretty unlikely that it is serious. Does my report coincide with my though DJmammo? Thank you all for your encouraging words on here, this site is amazing!
#POC203699781 - MAMMO DIAGNOSTIC W TOMO BILATERAL
#POC203699782 - US BREAST BILATERAL
BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM 3D/2D AND TARGETED BILATERAL ULTRASOUND: 12/13/2019
No prior exams were available for comparison.
The tissue of both breasts is heterogeneously dense. This may lower the sensitivity of mammography.
Digital mammography views were performed including tomosynthesis.
There are suspicious loosely grouped calcifications in the upper outer left breast. Stereotactic biopsy is recommended. No mammographic findings in the regions of palpable concern/pain in either breast.
Real-time ultrasound of the right breast 7 o'clock, and retroareolar regions and real-time ultrasound of the left breast 5-6 o'clock, and retroareolar regions was performed. Mildly ectatic ducts are present in both subareolar regions. No intraductal masses are identified. No solid or cystic lesions or suspicious acoustic shadowing in the area of pain in the left breast at 5-6:00 or in the region of palpable concern in the right breast at 7:00.
IMPRESSION: SUSPICIOUS FOR MALIGNANCY, ULTRASOUND BENIGN
Stereotactic biopsy is recommended for the loosely grouped calcifications in the upper outer left breast. Findings/recommendations were discussed with the patient and called to the ordering provider's office. Biopsy has been scheduled for 12/19/19.
No suspicious mammographic or sonographic findings in either subareolar region or the areas of palpable concern/pain. Continued clinical follow up is recommended.
Electronically Signed By: T. Claire Alleyne MD
ta/:12/13/2019 11:14:49
letter sent: Same Day BiRads 4/5
OVERALL STUDY BIRADS: suspicious for malignancy - Birad 40 -
Thank you Mammo for all of your help in this topic.
I was called back on my first mammogram for diagnostic mammo and the rad found a solitary 16mm group of amorphous calcifications (around 10 in total) with no palpable mass. He mentioned to me that this was a low risk lesion (he quoted 1 in 6 chance of being malignant). I have a biopsy scheduled on Friday. I don't have the actual report yet but was wondering if that 1 in 6 chance sounds reasonable to you?
Also, what could be the worst case scenario with a grouping of amorphous calcifications and no mass? Is stage 4 invasive even possible?
thanks so much for your help in advance.
happygal-
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Hi! Can someone look at what I posted above and give me their thoughts? I feel like I am over analyzing the report and it is making me anxious. I know there is nothing I can do either way so I am trying to remain calm. Do you think it is anything to worry about? What are the chances that it could actually be bc? I appreciate all of you!
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The only adjective used for the calcifications is "loosely grouped" which is not in itself a suspicious finding. There is no description of the shape of the calcs themselves or anything else about the pattern or distribution so our hands are tied making a judgement on what they represent.
The fact that no mass was seen on US is good in that it lowers the possibility that they are associated with IDC. This narrows the differential diagnosis to benign calcs, ADH and other atypias, or possibly early DCIS. Now a neg US does not mean that the pathologist won't see some cells that indicate areas of microscopic IDC but even if it does the prognosis is better than if it is big enough to be visible on US. Let us know what the biopsy shows.
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I personally stay away from the statistics since they have no clinical relevance if a biopsy is planned.
Its always good when no mass is seen on US. This narrows our differential diagnosis to benign calcs, ADH and other atypias, or possibly DCIS. Now a neg US does not mean that the pathologist wont see some cells that indicate areas of microscopic IDC but even if it does the prognosis is better than if it is big enough to be visible on US.
I have posted here a while ago the difference between staging and grading. In a nutshell, Grading means how abnormal the cancer cells that were obtained via biopsy, look under a microscope. Staging means how big the cancer is and whether it has spread. With this in mind "Stage 4" has no meaning prior to surgery. On a biopsy, DCIS is graded from 1 to 3, with grade 3 being the one closest to being IDC.
