Interpreting Your Report
Comments
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Mammograms are for all size breasts. Your other symptoms should be evaluated by the appropriate specialist(s).
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Thank you DjMammo
for all your response. It has helped me a lot.0 -
Morning, I underwent an MRI guided needle core biopsy on Tues. and my results are thankfully benign. Fat necrosis and foreign body giant cell reaction. I wanted to ask in your experience of seeing this, does it ever resolve? I don't want to do biopsies every year or every other for the rest of my life. If it does still show up on future images what should I expect?
What can I do to help myself? Besides trying not to injure or work the surrounding muscles too hard when working out and keep wearing proper support.
During the procedure I did have some liquid administered in between taking the samples. I assume this was saline, I didn't ask, but want to ask if you feel this may help aid healing this area at all? I was hoping that having to punch through the seroma area to get to this spot, that may actually help get this resolved. That was the only really painful part. Thanks once again for your input. I do appreciate it.
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If you had previously posted imaging reports, I do not recall them so I am going to assume a fair amount of facts for my response.
"Fat necrosis and foreign body giant cell reaction. I wanted to ask in your experience of seeing this, does it ever resolve?"
It does not resolve but it does evolve. In its early stages it looks suspicious on mammo but as the calcification increases it assumes its final benign form on mammo. On MRI it always looks suspicious if not familiar with its appearance but fat necrosis is a benign entity.
"What can I do to help myself?"
I assume the FN is from surgery but no side was mentioned so I will assume it was the side with the cancer and not the LCIS. Avoid more surgery and radiation as that is the most common combination of events that results in FN in the breast.
"During the procedure I did have some liquid administered in between taking the samples. I assume this was saline, I didn't ask, but want to ask if you feel this may help aid healing this area at all?"
Where and how was it administered? IV? PO? Injected into the breast? Perhaps a sclerosing agent was used to fill the seroma cavity to reduce the chances of it recurring? Look at the report of the biopsy it should tell you what it was.
"....having to punch through the seroma area to get to this spot, that may actually help get this resolved."
Some seromas last a very long time and if asymptomatic they dont present a problem. Draining them helps but they can refill with fluid. Occasionally if multiple punctures are made (fenestration) it may go away or at least take longer to recur if a sclerosing agent is not administered.
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Yes, it is my left. I will post recent reports and perhaps that may or may not change anything for you. Mammo and US from 12.31: Birads 2
Impression:
Left breast assessment: Benign. No findings suspicious for malignancy. Treatment related changes in left breast without adverse interval change since 2018. No correlate for the area of non mass enhancement can be found on ultrasound or mammography. Further management should be based on MRI findings.
Left: There is a lucent area in the center of the surgical clips representing an area of fat necrosis. The findings are similar to or slightly improved sin Dec '18. There has certainly been no adverse interval change. The appearance is within the expected range of postsurgical change. There are scattered punctate calcifications. Ultrasound will be performed. In the remainder of the breast no suspicious masses, calcifications or other abnormal findings are seen.
Targeted sonographic assessment is performed. At the 11:00 position, 4 to 5 cm from the nipple the seroma is identified measuring 1.7x1.7x0.9cm surrounded by a corona of hypoechoic tissue. There is no correlate for the MRI finding. No target for biopsy.
MRI report of 12.27: Birads 4 Suspicious
LEFT BREAST
Postsurgical changes are again noted in the upper inner left breast. A seroma is again noted in the upper inner left breast measuring 1.4 x 0.8 x 2.1 cm (image 108 on series 2 and image 112 on series 18). There is a slightly larger irregular area of
progressive enhancement at the anterolateral wall of the seroma now measuring 1.1 x 0.7 x 0.7 cm and previously measuring 1 x 0.7 x 0.4 cm (image 137 on series 6 and image 108 on series 18). There is an area of enhancement is in the upper inner right
breast approximately 5-6 cm from the nipple. Second look ultrasound is recommended for biopsy planning. If this area is not identified on ultrasound, MRI guided biopsy is recommended.There is no axillary or subpectoral adenopathy.
Left breast assessment:
Suspicious Slightly larger 1.1 cm area of irregular enhancement at the anterolateral wall of the seroma. Second look ultrasound is recommended for biopsy planning. If this area is not identified on ultrasound, MRI guided biopsy is recommended.
AS you can see, I was hopeful some of this area can actually resolve and not evolve. Thanks again!
