Interpreting Your Report
Comments
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This is just conjecture of course on my part but the phrase that seems to be the whole of the US report, sounds like a pre-programmed sentence from the voice recognition dictation software. Personally, I would have mentioned the fibroadenoma if only to say it was unchanged even if it were measured.
If that FA were newly discovered this past year (and not present and stable from mammos years ago) I would ask the rad to dictate an addendum referencing the FA. 'Unchanged' would be acceptable. Exact measurements would be nice but they can vary a mm or 2 from tech to tech and from machine to machine so if measurements are given look at them as "ball park". To trigger the need for removal the FA has to grow a significant amount on a 6 month follow up.
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I am looking for some advice while I wait to hear from my doctor. She only works 2 days a week. I received my reports via the online portal and now I am going crazy. A little back ground...I am 2.5 years out from treatment of IDC in my left breast. I had implants before cancer and this past August 2019, I had my left implant removed as well as the scar tissue and tumor bed tissue that was damaged from radiation. That tissue came back negative for any malignancy. I had new implant put in. This was all in the lower half of my breast.
I had a routine diagnostic mammo and MRI scheduled for 2/4/2020.
Here are the reports: (In a nutshell)
Diagnostic mammo: a focal asymmetry is seen in the superior aspect of the left breast. This contains interspersed fat. Ultrasound was performed and no solid or cystic mass is identified. There is no sonography can correlate for the focal symmetry.
MRI: in the upper outer aspect of the left breast there is a small area of clumped non mass like enhancement, which demonstrates slow uptake with progressive enhancement. Measuring 1.2cm x 1.2cm. This is located 6mm to the closest margin of the implant and corresponds to the focal asymmetry seen mammographically. However, given the site of the biopsy performed at the time of capsulectomy and implant replacement,would recommend further evaluation with tissue sampling.
Birad 4 (no letter after)
At this point I am fearing DCIS bc of the clumped nature. I know you cant diagnose but are there benign conditions that mimic this finding?I am confused bc the U/S showed nothing. Any insite is greatly appreciated. I am worried sick. Thank you.
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Too early to be worried.
Non-mass enhancement can be anything from DCIS to nothing at all as it sometimes disappears by the time the biopsy date rolls around. DCIS is not routinely seen on US. In general on MRI slow uptake with progressive enhancement is an encouraging finding.
Having had cancer previously any findings are considered more suspicious in general (have a higher pretest probability) than someone without prior cancer and similar findings. Plus you have had surgery in the past year in this area so this can be a confounding variable in making a decision on benign v. malignant. I would have been surprised if they did not recommend a biopsy.
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Thank you for your quick response. I am trying not to worry but having been down this road before, it is very easy to go to the dark side. I probably should stay off the internet and not read so much. As they say, a little bit of knowledge can be dangerous. Hopefully I will have some answers soon.
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Thank you very much for your response!
That is exactly what I will do. The FA was on my Mammogram and Ultrasound from July. No previous reports (age 53
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I have one more question concerning my report. Is it not true that a “clumped” internal structure of a non mass enhancement is usually about 80% indicative of malignancy? I know the other parts of my report seem encouraging but I’m focised on the word “clumped”.
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No, I am having a biopsy. I am trying to mentally prepare for what I feel it is going to show. Can you tell I’m a worrier....lol. When first looking at clumped non mass enhancements, I couldn’t find anything benign that supported that finding. I guess I’m looking for the needle in the haystack
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Know that the %'s that are published can vary widely from study to study for this. If it were an irregular enhancing mass with washout kinetics I could give you a fairly accurate statistic but the finding you are investigating is too vague and subject to individual interpretation to have any meaningful %'s attached to it and may be different in each online reference you read. Just remember that online research can be a double edge sword. So much depends on who is reading your scan, and even among experts opinions will vary. Don't be afraid to ask your doc for something to help you through this if you are finding it overwhelming.
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The MRI biopsy came back benign with Fibrocystic Changes and PASH (Pseudoangiomatous stromal hyperplasia)
Thank you DJMAMMO for your help!
