Interpreting Your Report
Comments
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So the papilloma was found on the biopsy recommended in the report you posted? It is not clear the way this information was posted.
Papillomas are all removed. We usually biopsy them before they are removed. There are some surgeons that prefer to remove them without the biopsy first but either way they are removed.
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Thank you so much for your reply. I feel fairly confident the ultrasound will be fine.
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Thanks djmammo, The MRI seems more cautious.
HISTORY: Suspicious findings on recent diagnostic mammogram and ultrasound for which biopsy was recommended.
TECHNIQUE: Precontrast images include axial T2 and STIR images. Fat-suppressed, subtracted axial images were obtained in a dynamic fashion at 1-minute intervals out to 5 minutes. An additional sagittal 3D slab sequence was obtained. The data was reviewed with CAD analysis. The patient was injected with 20 cc of Dotarem from a 20 cc single-use vial.
COMPARISON: Diagnostic mammogram and ultrasound done 2/3/2020
FINDINGS:
The breasts are composed of heterogeneous fibroglandular tissue.There is mild background parenchymal enhancement bilaterally.
Right: There is extensive stippled nonmass enhancement of the entire lower outer breast measuring at least 7.3 x 10 cm with extension to the nipple, which corresponds to the abnormal microcalcifications seen mammographically. The palpable right breast lump in the 6 o'clock position is visualized and measures 3.5 x 2.3 x 3.2 cm seen on series 602 image 80 and series 7 image 118. There is a similar smaller area of abnormal nonmass enhancement in the upper outer breast measuring 1.5 x 0.8 cm, located 2.8 cm away from the most superior aspect of the index area (series 7 image 125), this corresponds to a mass seen sonographically in the 11 o'clock position, 7 cm from the nipple. There is a single prominent lymph node in the axilla seen on series 603 image 34 with thickened cortex. There is diffuse skin thickening with enhancement, especially near the areola.
Left: No suspicious enhancing mass or nonmass enhancement. No adenopathy.
IMPRESSION:
1. Extensive abnormal enhancement mainly involving the lower outer right breast with an additional area in the upper outer quadrant. There is skin and nipple enhancement suggesting involvement.
2. Prominent right axillary lymph node.
3. No suspicious left breast finding.ASSESSMENT: BI-RADS Category 4: Suspicious findings.
FOLLOW-UP: Biopsy should be considered.
RECOMMENDATION: Ultrasound-guided needle biopsies of the palpable mass in the right breast 6 o'clock position as well as the 11 o'clock lesion seen on previous sonogram. Repeat right axillary ultrasound can be performed at the time of the biopsies.
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The combination of all the findings makes this all very suspicious. I have seen something similar in the past that on biopsy turned out to be a less common subtype of DCIS. Since DCIS usually does not spread to the nodes, there may be an element of IDC somewhere in there. Let us know what the biopsy shows.
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Thanks
will do!!
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Yes, the papilloma was found on the biopsy. It was not suspected during the ultrasound. The radiologist thought it was a fibroadenoma containing cysts. He was rather unconcerned about it. My breast specialist followed up with me today and said everything came back benign and the entire path report looks great. I am going in for an appointment to get all of the information, though, and discuss possibly removing the papilloma. She was concerned at the fact that it was 2.2 cm - but my husband and I definitely think that was a typo. I realize this is all great news, and I'm thankful for that. It's just so confusing, but I will have more answers next week. I just wish my breast would stop making these lumps and freaking me out!
Thanks for the insights you provide here and your time.
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Intial results have come back with
Pathologic analysis of the tissue obtained at 6 o'clock anterior shows:
Moderately differentiated invasive duct carcinoma and ductal carcinoma in situ.Pathologic analysis of the tissue obtained at 11 o'clock shows:
Moderately differentiated invasive duct carcinoma.Will see what my surgeon has to say when i see him next week
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Most of the breast surgeons I have worked with would get a pre-op MRI at this point to plan the next step.
Here is a downloadable booklet on BC care and management that may help:
https://www.cancer.net/sites/cancer.net/files/asco_answers_guide_breast.pdf
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Hi Djmammo. Thanks for all you do on this forum. Thoughts on my breast MRI? Biopsy this Wednesday. My last post details my history up until now, but the sparknotes anyway are Jan 15 4"x5" red area, veiny, hard to touch, hot to touch at 10 o'clock. Core biopsies at 10 o'clock said PASH, stromal fibrosis, and microcalcifications.
