Interpreting Your Report
Comments
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can they do mammograms on reconstructed breast with implant?
Last years mri for the left side said “thin rim enhancement is seen in the left parsternal region, mainly involving the subcutaneous soft tissues, and to a lesser extent the underlying chest musculature" (I have rib pain in this area still, they keep telling me it's “postsurgical changes")
This year the mri for the left side doesn't mention any ri enhancement or the parasternal region at all,but says “focus of magnetic susceptibility artifact medial to the upper portion of the implant which may represent a surgical clip."
The frustrating part is that both of these mris were done by the same institution (though different locations) bug in this new report where it says previous scans for comparison, it says “none."
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I guess my question is because my surgeon told me verbally that there are no clips in my chest. As luck would have it, his retirement date was yesterday. But a nurse reviewed his notes from my exchange surgery and also said there are no clips noted. Can something shoe up as metallic if it actually isn’t?
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I should also note that this is my left side/non cancer side, so there was never any biopsy or anything. The left side mastectomy was prophylactic.
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Thanks. I just messaged the plastic surgeon for a copy of the post surgical notes from both the mastectomy and the exchange surgery.
I will also contact the breast surgeon (although, sadly, he is out on medical leave due to having cancer himself!)
If it’s noted as a magnetic susceptibility artifact, is there any chance it could be something other than metal?
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"If it's noted as a magnetic susceptibility artifact, is there any chance it could be something other than metal?"
I don't know of any other materials that do this but I suppose there could be.
"Magnetic susceptibility artifacts (or just susceptibility artifacts) refer to a variety of MRI artifacts that share distortions or local signal change due to local magnetic field inhomogeneities from a variety of compounds.They are especially encountered while imaging near metallic orthopedic hardware or dental work, and result from local magnetic field inhomogeneities introduced by the metallic object into the otherwise homogeneous external magnetic field B0. These local magnetic field inhomogeneities are a property of the object being imaged, rather than of the MRI unit itself."
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Thanks! As long as it’s a clip or a staple or something and not anything that could be abnormal tissue or a lump that is bring mistaken for an artifact, I’m fin with it.
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Hello,
I had 2 biopsies yesterday for palpable masses. One under US for a 9mm spiculated mass attached to my chest wall and the other biopsy was a sterotactic mammogram biopsy for a new cluster (since 2/2019) of varying sizes of microcalcifications. The radiologist found even more microcalcifications in the biopsy sample than showed in my mammogram from earlier this week.
History: 11/2017 DCIS grade 3, ER/PR -, 1.5 cm with bilateral mastectomy.
My question: is there a greater chance of malignancy with a tumor that is attached to the chest wall or is that irrelevant?
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no official report has been released to me yet. They are withholding my mammogram report from Weds until ( my suspicion) they get the pathology and then can fill in the appropriate Bi-rads number. That is how this hospital has released my info in the past.
The 1st radiologist used the terms spiculated and Hypoechoic for the chest wall mass and casting microcalcifications for the other mass a couple inches to right.
The radiologist who completed both my ultrasound biopsy and stereotactic biopsy told me about the additional microcalcs that she get in the biopsy that didn’t show up in Weds mammogram. She also had the US tech turn on the color option to check for blood flow.
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Hello again, just wanting to update and ask more questions.
History: 41 year old, pre-menopausal with history of radiation to chest (Hodgkin’s Disease at 13 years old)
Annual MRI (taken at day 16 of my monthly cycle) detected an “irregular mass” measuring 1.8x1.8x2.4cm. Went in a week later for diagnostic mammo, ultrasound and biopsy this past week.
Diagnostic mammogram could not detect the mass.
Ultrasound found a “subtle hypoechoic area” measuring 1.2cm. Radiologist seemed perplexed but took a biopsy primarily due to the MRI report.
Djmammo, my questions for you are:
It seems to me a 2cm mass should be picked up by a diagnostic mammo, no?
Could the timing of my cycle affect the size of this mass?
Thank you!!