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Hi, I was told that my results are in, "but not finalized, and that they are waiting for a pot biopsy reading to confirm the findings." Can you help me understand that? Thank you.
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Here is my assumption. If it was the imaging center that told you, this refers to the post biopsy addendum to your biopsy report. This is where the final path report is reviewed by the rad that did the biopsy, and that info is compared to all the imaging to date to see if the findings agree. This leads to a recommendation for treatment or followup depending on the result of this comparison which is key info for you and your doc particularly if the findings disagree. The person you spoke to may not have seen the report and if they did, would not be allowed to give you the results if they were not a doctor or nurse navigator.
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djmammo, thank you. The person who told me this is not allowed to give me the results. She is only allowed to tell me if the results are in. I should hear today from my doctor and I’ll update here with the results.
Thank you so much for your help.
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Hi djmammo - I have question regarding professional norms and real world clinical practice and whether the situation I'm going to outline below is common or considered irregular. Thanks in advance - your experience and willingness to help this community cannot be adequately expressed!!!
I was referred for an u/s (which then also included a mammogram on site) for a palpable superficial mass near my mastectomy scar. Following the imaging, I met with the radiologist who stated the lesions were "probably benign" and she "recommended follow-up in 6 months". I expressed my concerns and requested a biopsy given my history of a positive DCIS margin post skin sparing mastectomy (with DIEP recon), positive LVI and multifocal DCIS and IDC. She said that she would order the biopsy at my request.
This morning my patient portal notified me the report from my January 27th imaging was available. The report does not reflect the information she provided me verbally and it appears that her opinion changed from a BIRADS 3 to BIRADS 4a.
I have copied the report below FYI (I know you will find it very superficial and lacking a lot of usual descriptive information).
RIGHT MAMMOGRAM
RIGHT BREAST ULTRASOUND
INDICATION: 44 years Female, palpable area
COMPARISON: March and 2018
MAMMOGRAM:
ACR A: The breast tissue is almost entirely fatty.
2 faint tiny focal asymmetries in the area of concern in the upper outer right breast
ULTRASOUND:
Targeted sonographic evaluation was performed of the area of concern at 9:00 4 cm from nipple. There is a superficial hypoechoic parallel nodule measuring 3 x 3 mm. Chest 2 there is another 4.7 x 2.9 mm nodule. The appearance was discussed with the patient and her husband.
IMPRESSION:
1. Patient is concerned about the 2 palpable lesions
2. Recommendation: Biopsy using ultrasound guidance for the larger deeper lesion
BI-RADS 4A (Biopsy recommended: low suspicion for malignancy).
Just so you know - I had an excisional biopsy performed last week and my results are currently pending.
Is it common to change a medical opinion and recommendation after a discussion with a patient? Although it does not change anything with respect to outcome - I find it odd....
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Just my thought, while you're waiting for dj. I think a Birads 3 would not get insurance approval for a biopsy right now, so your concern is exactly why they graded it a 4 which is suspicious and #1 under Impression. I would consider that a good thing! They are listening to you. Good luck! Hope it turns out benign.
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Thanks ctmbsiki. I suppose that is possible...but I'm in Canada though, so there isn't the same insurance approval processes/requirements as the US. In the end, it doesn't "really" matter, I was just curious whether djmammo had any experience or insight. I am too hoping for that b9 result!!! :-)
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Not odd at all, and the rad's opinion really did not change. They still think it is likely benign. The original B3 was changed to a B4a because you told them you wanted it biopsied. You cannot perform a biopsy from a B3 report, only on a B4 or B5. The report even mentions your concern about the lumps. Basically B4a =" B3 but the pt wants it biopsied". Let us know what the path shows.
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Thank you djmammo! I'll certainly update once I have the biopsy results.