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I have hx of mucinous BC. Had SMX 9/25/18 (no chemo, no radiation) with diagnostic mammos every 6months. Had mammo 5 days ago with US on remaining breast. Ultrasound-guided biopsy on 1/23. Of course, going nutsy waiting. The mammo findings were new mass with calcifications that are indeterminate. US found a shadowing irregularly shaped mass 9 x 10 x 7 with increased bloodflow that corresponds with mammo. My gut's telling me to get ready for another mastectomy. Seems like a lot of 'unfavorable' words in there! Your thoughts? Thanks!
Linda Garrett
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The phrase "...shadowing irregularly shaped mass ...with increased blood flow" is a very worrisome description. The description sounds more like IDC than a mucinous which is usually smooth and round.
Did the mammogram show a spiculated or otherwise non-smooth mass? Was the Birads 4 or 5 on the diagnostic exam?
Let us know what the path shows.
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Hi. I had a screening mammogram and was called back for a diagnostic. The radiologist read the diagnostic mammogram and ordered an ultrasound. After looking at the ultrasound, it was recommended that I have a Breast MRI. The MRI results suggest a biopsy. I do not have an appointment until Feb 11 for a consultation.
Are you able to help me understand the report?
There is an irregular enhancing mass within the right breast located near 12:00 position located approximately 6 cm from nipple measuring approximately 1 cm AP by .07 cm traverse by .06 cm cephalocaudal demonstrating increased T2 signal on STIR images. The mass demonstrates rapid initial enhancement and washout delayed enhancement (type lll kinetics). Size and morphology corresponds to the focal asymmetry from prior mammogram. The breast is somewhat turned on MRI exam due to coil placement.
Mass is suspicious. Given that the mass is clearly seen on mammography; tomosynthesis guided or stereotactic core biopsy is recommended for histology sampling.
Birads category 4 suspicious
Thank you for your input.
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Hello! I was diagnosed with Stage IV Hodgkin's Disease when I was 13 years old and underwent chemo and radiation to the neck, chest and abdomen. As part of my follow-up care, I have been getting yearly mammograms and breast MRIs since once I turned 30. My last mammo in April was normal and I had a normal clinical exam in September. I had my MRI a few days ago and a "suspicious irregular enhancing mass" that measured 2.4x1.8x1.8cm; BI-RADS 4. I've been searching these boards - but this seems like a large mass?? And the fact that I had a normal MRI 14 months ago (giving the radiologist had something to compare to), does not seem like a good thing in my mind.
There were "no MRI findings for chest wall intrusion" and "no suspicious axillary lymphadenopathy" - that's good(ish) news right? My doctor has been very tight-lipped and does not say much when I ask these questions. Thank you.
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Did you have a mammogram between your last MRI and now? I assume they will want a mammo and US now to confirm and further evaluate the MRI finding. Yes that sounds fast, and if real that is a fair amount of growth in a short time. The US will help with that.
Is there a paragraph in the current MRI report where they mention comparing this to prior MRI's? Do they refer to the current mass as being new?
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Thank you DJMammo - see ultrasound and diagnostic mammogram below
Procedure: WUS - US Breast RIGHT Complete CB
Reason: cb right breast asymmetry
Procedure Date: 12/13/2019 Accession Number: 15817548Diagnostic right Breast Ultrasound
History: Slightly irregular asymmetry right breast upper outer quadrant
Comparison: Mammogram today
Discussion: Imaging in the area of concern shows a simple cyst 4 mm at
10:00, not discretely matching the mammographic finding, because the
mammogram finding is slightly irregular marginated, MRI is recommended
for further evaluationImpression: Simple cyst seen at 10:00, probably not matching the
mammographic findingRecommendation: Because the mammographic finding is slightly irregularly
marginated, MRI is recommended for further evaluationBI-RADS: 0: Additional imaging
Unilateral right Diagnostic Mammogram
Technique: additional tailored views/exam was performed, with CAD.
History: Asymmetry
Comparision: 11/18/2019
Discussion: Additional views confirm 7 mm nodule upper outer quadrant, 8
cm from the nipple. Ultrasound will be performed.
Impression: Confirmation of nodule as described
Recommendation: See ultrasound report to follow
BI-RADS category 0: US will be performed0 -
The findings disagree to some degree. The MRI shows a mass corresponding to the mammo. The mass enhances so it must be solid but no solid abnormality is described on the US exam. The sizes also do not match up, 4mm vs 7mm.
The kinetics from the MRI raise the possibility that is may be fibroadenoma. They can be isoechoic thus difficult to see on US but adding in the use of the term "irregular margins" on one of the mammograms a biopsy will be necessary to reach a definite diagnosis.
If they are sure the MRI and mammo findings are the same entity then a stereo bx should be fine. If a diagnosis is not clear after that, an MRI biopsy would then likely be recommended. After a biopsy is performed, a marker is placed to see if the target that was sampled corresponds to the original mammo finding. In this case an US should also be performed at some time afterwards to see if the marker corresponds to the current US finding or one not previously identified.