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hi dynamo I just wanted to update you on my results,i was diagnosed with invasive ductal caricoma grade 1 provisional. with adjacent intermediate grade dcis. i am er and pr positive. my hers2 is borderline so this has been sent for ddish should get those results this week. my cancer is 1cm I am due into surgery for lumpectomy and sentinel node on the 7th. I just wanted your input on these results my ki-67 is 22% I am E-cadherin positive. no lympovascualar invasion seen and no family history at all of breast cancer I'm also 32 with 4 children. thank you I hope to speak to you soon x
ps also to remind you I am from the uk so these results may differ from yours
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As a diagnositic radiologist, I am not qualified to evaluate and advise you on specific path results. I do know however that cancers less than 1.4cm in diameter have a better prognosis, and that being ER and PR (+) allows your docs to use certain hormone blocking agents as a part of your treatment. Lack of LV invasion is also good news. The finding of (+) E-cadherin just confirms that this is not a lobular carcinoma (they lack E-cadherin).
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Dr. Thank you for your time yesterday. Here is the report from my Ultrasound last weds.
I had ultrasound biopsy of the area attached to the chest wall plus also sterotactic biopsy of the micro-calc on Friday. No results yet. At the biopsy for the micro-calcs the radiologist said she got the original micro calcs plus other ones that did not show on mammogram Weds. The radiologist from Weds said the new micro-calcs looked the same as my ones from DCIS dx. in 11/2017.
*ultrasound report*
52-year-old woman with history of bilateral mastectomies with
silicone implant reconstruction for right DCIS presents for evaluation of
increasing palpable lumps in the superior right breast. Aunt diagnosed with
breast cancer in her 30s.
COMPARISON: 2/7/2019 and prior studies dating back to 8/3/2012.
FINDINGS: Standard and implant displaced right CC; standard right MLO, ML;
implant displaced spot magnification ML and CC views were performed to
evaluate the palpable areas of concern and right calcifications. A right
subpectoral silicone implant is present without evidence of rupture or leak.
The residual right subcutaneous tissues are predominantly fatty.
Triangle shaped palpable markers were placed over the areas of palpable
concern in the superior right breast. Multiple round and oval radiolucent
masses with thin peripheral rims are noted in the tissues deep to the markers,
consistent with benign oil cysts. Some of these are more visible compared to
the 2/7/2019 mammogram. Ultrasound of the palpable areas of concern was
performed per patient direction at the 10:00, 10:30, 11:00, 11:30, 12:00 and
1:00 positions. Multiple anechoic oval benign oil cysts are present, which
correlate with the mammographic findings. The largest oil cyst measures 1.0 x
0.9 x 0.9 cm at the 12:00 position 12 cm from the nipple. No further follow-up
or intervention of the benign oils breasts is warranted.
At the 11:30 position 9 cm from the nipple is a heterogeneously hypoechoic 9 x
9 x 9 mm mass with peripheral vascularity and obscured borders. A BB was
placed on the overlying skin and repeat mammographic images were performed.
This correlates with a 9 mm focal asymmetry that does not appear as classic
fat necrosis. Findings are considered indeterminant and ultrasound-guided
biopsy is recommended. Findings and management options were discussed with the
patient. Permission for biopsy was obtained from Dr. --------
Also noted is a 1 mm area of calcification in the upper outer reconstructed
right breast. Given her history of grade 3 DCIS, attempt at upright
stereotactic core biopsy will be arranged. If this is unable to be biopsied by
stereotactic guidance, tissue diagnosis, surgical
consultation and mammographic needle localization for excision could be
performed. This was also discussed with the patient.
IMPRESSION:
Right breast:
1. Suspicious. At the site of palpable concern in the 11:30 right breast is an
indeterminate 9 mm mass. Ultrasound-guided core needle biopsy will be
arranged.
2. A 1 mm area of calcifications in the upper outer right breast are now
identified and the patient desires biopsy. Attempt at upright stereotactic
core biopsy will be arranged.