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DJMammo,
I want to thank you for answering my previous questions. I had a stereotactic biopsy today which has now proposed new questions.... When the doctor came in the room, her first comment was "I would bet $20 this is scar tissue from a drain". She proceeded to show me a picture of my mammo. She didnt really explain what she saw or didnt see. Fast forward to the end of biopsy and getting ready to leave and she made the comment. It wasn't hard tissue that I removed, it was soft and squishy and that is good. So now I am left to wondering what this all means until next week. I know that I have no mass and now I know there aren't any calcifications. I am very confused as to what is happening. In a way, I wish she didn't say anything. My reports still dont add up to scar tissue but in some ways things dont add up for cancer. Any thoughts?0 -
hi, I hope I am posting this correctly! Thank you DJ Mammo for any insight. I had a follow up Diagnostic mammo and US last week. I am a bit confused by this report: the Radiologist spoke very fast and said, “I could have a biopsy if I wanted to know for sure” as he was explaining his findings (microcalcifications) but if I were his wife-I could wait and follow up. But after reading this report, it looks like I chose to wait. I never made any decision. I just listened to his reasoning and how he suggested I could wait. I follow up with my Doctor Monday-I will see what she thinks. Thank you in advance!
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sorry, I posted my report in my topic on the Not diagnosed , but worried’ page titled “question about microcalcifications” thank you:)
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I have been asked to come in for further testing based off of the following findings on my mammogram. How much of a concern is this?
Composition: The breasts are heterogeneously dense, which may obscure small masses.
There is a focal asymmetry in the mid outer RIGHT breast middle third centered
approximately 6 cm behind the nipple.
No suspicious mass, architectural distortion, or calcification is seen in the LEFT breast or otherwise in the RIGHT breast.0 -
Some background and also an addendum. The hospital did call me yesterday and said my results were benign- but that a papilloma was found. They stated the papilloma was benign- but the radiologist did not put in any specific instructions for follow up because she said some docs like to remove them while others don't. I've had one benign papilloma in the past, 11 o'clock position (same breast). It was excised and found to not have any cancerous or atypical cells. I also have a fibroadenoma in the same breast (3 o'clock). I guess I'm confused regarding the calcifications, though the day of my biopsy, the radiologist said this is normal. He stated day of biopsy that he'd be very, very surprised if this was anything bad (which it came back benign, so yay!).... he made it clear he was only doing the biopsy because of my present fibroadenoma. I don't have the pathology report yet, but I was wondering if any of this is indicative of an increased chance of cancer? Thanks so much!
Patient presents with a lump in the anterior 6 o'clock left breast.
The tissue of both breasts is extremely dense, which lowers the
sensitivity of mammography.
There are new loosely grouped calcifications in the left breast at 6
o'clock anterior depth. These are nonspecific.
No other suspicious masses, calcifications, or other findings are seen
in either breast.
IMPRESSION: SUSPICIOUS OF MALIGNANCY
The new grouped calcifications in the left breast at 6 o'clock
anterior depth are nonspecific.
These are in the vicinity of the lump.
Ultrasound will be performed for further evaluation.
ULTRASOUND OF LEFT BREAST: 2/10/2020
Color flow and real-time ultrasound of the left breast were performed.There is a 2.2 cm lobulated mass in the left breast at 6 o'clock
anterior depth. This is partially solid/partially cystic and contains
calcifications.
IMPRESSION: SUSPICIOUS OF MALIGNANCY
The 2.2 cm lobulated mass in the left breast at 6 o'clock anterior
depth is at an intermediate suspicion for malignancy.
An ultrasound guided biopsy is recommended.OVERALL STUDY BIRADS: 4a Suspicious abnormality - low suspicion for
malignancy0 -
Thought i might add this for thought and translation. Now just playing the waiting game...
This was my mammo on 2/3 with an ultra sound.. .followed up with an mri on 2/10 and biopsy on 2/12
FINDINGS:
Mammogram:
Tissue Density: The breasts are heterogeneously dense, which may obscure small masses.There is an area of grouped, heterogeneous regional calcifications spanning a somewhat ovoid area measuring 5.9 x 5.6 cm centered in the lower right breast. There is a palpable marker overlying this region. Note is also made of diffuse skin thickening anteriorly and mild right nipple inversion. There is no definite masslike margins. There is no definite distortion. The left breast is grossly unremarkable.