US showing mainly numerous cysts, then mammo x 10, then 10 o'clock biopsy, then mammo x 12 to check mainly numerous microcalcifications, then MRI. Next biopsy Wednesday for 3 o'clock suspicious mass.
Note: it says last period over 2 years, but I do spot, but have had Mirena IUD for 3 years. I'm 31 and maternal grandma and great aunt dx BC in 40's.
Looking forward to biopsy report, but concerned about this report beyond the mass to be biopsied? But maybe the report beyond the mass is more normal than I’m thinking?
FINAL REPORT
2/12/2020 bilateral breast MRI
Clinical statement: New onset breast erythema and edema, recent negative mammogram and ultrasound
reported last menstrual period: greater than 2 years
Technique: Equipment: GE Discovery MR750w 3.0T (MSKHAR Room 1826) 8 channel breast coil
Sequence: axial acquisitions T1- and T2-weighted sequences; without and with fat suppression; without IV contrast and with multiphase post contrast. Post processing: multiplanar and subtraction reconstructions 3D MIP performed on acquisition scanner.
Comparison: none
Findings:
Breasts: Extreme fibroglandular tissue with marked parenchymal enhancement.
Right breast: within the right breast 3:00 axis anterior third depth there is a slightly irregular heterogeneously enhancing mass measuring 0.7xm x 0.7cm. Scattered areas of patchy mass and non mass enhancement within right breast without a additional common finding.
Left breast: no suspicious finding. Scattered areas of patchy mass and non mass enhancement without a dominant suspicious finding.Other: none
Impression: indeterminate mass within the right breast 3:00 axis for which a second look ultrasound is recommended to perform a biopsy under sonographic guidance. If no sonographic correlate is seen, recommend an MRI guided biopsy. These may be scheduled on the same day.
Probably benign patchy mass and non mass enhancement bilaterally for which a six-month follow-up MRI is recommended for stability as this is the patient’s baseline.BIRADS: 4- suspicious
Recommend right breast biopsy
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General question - I have been diagnosed with ALH so I am on 6 month Mammo/6 month MRI rotation due to high risk. Next MRI April 2020. What is the best MRI machine to request or search around for when getting a breast MRI? I live in Washington DC metro area and would like to go to a progressive location with good MRI equipment.
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CasM,
I have heard the Washington Radiology has the best equipment and people. Also, if you drive up to Baltimore, Johns Hopkins Green Spring Station.
Good luck!
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Looks like they are only concerned about that one spot to biopsy. The rest they just want a 6 month follow up.
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HI djmammo. I got a BI-RADS 0 on diagnostic mammo and will need an MRI. Was hoping you could chime in on this from my mammo report:
"Post-therapeutic changes noted within the left breast. Grouped calcifications are noted within the lumpectomy scar site in the upper-outer left breast. Magnification views demonstrate these calcifications to have a punctate morphology located at the lumpectomy scar site measuring up to 2 cm. It is unclear if these calcifications are new, and may be related to postsurgical fat necrosis or are residual calcifications from patient's known DCIS."
Recommendation was not to proceed with ultrasound and instead have MRI for further eval.
I guess my questions is - on mammo, do calcifications related to fat necrosis closely resemble microcalcs that indicate DCIS? I thought ultrasound could be used to identify fat necrosis so I wasn't sure why she abandoned it in favor of MRI.
Thanks for any help you can offer! MM
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Thanks DJ. I am not sure what machine my previous MRI but I am using the same company just not the same facility or machine. I wanted to go with a 3T because I vaguely remembering you mentioning it once before in a previous post.
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Thanks SimoneRC. I will check out Washington Radiology, they have done a few of my 3D mammos.
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"...on mammo, do calcifications related to fat necrosis closely resemble microcalcs that indicate DCIS? I thought ultrasound could be used to identify fat necrosis so I wasn't sure why she abandoned it in favor of MRI"
Calcs related to fat necrosis can look suspicious very early on in their formation. They later take on the classic curvilinear "eggshell" kind of calcification.
I would really not consider US to diagnose fat necrosis, it does however have a classic appearance on MRI which can look suspicious to the untrained eye.
If it were me, I would pull out all your mammograms of that breast and carefully assess and count the number and appearance of the calcs in that area before and after surgery as well as the wire localization films and the specimen radiograph taken at the time of the lumpectomy. One needs to try to account for all of them before assuming which are old and which are new.