3. Multiple benign oil cysts in the area of palpable concern spanning the
10:00 to 1:00 reconstructed right breast, for which further clinical
management is deferred to Dr. ------
**The multiple oil cysts are all in a line along the top of my right breast (with the suspicious one in the middle) and also down the outer side of the right breast. Could those me enlarged lymph nodes? I'm concerned that they are all in line. Nothing is on the left side at all and I had a bilateral mastectomy on 12/21/17.
The mammogram report is similar and if you think that will help, It is below.
Triangle shaped palpable markers were placed over the areas of palpable
concern in the superior right breast. Multiple round and oval radiolucent
masses with thin peripheral rims are noted in the tissues deep to the markers,
consistent with benign oil cysts. Some of these are more visible compared to
the 2/7/2019 mammogram. Ultrasound of the palpable areas of concern was
performed per patient direction at the 10:00, 10:30, 11:00, 11:30, 12:00 and
1:00 positions. Multiple anechoic oval benign oil cysts are present, which
correlate with the mammographic findings. The largest oil cyst measures 1.0 x
0.9 x 0.9 cm at the 12:00 position 12 cm from the nipple. No further follow-up
or intervention of the benign oils breasts is warranted.
At the 11:30 position 9 cm from the nipple is a heterogeneously hypoechoic 9 x
9 x 9 mm mass with peripheral vascularity and obscured borders. A BB was
placed on the overlying skin and repeat mammographic images were performed.
This correlates with a 9 mm focal asymmetry that does not appear as classic
fat necrosis. Findings are considered indeterminant and ultrasound-guided
biopsy is recommended. Findings and management options were discussed with the
patient. Permission for biopsy was obtained from Dr._____
Also noted is a 1 mm area of calcification in the upper outer reconstructed
right breast. Given her history of grade 3 DCIS, attempt at upright
stereotactic core biopsy will be arranged. If this is unable to be biopsied by
stereotactic guidance and if the patient desires tissue diagnosis, surgical
consultation and mammographic needle localization for excision could be
performed. This was also discussed with the patient.
IMPRESSION:
Right breast:
1. Suspicious. At the site of palpable concern in the 11:30 right breast is an
indeterminate 9 mm mass. Ultrasound-guided core needle biopsy will be
arranged.
2. A 1 mm area of calcifications in the upper outer right breast are now
identified and the patient desires biopsy. Attempt at upright stereotactic
core biopsy will be arranged.
3. Multiple benign oil cysts in the area of palpable concern spanning the
10:00 to 1:00 reconstructed right breast, for which further clinical
management is deferred to Dr. _______.
Thank you again for your expertise djmammo.
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Hi,
My wife is the 41 year old mother of two small children and received this contrast MRI report that we are trying to understand:
REASON FOR EXAM: Screening. History of right excisional biopsy showing fibrocystic changes in 2009.
COMPARISON: Screening mammogram 12/27/2019.
TECHNIQUE: Axial fat-saturated T2, T1 FLAIR, dynamic FSPGR contrast-enhanced axial images, and delayed contrast-enhanced high resolution images. Images are reviewed in the axial, sagittal and coronal planes on an independent workstation using CADStream software for display and analysis. Images were obtained after the IV administration of 5.5 cc Gadavist.
FINDINGS:
There is prominent bilateral background parenchymal enhancement with multiple similar foci scattered throughout both breasts.
In the outer right breast toward 9:00, 3 cm from the nipple, there is an area of clumped nonmass enhancement measuring 2.8 cm AP by 1.1 cm transverse by 3.4 cm CC (series 104, image 48/106). This shows areas of washout kinetics.
No abnormal mass or non-mass enhancement is seen in the left breast.
Normal lymph nodes are seen in the axilla bilaterally. The chest wall appears normal.
IMPRESSION:
BI-RADS 0. Incomplete: Need Additional Imaging Evaluation. Recommend ultrasound of the right breast. May consider ultrasound or MRI guided biopsy of the right breast pending findings.
