Interpreting Your Report
Comments
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djmammo thank you for your reply.
"Was this area grade 3 DCIS?"
No, it was grade 2.
When you listed 1) and 2), does it mean the situation could 1) or 2)?
If it was 1)-would not this be a part of first area and not part of margin, my understanding that it was found in 2mm margin, 0.5 mm from the first DCIS area.
Should i ask a doctor if this second DCIS was "without calcification". He would know, right?
I will ask the doctor re MRI as well.
thank you
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The bottom line is they found grade 2 invasive ductal cancer and grade 3 DCIS in the samples taken from the right breast.
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Hi djmammo, I really appreciate you sharing your knowledge. I am scheduled for a MRI guided biopsy in a couple of weeks. I am wondering if there are benign conditions that could have this appearance on MRI or if it’s more likely to be DCIS. Thanks!
BILATERAL BREAST MRI WITH AND WITHOUT CONTRAST
CLINICAL HISTORY: 39-year-old woman with a family history of two sisters with breast cancer. Patient herself has tested negative for the BRCA1 and 2 mutations. She has no current breast related complaints. Patient indicates she stopped breast-feeding on 11/13/2019. MRI is performed for high risk screening purposes.
COMPARISON: Prior mammograms and ultrasounds dating back to 7/5/2019.
LMP: 12/27/2019 (day 11).
TECHNIQUE:
TSE T1 coronal images, inversion recovery axial images, T1W TSE axial images, pre contrast 3D-T1W fat-saturated axial images at 1 mm slice thickness, dynamic 3D-T1W fat-saturated axial post-contrast images at 1 mm slice thickness, and delayed 3D-T1W fat-saturated axial post-contrast images of both breasts were obtained. Axial subtraction images were obtained from the precontrast T1W and the dynamic post contrast T1W images. Sagittal and coronal reconstructions of both breasts were performed using the post-contrast images, as was MIP of both breasts. Intravenous administration of 9 cc of Multihance for this study was administered uneventfully. Aegis computer aided detection was utilized in the interpretation of this breast MRI examination.
IMMEDIATE ADVERSE EVENT: None
FINDINGS:
BACKGROUND PARENCHYMAL ENHANCEMENT: There is moderate background parenchymal enhancement. Degree of background enhancement likely reflects parenchymal response to hormonal stimulus.
TISSUE COMPOSITION: Heterogeneous fibroglandular tissue.
RIGHT BREAST:
12:00 N6: Linear nonmass, rapid persistent enhancement measures up to 1.3 cm (image 120/224 postcontrast sequence). There is faint associated T2 hyperintensity.
There is no evidence of right axillary lymphadenopathy.
LEFT BREAST: There are no suspicious enhancing masses or areas of non-mass enhancement that stand apart from background to suggest malignancy.
There is no evidence of left axillary lymphadenopathy.
MEDIASTINUM/LIVER/CHEST: No suspicious incidental findings.
IMPRESSION:
1. Right breast: Indeterminate, linear nonmass enhancement at the 12:00 N6 position. MRI guided biopsy recommended.
2. Left breast: No suspicious MR enhancement to suggest malignancy.
BI-RADS ASSESSMENT CATEGORY 4 SUSPICIOUS
RECOMMENDATION:
1. Right breast MRI guided biopsy, 12:00 N6 position.
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Linear non-mass enhancement can be DCIS or it could be nothing or something in between. Since no mass is described the odds of IDC are lower.
MRI is not read in a vacuum however. The findings on mammo and US in that area (if any) influence what is seen on MRI. Were any suspicious calcs seen on the mammo in the area of enhancement on the MRI?
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Thank you, no there were no suspicious findings on my previous screening mammogram and ultrasound (6 months ago)
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The lack of suspicious calcs there, should decrease the odds of them finding high grade DCIS in that spot.
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DJMammo,
Can you please explain this? I saw the BS today, but of course, didn't see the report until after I saw her. She said that an excisional biopsy is needed. I am electing to have a bmx because I am BRCA2+.
My question is, is this pathology report indicating they suspect DCIS?