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Thank you for your input.
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Thanks for your quick reply! Not spiculated (as was on the mucinous mammo) and not described as non-smooth - just irregular. Birads is 4B. Anxiously (very!) awaiting path results. Will let you know. Thanks again.
PS Just logged into patient portal. Report of biopsy describes 'it' as hyperechoic irregular solid mass.
Linda
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Thank you. The MRI report says “there is now evidence of...". The “now" part of the sentence leads to me to believe they compared it to my prior MRI results (which again was roughly 14 months ago).
Yes, mammo and ultrasound (with biopsy) are scheduled for Tuesday0 -
Thanks DJMammo! Got THE call today and it's fat necrosis. So relieved! Thanks for your help!
Linda
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Good Afternoon,
I have been diagnosed with LCIS and before my Dr removes it, he wants to make sure the MRI is not showing IC or DCIS. From looking at my MRI report does it look like there is anything to worry about? The nodular enchancement or the moderate to severe BPE.
Thank you for your time!
Study Result
Impression
IMPRESSION:
1. No worrisome enhancement seen at the left breast biopsy site or otherwise of
the bilateral breasts. However, there is moderate to severe background
physiologic enhancement which could limit detection of a subtle finding.
Furthermore, early noninvasive breast cancer may not clearly demonstrate
findings by breast MRI. A follow-up breast MRI in one year would be recommended
to ensure stability of these findings. The patient should continue to have
annual screening mammogram in the interim.
BI-RADS Assessment Category 3: Probably benign- Short-interval follow-up
suggested.Narrative
MRI BILATERAL BREASTS WITHOUT AND WITH CONTRAST, 1/16/2020.
CLINICAL HISTORY: Stereotactic biopsy December 2019 showing high risk benign
noninvasive lobular carcinoma in situ. Family history of breast cancer.
Technique: Multiplanar multisequence imaging of the breast were performed prior
to and following the uneventful intravenous administration of 19 mL of Dotarem.
Postcontrast imaging was performed using a dynamic technique. Images were
reviewed using the Dynacad software package.
Sequences obtained: Axial T1 with and without fat saturation, axial STIR, and
dynamic axial postcontrast fat-saturated T1-weighted images. Additional
subtraction images, maximum intensity projected images, and sagittal
reconstructed images were made from postcontrast images.
Comparison studies: Bilateral mammogram 12/13/2019, and post biopsy mammogram
12/19/2019.
FINDINGS:
Focal artifact occurs in the upper left breast located 6 cm from the nipple best
appreciated on STIR image 28 consistent with prior sampling at this level
showing LCIS. The breasts are composed of heterogeneous fibroglandular elements.
No enlarged axillary lymph nodes are seen. No enlarged internal mammary lymph
nodes are seen. Evaluation of the lungs is limited by MRI imaging. However, no
obvious pulmonary masses are seen. No significant pleural effusions are seen.
The liver is obscured by cardiac motion artifact and only partially visualized.
However, no focal signal abnormalities are seen prior to, or following
administration of contrast to suggest a possible hepatic lesion.
Following the administration of intravenous contrast, normal enhancement is seen
of the heart and vascular structures of the breasts. Moderate to severe
background physiologic enhancement is seen which could limit detection of a
subtle lesion. The patient's biopsy site is seen on approximately axial
postcontrast image 377. No clearly worrisome adjacent enhancing mass or
nonmasslike enhancement above background is seen. Adjacent nodular enhancement
is seen on axial postcontrast image 368 although this is similar to additional
benign enhancement seen throughout the bilateral breasts. Slight increased
enhancement is seen symmetrically in the outer breasts which is more typical of
benign physiologic enhancement. No worrisome dominant enhancing mass, or
asymmetric nonmass-like enhancement above background is seen. No evidence of
skin thickening, or nipple retraction is seen. No enhancing osseous lesion is
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Thank you for your response, I appreciate it!
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Hi djmammo!I'm new here and have been reading through the forums looking for possible answers to my questions so I'm grateful to have stumbled upon this particular discussion! May I kindly request your insight? I am scheduled for a second 6 month follow-up ultrasound on February 6 for a complex cyst. Below is the report from the first follow-up obtained six months ago. I will also be getting a mammogram at that time as I am now 40. It seems to me that my report may be somewhat vague in its descriptors. There is no mention of why the cyst appears complex, whether it is parallel, nor is there a birads category. Is it possible they're using the terms complicated/complex interchangeably? I'm becoming a bit more concerned with waiting if it's indeed complex because although the cyst wasn't palpable on clinical breast exam 6 months ago and the ultrasound was able to document its stability, it's now palpable on self breast examination. Thank you in advance for any input.