She had a routine 40 year old mammogram (late because she was still breast feeding on her birthday) which showed dense tissue. We decided to do a contrast MRI which found the Non-Mass Enhancement. The radiologist was unable to see anything on the second look ultrasound. The next step is a MRI guided biopsy. We are very worried.
What is the chance this is cancer?
What is the chance this is metastatic cancer?
My wife had a lumpectomy for two masses ten years ago very near (if not in this exact same) area. They were both biopsied and found to be benign.
Thank you for your help!
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I'll do my best. Current and past history is incomplete and the actual full reports of mammo and US are not provided. This is an interpretation of the isolated findings described in the MRI report above.
"What is the chance this is cancer?"
If they see no mass on the MRI nor on the US the chances of IDC are low but DCIS is a possibility.
"What is the chance this is metastatic cancer?"
Do you mean what is the chance there has been spread from this finding in the breast to another location? Or are you asking if this finding in the breast is a metastatic deposit from elsewhere in the body? Is there a history of a prior cancer somewhere? The lymph nodes are reported as normal. In the breast mets usually present as a mass. No masses were described.
"My wife had a lumpectomy for two masses ten years ago very near (if not in this exact same) area. They were both biopsied and found to be benign."
If they were benign, she did not have a lumpectomy, she had an excisional biopsy as noted in the report above. The term lumpectomy is reserved for cancers. If you tell one of her doctors she had a lumpectomy they will conclude she has had prior surgery for cancer of the breast.
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Thank you for getting back to me DJMAMMO!
I apologize for using the wrong term, I guess she did not have a lumpectomy, instead she had an "excisional biopsy"
I was asking what the chance was that this finding on the MRI had spread to another area. My wife has never had any kind of cancer in the past. She also has no breast cancer in her family history.
So if I understand correctly based on this MRI there is a possibility of DCIS and a low chance of IDC?
Thank you for your help!
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So if I understand correctly based on this MRI there is a possibility of DCIS and a low chance of IDC?
The short answer is 'yes that is correct'. Once the area is biopsied there may be microscopic areas of IDC since it arises from areas of DCIS. If the biopsy shows either of these when the lumpectomy is performed they will remove at least one lymph node to see if there is any evidence it has spread. Chances of spread of IDC are extremely low without a mass present, and with negative nodes. DCIS does not ordinarily metastasize.
The alternative is if this is in the area of prior surgery it could be related to the prior benign process. Let us know what the biopsy shows.
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DJmammo, do you have any experience with thyroid ultrasound?
I'm having trouble understanding how I have 2 nodules in the right lobe but the left lobe is the one that appears enlarged.
The report says:
Indication: Enlarged thyroid gland
Thyroid gland size (mm): right lobe 16 x 45 x 14, left lobe 14 x 42 x 60, Isthmic thickness 3
Right side:
nodule 1: size 14 x 10 x 9; location - mid; solid; isoechoic; margins - smooth; vascular flow - minimal
nodule 2: size 8 x 8 x 8; location - inferior; solid; isoechoic with central portions of decreased echogenicity; margins - ill-defined; vascular flow - minimal
Impression: right sided thyroid nodules the larger one amenable to FNA
I don't know if there's any significance to thyroid nodules after breast cancer, but I'm going to ask to skip the FNA. If the larger nodule that they say can be aspirated had ill-defined margins, I might submit to an FNA. But since they can't FNA the one with the ill-defined margins, I'm thinking why bother.
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Thanks DjMammo. Do you think there’s any possibility of there being a typo in the actual measurement of the thyroid lobes? They seem very different
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pesky - I think you're asking something he's already answered. He hasn't dealt with thyroids in more than 16 years and is not comfortable making statements about thyroids. Hope your doc can give you the answer.
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my question was simply about the anatomy of a thyroid re: typical lobe sizes, not about the ultrasound report itself.
But no worries,I will look this up on google.0 -
Hello,
I am hoping you can help me determine how bad this is. As someone who already had breast cancer I am extremely worried. Any help you can give me is greatly appreciated.