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I want to thank DJMammo for all that he does for this board. He is a blessing. I got my biopsy report today. It is benign!!! She said it is scar tissue from radiation. I dont have the correct terminology as I dont have the report in front of me. Thanks again for all you do.0
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Yes I agree with all the appreciation for DJmammo! Thanks for helping us out and giving some peace of mind
I’ve made an appointment w my breast surgeon to review all the old imaging and film. Hope mine is just scar tissue too!
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Here’s my report from my ultrasound I had Tuesday. The words architectural distortion concern me. I had a biopsy for calcification 22 years ago
A repeat ultrasound was performed
of the upper right breast at the 12 o'clock position. A
surgical scar and some architectural distortion is present at this site. In the scar,
there is a 1.3 cm in maximal diameter nodule and tiny cyst. This is thought to be benign
change from the prio
r surgery but can be biopsied with ultrasound if clinically indicated.
ASSESSMENT: PROBABLY BENIGN (BI
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RAD3)
RECOMMENDATION:
Surgical evaluation of the right breast . Keep follow up appointment with Dr. B. Landry.
If not biopsied, a six month follow u
p ultrasound is recommended.
Follow
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up diagnostic mammogram of the right breast in 6 months to re
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evaluate for
stability.
Risk Value(s):
Myriad Table: 1.5%, GAIL 5 Year: 3.5%, NCI Lifetime: 15.0
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20
REASON FOR EXAM: clinical finding. RT MEDIAL BREAST LUMP FOUND BY MILEK
Last mammogram was performed 1 year and 2 months ago.
MAMMOGRAM BILAT DIGITAL
DBT
3D Procedure
3D Bilateral CC and MLO view(s) were taken.
2D Synthetic Bilateral CC and MLO view(s) were taken.
Technologist: Brookes F. Borne, RT(R)(M)
Prior study comparison: November 20, 2018, bilateral mammogram screen digital performed at
Thibod
aux Regional Medical Center . November 17, 2017, bilateral mammogram screen
digital performed at Thibodaux Regional Medical Center .
The breast tissue is heterogeneously dense. This may lower the sensitivity of mammography.
No new masses or malignant ty
pe calcifications are identified. Specifically, no changes
are identified in the region of concern in the medial right breas
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the mammo showed no change from the one done 14 months before and that I have dense breast
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Dear DJmammo,
I had previously asked a question on my breast mri more than one year after implant reconstruction that stated (on the prophylactic non cancer side) “focus of magnetic susceptibility artifact medial to the upper portion of the implant which may represent a surgical clip.”
Surgicsl notes do not indicate a clip but I hadn’t thought any more about it until I saw my oncologist today and she said that’s just how the radiologist refers to anything they see but she’s not convinced it’s not a lump and is making me go see the breast surgeon.
In your experience, is the language “magnetic susceptibility artifact” usually specific to something that is clearly an artifact and not an anatomical abnormality?
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"...she said that's just how the radiologist refers to anything they see but she's not convinced it's not a lump"
That explanation makes no sense at all. No radiologist would say that.
In your experience, is the language "magnetic susceptibility artifact" usually specific to something that is clearly an artifact and not an anatomical abnormality?
Not by experience, by definition.
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Hi Djmammo, I was wondering if you could help explain an old path report I have from 2007 ( after having a recent biopsy, I remembered I had a copy of a previous biopsy and wanted to see what it said out of curiosity-this was found after I had my first daughter in 2005-we decided to watch it and by 2007 we removed it. Was told it was a Fibroadenoma). Thank you!
Surgery date: 6/29/07
Submitted as “”Breast Left Breast Mass”
-Nodular portion (2.4 cm) of Benign Breast tissue showing:
-Focal microscopic Fibroadenoma (0.4cm).
-Stromal Fibrous Changes.
-Rare focus of duct ectasia with sclerosis and associated microcalcification.
-No malignancy is identified.
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My questions are: what does rare duct extasia mean? Also, I don’t understand the sclerosis part? Is this related to the duct ectasia or is this like the sclerosis that could be related to increased BC risk?
Thank you
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Not a pathologist but I'll do my best.
Ectasia means dilatation. In path-speak when looking at something under a microscope "rare" refers to the number of things seen. It means only a very few of these dilated ducts were seen. The range goes from "rare" to "too-numerous-to-count".
The phrase "sclerosis and associated microcalcification" may refer to sclerosing adenosis but I can't be sure.