A. Breast, left, site 1, upper inner quadrant, core biopsies: - Adenosis, columnar cell change and usual ductal hyperplasia with periductal chronic
inflammation, and lobular and periductal fibrosis.
B. Breast, left, site 2, upper outer quadrant, retroareolar, core biopsies:
- Predominantly fatty breast tissue with focal periductal and interstitial fibrosis.
C. Breast, right, site 3, upper outer quadrant, core biopsies:
- Focal ductal/ lobular atypia; see comment.
- Associated lobular and periductal fibrosis.
16s
Comment Your ValueAn initial cross section of a core in specimen C reveals an altered lobule with focal prominent cytoatypia (including mitoses and hyperchromasia), raising consideration of atypical hyperplasia or DCIS with lobular extension. This is lost on deeper cross section, and remains histologically indeterminate in this sample. Consequently, careful correlation with clinical and imaging findings is recommended for concordance and follow-up. If clinically indicated, excision or other studies could be contributory.
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My question is, is this pathology report indicating they suspect DCIS?
They found some abnormal cells but not enough of them to make a definitive diagnosis. They list a few possibilities such as ADH and DCIS in their differential diagnosis. Its less "suspect" and more "cannot exclude".
What they found is sufficient to warrant an excisional biopsy. This should provide them with more material to work with so that a definitive call can be made.
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I’ve had two masses that I’ve had followed for the past year, and after my last appointment they’ve scheduled a biopsy. I just read the report and wonder if given that radiologist seems to feel they are benign Fibroadenomas, if a biopsy is really necessary and if it would be careless for me to ask them to continue to follow instead of biopsy. Thanks for any advice
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hi I've been to see a breast consultant after finding a small lump in my right breast my doctor sent me a urgent referral i was seen by the consultant he examined me and sent me down to breast screening were they gave me a ultrasound to which they found the lump and decided to perform a core biopsy on this anyway I went back upstairs to my consultant he said theyve performed a biopsy and that he will see me next week with the results
ps I also have breast implants
my doctor has recieved my ultrasound result still awaiting biopsy results. please can anyone make me feel better please going out of my mind here so this the results
both implants appear to be intact and no repture or capsule contracture on the right breast in the 9oclock position that gave the impression of benign findings this could be a post OP change.
an ultrasound scan at the site of clinical concerned showed a 8mm solid hypoechoic lesion with angular margins overlying the implant this was biopsied under aseptic conditions this is a u3/u4 lesion and will update next week with the results I should also tell you I'm from the uk so not sure if my results differ from somewhere else
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I have no idea what to think right now. But I am such an over thinker and keep running different scenarios in my mind on this.
I went in for my yearly Mammogram not worrying about a thing. My left breast has been super sensitive for over a month or longer. I figured it could be related to recent weight loss, or maybe just hormonal. I am 45 years old and had 2 biopsies December 2017. The findings were B9. Last years Mammo was normal in 2018.
Just had my yearly last week. I was called back yesterday to come back for more imaging and an ultrasound for this Tuesday and was told I will get the results and possible schedule a biopsy.
Everything I have read says that there should be no pain or sensitivity. It is still just as sensitive.
Just a bit nervous now. And the waiting is the worst.
Narrative:
BILATERAL DIGITAL SCREENING MAMMOGRAM + TOMOSYNTHESIS
CLINICAL INDICATION: 45 year-old woman presents for annual screening
mammogram. Patient has no family history of breast malignancy. She had a
benign left breast biopsy on 1/8/2018 yielding fibroadenoma. She had a benign
right breast biopsy in 2018. No current breast complaints.
COMPARISON: 12/21/2018 back to 12/20/2017
TECHNIQUE: Bilateral routine digital mammography and tomosynthesis were
performed. Digital mammographic images were processed through the R2 Imager
Checker.
FINDINGS: The breasts are extremely dense, which lowers the sensitivity of
mammography. The mammographic appearance of both breasts are stable. A biopsy
clip is seen in the superior right breast. Stable scattered benign
calcifications are seen in the superior right breast. A biopsy clip is seen in
the upper outer left breast. There is a nodular focal asymmetry in the upper
outer posterior left breast. Bilateral axillae are unremarkable.