CLINICAL INDICATIONS: 56-year-old female patient documented with possible new mass at the 12:00 radius of the left breast on today's mammogram. Assessment by ultrasound recommended.
FINDINGS:
Exam compared to a left breast ultrasound from December 12, 2017.
There is a revisualization of a fibrocystic island at the 12 o'clock radius closed to the nipple measuring 5 x 9 mm accounting for t he mass seen in the central slightly upper quadrant of the left breast on mammogram.
AT the 1:00 radius at 2 cm from nipple there is a round hypoechogenic mass with slightly indistinct border showing questionable posterior through enhancement without vascularity measuring 3 x 5 x 4 mm that could be a good correlate for the new mass seen on mammogram.
At the 1:00 radius at 4 cm from nipple there is an antiparallel hypoechogenic mass with relatively circumscribed border measurin g 5 x 3 x 4 mm unchanged since 2017 and corresponding to the previously biopsy-proven fibroadenomatous changes
Small cyst at the 4:00 radius.
No suspicious axillary lymph node.
TECHNIQUE:
The technique as well as a possible complication were explained to patient gave an informed consent.
Under aseptic technique local anesthesia was perform at the 1:00 radius using 10 cc of Xylocaine. Under ultrasound guidance an attempt to aspirated the lesion was performed without success. Afterwards 3 passes with a 14-gauge needle were obtained of the targeted lesion. A clip was inserted deployed the slightly superiorly and anteriorly to the lesion.
No evidence of immediate complication.
Postprocedural mammogram shows the clip in the upper slightly outer quadrant. The location of the clip could correspond to the right lesion although it is hard to tell with certainty as the lesion was breast appreciated on the MLO view and that only a lateral view of the breast was performed on the postprocedural mammogram.
IMPRESSION:
Uneventful core biopsy of the new mass with indistinct border at the 12:00 radius of the left breast likely corresponding to the new mass seen on mammogram although exact correlation remains difficult given that the procedural mammogram only include d cc and lateral view. Patient will have to be called back in a short delay to perform a MLO combo tomosynthesis of the left breast to assess clip position in respect to the newly seen lesion on mammogram. This can be done on the same day as the next visit with the surgeon for the biopsy result. This will have to be arranged by the treating surgeon.
BI-RADS IVB
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If you have already had it biopsied you will know what it is fairly soon regardless of my opinion.
The phrase "...posterior through enhancement without vascularity..." leans toward the benign side of things if that will help you while you are waiting. Did they forget to put a conclusion and a BIRADS # on the reports or did you omit them?
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Thank you for responding, djmammo. The Birads is 4b (it's at the end of the report). I think that means 10-50% cancer, right?
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B4 means it needs a biopsy. The letters are used by the MQSA for the radiologist's yearly evaluation to gauge how confidently they are making their diagnoses. These are compared to the rad's false positive and false negative statistics. You can't count on them to predict your particular outcome. It will either be positive or negative.
The impression is the summation of all the findings giving all those terms meaning. What was their impression? Did they say what they thought it might be or did they just say biopsy it?
Post the path when you get it.
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They did a U/S guided biopsy with a 12 or 20 gauge needle (don't remember). At first they thought it could be a complex cyst, so they put a needle in it to see if it would collapse, and it didn't, so they did the 12/20 gauge needle biopsy and took 3 samples
Their impression was that they weren't sure if it was cancer. They said that since the U/S showed the new lesion they saw on the mammo, they had to biopsy it.
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In July my mammogram came back with BIRADS 4
Had a papilloma and a Fibroadenomia
They removed the papilloma.
Just had 6 month Mammogram
I thought that I would see a measurement to compare the size of the Fibroadenomia comparing to the scan 6 months ago.
instead of what I expected this is the report. I’m 53 and wondering if I need to be concerned that there is no measurement of the Fibroadenomia. There was a biopsy done on it in Aug that came back benign
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