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Thank you so much for your reply, I will be patient and try to not dwell on what I cannot control. I will update with the final results.
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- with additional tomography images there is a persistent area of nodularity identified far posterior, near the chest wall, which localizes to the central portion of the breast.
- there is suggestion of a fatty hilium on tomography
- Several distended ducts in the retoareolar location.
- Scattered areas of fibroglandular density
From ultrasound:
- Questionable lymph node deep at the 6 o'clock position measuring 1.2 cm with a normal echogenic center
I was advised to repeat the diagnostic mammogram in six months. I am asking instead for an MRI, but wonder if I am being too paranoid. Any thoughts are appreciated!
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The report is oddly worded. I am not sure what "questionable" refers to. Are they not sure its a lymph node, or are they not sure if its a normal lymph node? There really isn't much else in the breast other than a lymph node that would have an echogenic (fatty) center. If you have the MRI done let us know what it shows.
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djmammo here is the interpretation of my ultrasound and mammogram that I had a few weeks ago. This is the interpretation from the breast care clinic where I got my biopsy done Monday. It is more detailed than the original radiologist had stated. They found an enlarged lymph node under my arm and biopsied it as well as the original mass that was found. I’m currently waiting on biopsy results but if you could give me your opinion on this I’d appreciate it. I know you were curious to know about the margins and lymph node involvement so I figured I’d give an update 0 -
thank you I will
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just got results. It’s cancer. Invasive ductal carcinoma. The lymph node was clear but the large breast mass is cancer.
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Hi guys! I just received a call from the nurse with the path report and was told I have LCIS, she said it is not cancer but they want to take the area out. I am not sure what any of this means but I have an appt with a breast surgeon on Jan. 7
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Thank You djmammo. I’m feeling much better now that I have an answer. Quick question if you can answer it. The enlarged lymph node they biopsied was clear. Would that mean all lymph nodes are clear? And if it hasn’t spread to lymph nodes does that mean it for sure hasnt spread anywhere else? Or could it spread to other places without affecting the lymph nodes
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hray, until djmammo signs on again to reply to your question, the quick answers, unfortunately, are "no" and "no".
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Beesie, you are so helpful!!! You always have just the answers I’m looking for. So it is possible to spread to other places without affecting the lymph nodes
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hray - yes & yes. It can go to other lymph nodes. It can go to brain, bones, liver, etc. Better not to get so far ahead of yourself out on those limbs.
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Thank you for those answers MinusTwo
What do you mean don’t get so far ahead of myself out on those limbs? Just try not to think about those until I know more?0 -
hray - Of course it's possible that you have METS De Novo - originally diagnosed after the cancer has already spread to other parts of your body. It is not likely. Do not dwell on it.
Of course all of us know cancer could come back at any time. But life doesn't work if you spend all your time worrying about when/if the cancer might come back. Just don't start down those roads before you even meet with the experts and have a treatment plan.
Edited to add - of course it's possible that I'll get hit by a bus tomorrow too... if you see what I mean.
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I have a question for DJM, it is niggling in the back of my mind for a while now.
I have had 3 surgeries on my breast. Clips (markers?) placed each time. Mamm looks like I was shot in the boob with a shotgun, little pellets everywhere. I always walk over to the screen after a picture is taken and look at my mamm. I am curious. Even the tech remarked wow, and counted the pellets. She counted 12. Pointing to each as she counted them.
This last mamm, same place, different tech, student also in attendance. Pic taken. I walk over to view the mamm only there are maybe 5 markers showing. I say, wow, that is different from last time! Tech remarks, no, that's the standard amount of markers. And I walk out thinking...two people, myself and the former tech, witnessed all those little pellets in my boob and now suddenly they're gone?