Impression:
1. Nodular focal asymmetry in the upper outer posterior left breast. Further
evaluation with left diagnostic mammogram and left breast ultrasound
is recommended ASAP.
2. Stable right mammogram.
BI-RADS Category: 0 - Incomplete - Need Additional Imaging Evaluation
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The report does not give a very detailed description of the finding. The designation U3/U4 I assume is the UK's version of our BIRADS and your finding fits somewhere between U3 and U4 based on ultrasound appearence using this key:
U2 = probably benign lesion, U3 = an abnormality present of indeterminate significance, U4 = features suspicious of malignancy
Here is a better explanation: https://www.ncbi.nlm.nih.gov/pubmed/15708456
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hi thank you for your reply, the report from the ultrasound doesn't give much info other than the u3/u4 I think your right this is the equivalent to your birads, do you think I am best waiting for the biopsy results thank you again charlie
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Hopefully those results will tell you what's going on. You docs will tell you what's next after that. Nothing else for you to do at this juncture really.
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Any reason why the doc and radiologist (twice) would request a biopsy on the left breast which is apparently birads 0 - I was under the impression that meant further scans. Just been told right breast is birads 3 which im good to do the watch and see method.
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Can someone tell me what the difference is between nodular focal asymmetry and just focal asymmetry? Is there a difference? Does nodular mean a mass?
It's been days and no one answers any of my concerns. I am really nervous.
Narrative:
BILATERAL DIGITAL SCREENING MAMMOGRAM + TOMOSYNTHESIS
CLINICAL INDICATION: 45 year-old woman presents for annual screening
mammogram. Patient has no family history of breast malignancy. She had a
benign left breast biopsy on 1/8/2018 yielding fibroadenoma. She had a benign
right breast biopsy in 2018. No current breast complaints.
COMPARISON: 12/21/2018 back to 12/20/2017
TECHNIQUE: Bilateral routine digital mammography and tomosynthesis were
performed. Digital mammographic images were processed through the R2 Imager
Checker.
FINDINGS: The breasts are extremely dense, which lowers the sensitivity of
mammography. The mammographic appearance of both breasts are stable. A biopsy
clip is seen in the superior right breast. Stable scattered benign
calcifications are seen in the superior right breast. A biopsy clip is seen in
the upper outer left breast. There is a nodular focal asymmetry in the upper
outer posterior left breast. Bilateral axillae are unremarkable.
Impression:
1. Nodular focal asymmetry in the upper outer posterior left breast. Further
evaluation with left diagnostic mammogram and left breast ultrasound
is recommended ASAP.
2. Stable right mammogram.
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slf - what is your doctor telling you? You can check with both your PCP and your GYN.
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haven’t told me anything I was just told I need to go back for more images and an ultrasound.
I just didn’t know if nodular meant a nodule was seen?
I’ll just wait for the new images on Tuesday.
Thank you
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In 2018 I had my first mammogram. 2D. Dense tissue to 2D from here on out.
In 2019 I had a 3D mammogram that found a focal asymmetry in "far posterior lateral left breast seen on exaggerated lateral cc view". Went for diagnostic mammogram and it was normal tissue folded upon itself.
Just had my 2020 3D mammogram Thursday and they found "indeterminate asymmetry in central posterior left breast on cc view only". Got called back but haven't schedule appt yet (just found online results today).
I can't find anything online about "indeterminate" asymmetry. What does this term mean?
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"I can't find anything online about "indeterminate asymmetry". What does this term mean?"
And you won't. It just means we cant tell what it is on just this one exam.
On a screening exam we occasionally see things that may or may not be real, especially if it is only seen in one view. Anything that we see that we cannot specifically name, we call it indeterminate.
I would be more interested in whether the current and prior mammo were compared as this may be the same "finding" as last time. Do they address that in a part of the report that you did not include here?
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Hi djmammo! I finally got the second pathology report with hormone status. I have no idea what any of this means. Can you help please?! Thanks!