Ultrasound: Ultrasound of the right breast demonstrates an irregular hypoechoic area at the 6 clock position, 3 cm from the nipple measuring 1.4 x 1.1 x 0.8 cm which appears to be associated with a few possible microcalcifications. There is a complicated cyst at the 8 o'clock position, 2 cm from the nipple associated with a few calcifications measuring 1.0 x 0.6 x 0.6 cm with smooth well-defined margins. There is no posterior acoustic shadowing or abnormal vascularity. At the 9 o'clock position, there is a heterogeneous hypoechoic nodule at the 4 o'clock position measuring 0.4 x 0.4 x 0.5 cm which appears slightly taller than wide with mild posterior acoustic shadowing. There is no abnormal vascularity. At the 11 o'clock position of the right breast, the 7 cm from the nipple, there is an irregular hypoechoic area with posterior acoustic shadowing which is difficult to measure due to the shadowing but measures approximately 0.9 cm in diameter.
Ultrasound of the right axilla demonstrates morphologically benign-appearing lymph nodes measuring 1.1 x 0.9 x 0.7 cm and 1.3 x 1.0 x 1.0 cm.
IMPRESSION:
There are highly suspicious findings in the right breast as described above including grouped microcalcifications, skin thickening, nipple inversion, and multiple suspicious nodules seen on ultrasound for which biopsy is recommended. This can either be performed stereotactically or under ultrasound guidance. Given the relatively extensive findings, MRI should be considered as well. The findings and recommendations were discussed with patient at the time of the procedure.ASSESSMENT: BI-RADS Category 5: Highly suggestive of malignancy.
FOLLOW-UP: Biopsy should be considered.
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Hi djmammo-
First off you are a true earth Angel helping on here. Thank you.
I had another mammogram this year. Last time I had one in a different state I had to get an ultrasound on an area that was 2 to 3 cm fibroglandular tissue-which was confirmed. I didn’t have those results on a CD to Give to my breast center on this past mammogram so I have no Birads.
This recent mammogram is so very vague. I have a follow up mammogram and ultrasound in a week. The Radiologist who actually read these results called me personally to tell me I needed to come back in as soon as I could.
So vague. I have had a breast reduction about 25 years ago and I am assuming the scar tissue is getting worse. The only thing I can say for symptoms is-my right breast the nipple was itching for a while. My breast has weird looking skin on it-can see the hair follicles (at first I thought I was prego)
Can you help me with this? What is subareolar region and what does PARTLY circumscribed mean. I know what partially means. But this says partly.
Thank you for your time and all you do
COMPARISON: None.
COMPOSITION: Heterogeneously dense- this could obscure detection of small masses.
MAMMOGRAM FINDINGS: No suspicious masses, calcifications, or unexplained architectural distortion are seen in the left breast.
On the right, there is a question of a 6 mm partly circumscribed mass in the subareolar region and additional imaging is recommended.
BI-RADS 0- incomplete: Need additional imaging evaluation.
RECOMMENDATION: Additional imaging is recommended of the right breast with spot compression views as well as ultrasound if needed and/or biopsy.
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Just a small question - it’s my understanding that seeing architectural distortion in the area of an excisional biopsy is considered normal. Is it common for the radiologist to request an ultrasound when this is seen? I do also have pain and swelling in the underarm area. Perhaps it’s for that. Thank you
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Screening reports are intentionally vague when there are finings since a) the finding is often not clearly seen well enough to say more about it and b) the diagnostic exam may show that the finding wasn't real.
We are taught that if the margins of a mass are not completely seen all the way around 360 degrees we have to bring the patient back even if what is visible is smooth and benign in appearance (partially circumscribed).
Subareolar means "beneath the areola", basically behind the nipple.
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A surgical scar is one item on the list of causes of architectural distortion. If we know there has been prior surgery, either by history or by adjacent finings in the breast, we will call it a scar either in the body or perhaps just the conclusion of the report. It may just be called post-op changes and not scarring per se.
If we had no history of prior surgery, and no prior study for comparison, and there are no surgical clips or other clues, we might call someone back to make sure its a scar and not a cancer.
The other reason would be if we know its a scar but it has gotten bigger or denser since prior studies.
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