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Thank you for your insight. I'm going to bring it to my breast surgeon to see what she thinks also. Maybe the terminology was a little different back in 2007? Would this be something I should ask/be concerned about
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Hi djmammo,
I'm emotionally torturing myself for going through with what turned out to be a needless excisional biopsy since the results were benign. Of course I'm happy that the results were benign, but I'm unhappy with what looks like will likely be a scar for life and I think the breast that was operated on now looks slightly smaller to me. I was already an A cup to begin with, so smaller is upsetting to me. I should have asked in this thread before doing the excisional biopsy, but I'm still torturing myself wondering if I did the right thing rather than choosing the option to watch and see for 6 months. So based on this, did I do the right thing in getting the excisional biopsy? This was the original screening results:
ULTRASOUND:
TECHNIQUE: A bilateral breast ultrasound was performed with complete evaluation of the four quadrants, retroareolar regions, and axillae.
FINDINGS:
In the right 9 o'clock periareolar region there is a 9 mm lobulated hypoechoic nodule with an irregular anterior margin.
Complicated cysts are seen in the right breast at 12 o'clock-N 2, 12 o'clock-N2, left breast 1 o'clock-N1, left breast 2 o'clock-N5, 2 o'clock-N5.
IMPRESSION:
1. There are no mammographic abnormalities.
2. Sonography demonstrates complicated cysts. In the right 9 o'clock periareolar region there is a new 9 mm solid lobulated hypoechoic nodule with an irregular anterior margin. An ultrasound-guided needle core biopsy is recommended for pathologic assessment.
FOLLOW-UP: Ultrasound guided biopsy.
ASSESSMENT: BI-RADS Category 4: Suspicious.I did the ultrasound guided biopsy, it was extremely easy, and was hoping that would be the end of it. The radiologist said the nodule was moving around and seemed to be definitely acting benign according to him, but he just needed to prove that it was benign with pathology results. The technician helping him thought that the only reason they recommended a biopsy was because of my family history (my mother was diagnosed with breast cancer at 48 and I'm 45) and that it looked benign to her too. Then 8 days later these were the results I got:
BREAST SURGICAL PATHOLOGY ADDENDUM:
-Benign fibrofatty breast
Pathology results indicate that the specimen is benign.
The pathology results are discordant with the imaging.
Surgical excisional biopsy is recommended.Shocking to me that they would suggest an excisional biopsy when the radiologist was so sure it was benign and these results even say benign findings. Is "benign fibrofatty breast" not a legitimate reason for seeing a suspicious nodule on an ultrasound, thus rendering the results discordant? I tried calling the radiologist, but he never called me back.
I wound up getting an appointment with a surgeon pretty fast and got the excisional biopsy soon thereafter, so I didn't have much time for a 2nd opinion, and I also wasn't thinking entirely clearly since I was afraid of cancer, and was going through a major amount of anxiety for a month over this at this point and had a lot of trouble functioning at all due to anxiety. The surgeon too thought it was very likely benign, but for some reason wanted to remove it. I'm not sure I got a sufficient answer as to why.
The final pathology findings after the excisional biopsy were:
Fibroadenomotoid Nodule (0.5 CM)
Pseudoangiomatous stromal hyperplasia (PASH)
Fibroadnomatoid Changes
Fibrocystic changes
All benign findings. So obviously in hind site, I could have just watched it and waited 6 months, but instead I took the doctor's advice and removed it to make sure it wasn't cancer. I'm not sure if I should feel deep regret here that I spent thousands of dollars on this procedure and also have scarred myself for not an amazing reason, or relieved that it's not cancer, or a little bit of both. I'm afraid this is just going to continually happen. It was my 2nd screening post 40, and for both I needed a biopsy. For the first one though 2 years ago, the stereotactic needle biopsy came back benign and also concordant, so I didn't need an excisional biopsy that time. That time it was for suspicious micro-calcifications in an entirely different area of the same side. Given that my mother had breast cancer at close to my age, I suppose I'm considered high risk and definitely fear that breast cancer might be in my future, but my question is, did I make the right choice going through with the excisional biopsy based on the above results? I really don't want to continually go through excisional biopsies needlessly until there is nothing left to biopsy. I'm hoping once it heals more I'll be less freaked out by what I did.
thanks!
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I'm not djmammo (clearly) but I will say you made the most informed decision you could at the time. You could always flip this situation in your head: what if you hadn't done the excisional biopsy and in fact it was cancer? Then you'd beat yourself up for not acting.
So this complete internet stranger says extend some grace to yourself and stop beating yourself up. You made the best decision you could at the time.
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