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I am not a pathologist so I cannot give you any real details of what these results mean in a practical sense except to say when the tumor is positive for these receptors it allows the use of certain additional medications that those without these + receptors, cannot use.
Here is an article on the topic: https://www.webmd.com/breast-cancer/breast-cancer-types-er-positive-her2-positive#1
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Good information! Thanks.
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Hi DJMAMMO,
I am new here in this forum so please bare with me. I am 32 yo with no family history on both sides. I've been experiencing pain in my breast since December 2019, both breast but most of the time its my left. Constant tenderness, sometimes an ache near my left armpit radiating to nipple. So I visited my OB and had a sched of ultrasound. I had US yesterday and its the 4th day of my period.The result came BiRads 3 and the OB seems not concerned but did not explain to me the results in detail. She just said it might be due to my hormones since the result said its benign, so I don't know if I should be worried
However since my period, the pain in my breast seems to stop. But I'm too afraid it will come back 4 days after my period just like last month.
Can you help me understand my results. The OB checked my breasts and no lumps were found. I am not sure in my result which impression came benign
Hope to hear from you, thank you.
Clare
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Findings
The breasts are symmetric in size with homogeneous (fibroglandular)
background echotexture.
Cluster of cysts are seen at 12 o'clock position 2cm from the nipple wtih sizes of cyst
measuring from 0.30cm to 0.67cm and at 9 o'clock position 2-3cm from the nipple
with sizes measuring from 0.36cm to 0.9cm of the RIGHT breast and at 3 o'clock
position 2-3cm from the nipple of the LEFT breast with sizes of cyst ranging from
0.29cm to 1.03cm.
Septated cysts are seen at 9 o'clock position 4cm from the nipple measuring
1.8 x 1.3cm and at 3 o'clock position 2-3cm from the nipple measuring
0.65 x 0.63cm of the RIGHT breast.
Cyst with calcification is seen at 10-11 o'clock position 3cm from the nipple of the
LEFT breast measuring 0.48 x 0.4cm.
Simple cysts are seen at 12, 12-1, 1, 2, 3, 4, 4-5, 5-6, 7, 8, 8-9, 9 o'clock positions
and retroareolar area of the LEFT breast with sizes measuring from 0.21cm to
1.03cm in diameter.
Similar simple cysts are seen at 1,2,2-3,3.4.5.5-6.6-7.9, 10-11 o'clock positions and
retroareolar area of the RIGHT breast with sizes measuring from 0.23cm to 1.5cm
The lactiferous ducts are not dilated. The axillae are unremarkable.
Impression
Cluster of cysts, bilateral
Cyst with calcification, left
Septated cysts, right
Simple cysts, bilateral
BI-RADS CATEGORY: 3
Recommendation: short term follow-up
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Cysts commonly cause pain and there is no mention of a suspicious mass. So far so good.
The calcification in the cyst is not adequately described likely because its an US and not a mammo. That might be the reason for the short term follow up. Have you had any prior studies that would have been compared with this study?
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Hi DjMammo,
I am really thankful for your response .. I have not been referred for a mammo and maybe because of my age. I have also an aching shoulder armpit and arm in my left side, I asked the doctor if its related to my cysts but she said its probably not, and that I should go to an ortho.
Is it normal to have to have too manu cysts?
Do I have to worry about the calcification?
I am trully greatful for your explanation. I think i can sleep with less worry .
Clare
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"Is it normal to have to have too many cysts?"
Not sure how to answer that. I have seen breasts with no cysts and I've seen breasts that were mostly cysts.
"Do I have to worry about the calcification?"
Depends on what kind they are, what they look like. You will have to ask your radiologist about them.
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Thank you DjMammo,
Is mammogram fit for small breasts? because I have small breasts and I don't know if I'm fit for that.
Also, is it possible that my armpit and shoulder pain is due to the cysts that I have ? I'm scared about this, it really bothers me.
So sorry I have many questions in my mind, I'm really anxious of what was going on in my upper body. I think I should also mention that I have another condition that I'm treating right now. I have acid reflux / gerd
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