Here's the question, do those little markers migrate? Rust? Become invisible? I can probably find the reports that state that markers were placed and how many. I do know for a fact that with each surgery, markers went in. 3 breast surgeries, one armpit surgery. Someone said to me, make damn sure that your actual mamm with your actual name on it was looked at by the radiologist. I am wondering if some error has not taken place and perhaps the pic on the screen was from the last patient? Because my boob usually looks like duck hunting accident. If the pic I saw was the same pic the radiologist saw... I am not feeling secure about this at all. I am not even sure who I talk to about this? I feel like I'm in one of those Sesame Street skits where there are 4 mamms up and someone singing, "One of these things is not like the others..."
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Markers are placed after each biopsy done in radiology, one per biopsy site.
If you have surgery afterward for a malignancy, the biopsy marker associated with it is removed with the tumor.
Any markers placed during a biopsy with benign results stay if the mass is not removed.
Some surgeons use metal clips during breast surgery and some do not. They do not look like biopsy markers.
If you have more metal objects in your breast than you have had benign biopsies, then the rest are surgical clips.
They do not disappear or dissolve. There may be a different number in each breast. They might not all be visible on compression views since they show a smaller field of view.
Surgical clips
Biopsy markers
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Thank you DJ. All the objects I have seen in my mamms look the the ones in the first picture, the surgical clips. They are all uniform in appearance, unlike the other photos, which look quite different.
My biopsy was a surgical biopsy. The report states that clips were placed. Same with lumpectomy. Then I had bleed into surgery site and I had a second surgery within hours of the lumpectomy to get the blood out and stop the bleeders. MORE clips were placed.
I appreciate your reply.
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I'm new to this site! I'm 35 years old and noticed a lump 4 weeks ago.
I felt a lump and went to my obgyn. She scheduled me a mammogram and ultrasound. The report showed heterogeneously dense tissue. Benign intramammary node in right breast. 1.4 cm palpable oval mass with circumscribed margins in left breast at 8 o'clock middle depth. BI-RADS 4a
The radiologist said it could be be a fibroadenoma and scheduled me an ultrasound guided core needle biopsy during which they placed a titanium marker clip. The biopsy report said solid mass at 8 o'clock posterior depth. The pathology results said 1.4 cm oval hypoechoic mass, circumscribed margin at 8:00. 3 cores of soft, yellow and tan, fibrofatty tissue ranging from 1.0 to 1.5 cm in length and .2 cm in diameter. Sections show benign ducts and lobules with patchy, fibrous stroma. Despite review of multiple additional recut sections, a distinct lesion is not identified.
The doctor said it was not a fibroadenoma but that the results were inconclusive, and now I have an appointment to get a surgical biopsy. He said it was probably fibrosis (which seems to be an umbrella term from what I've looked up). He gave me the impression that it was rare for the results to not come back matching what they thought (fibroadenoma) and that of those rare cases few go on to have another biopsy (which confuses me that I am, if they think it's nothing too serious). My surgery to remove it is 3 weeks away so it will drive me crazy not knowing for that long.
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I assume the path report also said "no evidence of malignancy" or other words to that effect. Let us know what the next one says.
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No, I don't see anything like that anywhere. I don't feel like they told me much, and I'm confused as to why I'm getting another biopsy if they aren't concerned with these results (or lack of).
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There is a strict protocol that is followed in these circumstances.
When the path comes back from a core biopsy, the radiologist that performed that biopsy reviews it and issues a report as an addendum to the biopsy report. Here both are reviewed and they decide whether or not the path result is compatible with the imaging result. If they agree then it is called "concordant" and if not it is called "discordant" and they discuss why that is the case and issue a recommendation. If discordant there is either a repeat core biopsy or the pt is referred to a surgeon to have the finding removed so that it can be evaluated as a whole by the pathologist.
I assume from your posts that the path results were discordant and that the answers you seek would be in the radiologist's path addendum.
EDIT: no matter what the original impression was on imaging, benign or malignant, if the path comes back as "normal breast tissue" or something similar to that, it is still discordant since there was neither a cancer found nor specific evidence of a benign entity in the sample.
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