EXAMINATION: BREAST ULTRASOUND LIMITED LEFT 8/5/2019 1:48 PMHISTORY: left breast 6:00 complex cyst; Solitary cyst of left breast.
DISCUSSION: Comparison is made to prior ultrasonographic study dated
02/07/2019. A targeted left breast ultrasound was performed from the
3-6 o'clock positions including the retroareolar region. In the 3
o'clock position 4 cm from the nipple there is a 7 x 6 x 9 mm simple
cyst. In the 6 o'clock position 4 cm from the nipple there is a
complex cyst or possible blocked measuring 7 x 2 x 11 mm previously
measuring 7 x 3 x 10 mm
IMPRESSION
Stable appearance to complex cyst or duct in the 6
o'clock position of the left breast. A follow-up left breast
ultrasound in six months is recommended to document continued
stability or regression of the findings. Additionally as the patient
is 40 years of age a bilateral screening mammogram is recommended at
that time
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Is it supposed to read "complex cyst or blocked duct" ? There was no change in the first 6 months which is good.
What you are feeling may be something new, or this cystic finding, it would be hard to tell just by feeling it. Benign cysts can enlarge and so can blocked ducts and still not be a problem. Parallel or non-parallel orientation refers to solid oval masses. I only see the word complex here, did they call it complicated on the prior US? I assume its not a simple cyst due to internal echoes which can be seen in either complex or complicated cysts and also in blocked ducts. I dont see a mention of a Doppler exam for blood flow. There is also no mention of shadowing or through transmission.
Either way you will know in about a week.
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Indeed I will, thank you! It has always been referred to as complex in previous reports soI’m definitely going to ask a few questions. Hopefully the mammogram will yield some helpful information as well.
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Dear DJMammo,
Just got the results of a breast MRI for follow up of a palpable lump in my right breast (had double mastectomy with implant reconstruction).
The report says right side implant is intact and nothing abnormal seen.
However, on the left side, at a spot where I've had persistent rib pain, it says:
"There is a focus of magnetic susceptibility artifact medial to the upper portion of the implant which may represent a surgical clip."
The problem with that last year when I initially presented with the right breast mass post bilateral mastectomy, I was told it was probably a surgical clip, so I contacted the plastic surgeon's office and was told "the surgeon did not leave any clips after your exchange surgery in November 2018."
Assuming this is a benign finding but is NOT a surgical clip, what else might it be?
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Hi! Yesterday I had a Mammogram and Ultrasound that were ordered due to bloody discharge I had experienced a few days prior.
The doctor at first suspected an intraductal papilloma but then after switching the mode on the Ultrasound screen to a color setting, she seemed puzzled and said perhaps it was a prominent duct instead. I wasn't entirely sure what she meant but her concern level seemed low. She did order a biopsy and I scheduled it for two weeks from today.
I left the office feeling pretty positive. Now that I see the report and see a Birads4 rating, I am feeling much more concerned.
Can you offer any additional guidance as to what this report means?
Thank you so very much for your time.
Report:
1. 10 mm hypoechoic mass in the right subareolar region at 7:00.
Assessment: Right breast: BI-RADS Category 4, suspicious abnormality. Biopsy is recommended in the absence of clinical contraindication.
Recommendation: Ultrasound guided cyst aspiration with possible biopsy. Findings and recommendations were discussed with the patient who was scheduled for the procedureFocal asymmetry in the right subareolar region shown on subsequent ultrasound to represent a prominent duct versus solid mass.
Assessment: Bilateral Breasts: BI-RADS category 4, suspicious abnormality. Biopsy should be considered in the absence of clinical contraindication.0 -
Papillomas are very vascular on color Doppler. If one does not see this kind of blood flow, one questions whether it is actually a papilloma.
No matter what the finding looks like or how much we may think its benign, insurance companies will not reimburse for a biopsy without at least a BIRADS 4 rating. Don't take it literally at this point.
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Hi DJ Mammo. I don't have any prior mammograms because I had a complete double mastectomy with implant reconstruction (mastectomy Nov 2017, exchange surgery Nov 2018). The breast MRI from around this time last year does not make any mention of this. Nor does the breast ultrasound I had last spring.
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It might not be seen on an US. Can you post that previous MRI report?
The description indicates it is metallic so if its not a clip and you have had no procedures between your last MRI and now it would have to be a foreign body possibly from an injury? My money is still on a surgical clip. If you really need to know, a one or two view mammo will answer the question.
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