Interpreting Your Report
Comments
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"Mass with calcifications" can go either way. There are benign and malignant entities that can be described this way. More descriptors would be necessary to make the distinction between the two in a report. Biopsy would confirm it either way.
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could someone look over my US results? Lump found in early Jan/late December as I do monthly self exams. Waited to see if cycles would change the lump as I've never had one before. Family history - Mother had ovarian cancer at age 20. My mother's cousin and aunt both had breast cancer, not sure what type. My mother passed from lung cancer, non smoker, age 47.
This was done at a regional hospital and I have since been referred to a breast center where I will have new ultrasound and mammogram done tomorrow afternoon. The surgeon I was referred to “did not like the US came from a outpatient hospital setting". She said larger lump is not concerning but smaller one is. Both are very palpable.
At the 12 o'clock axis there is an oval, solid,hypoechoic nodule without internal vascularity. It measures 8x16x12 mm in size, longer and wider than height.
At the 2 o'clock axis there is a hypoechoic nodule with posterior acoustic shadowing. This is smaller measuring 3x6x6 in size and wider than its height. It is a vascular as well.
Impression: the patient has 2 small solid nodules in right breast, described above. These are likely to benign adenomas given their features and patients young age.
However, the smaller of the 2 is somewhat heterogeneous and does exhibit posterior acoustal shadowing. Although I do believe that this module has high probability of being benign I would recommend 6 month follow up sonogram to ensure this is stable over time.
I know there are good signs and not so good signs in that right?
Thanks everyone !
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Hi,
I am trying not to jump to conclusions before I get the biopsy results on Thursday BUT my report has more of the "bad" terms than good. Please explain my report in "simple terms".
FINDINGS: There are scattered fibroglandular elements noted. There is no suspicious mass, architectural distortion or suspicious calcification in the right breast. An irregular mass is noted in the upper outer left breast in the patients area of concern. There are associated microcalcifications. Prominent appearing left axillary lymph nodes are noted on the MLO view.
Targeted left breast ultrasound was performed. At 2 o'clock N11 in the left breast there is a 3.6x2.0x3.0 cm irregular hypoechoic mass. Internal vascularity is noted within the mass. 6 mm superior and lateral to the mass there is an additional 0.7x0.9x0.7 cm irregular hypoechoic mass concerning for a satellite lesion. Targeted ultrasound of the left axilla demonstrates a 2 cm lymph node with complete effacement of the fatty hilum. The cortex measures up to 7 mm in thickness.
IMPRESSION:
Highly suspicious left breast mass with closely adjacent sub-centimeter mass concerning for a satellite lesion. Ultrasound guided core biopsy of the larger primary mass is recommended.
Suspicious left axillary lymph node concerning for matastic disease. Ultrasound guided core biopsy of this left axillary node can be performed if clinically desired.
BRIADS FIVE
BREAST TISSUE DENSITY B
Thank you for any help you can give
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The fact that your nodules are avascular (no internal blood flow) and that they are wider than tall (long axis parallel to the chest wall) is good as these are features of benign fibroadenomas (FA's) and I am guessing that these features are why they are willing to look at it again in 6 months to check for interval growth rather than biopsy them. Even if benign, if FA's are fast growing most surgeons would recommend removal. Let us know what the new imaging studies show.
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Simply put this is an abnormal report. The description of the left breast mass suggests this is a cancer, with an adjacent smaller cancer. The description of the lymph node suggests it has already spread outside the breast. They will want to biopsy the larger mass and the node. At some point after that I would expect them to remove both masses and the lymph node at surgery. Depending upon the type of cancer found, there may be radiation and/or chemotherapy to follow.
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djmammo,
Thank you for the clarification.
I could feel the lump in my breast and knew it was not good when my doctor changed from the screening mammogram to the diagnostic. I saw the doctor on Thursday, the 22nd. She also scheduled an appointment with a breast specialist for the 1st. After the mammogram, I was told to wait to have an ultrasound. The tech told me to wait to talk to the radiologist. The radiologist told me she was going to see if I could see the breast specialist that day; that I should not wait until the appointment on the 1st. I saw the breast specialist and she scheduled the biopsy (and it was done) the next day. I have an appointment on the 1st to get the results from the biopsy.
I am 53 with no family history of breast cancer. My mother's side of the family (mother, maternal grandmother and grandfather and uncle) had different types of cancer (colon, pancreatic, esophageal). I am anxious, nervous, scared.....but I want to be prepared for whatever the outcome may be.
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Over 70% of patients who develop breast cancer have no family history of breast cancer. Having family members with other cancers however can increase one's risk as described in this article:
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Thank you, djmammo! The more info I get, the calmer I feel. Whether it is good news or not.
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Well, we are still in limbo! We got the biopsy results but it says, "The histologic findings and the imaging findings are potentially discordant. Consultation with a breast surgeon and or other appropriate medical specialist is recommended for a evaluation and possible surgical biopsy." My doctor said that, basically, the biopsy doesn't match the diagnostic mammogram and sonogram findings. I have an appointment with Dr. DeWing, breast surgeon/oncology, on Monday early to see what's next!
What does this mean to you? Do you think that they are thinking it’s cancer and since the biopsy doesn’t match we need to look again! This has me even more concerned! The sonagram wording is above in my previous post.
Thanks
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Its a little wordy, bear with me.
A biopsy result is said to be concordant when the result from path matches the appearance of the abnormality on imaging either benign/benign or malignant/malignant. A biopsy result is discordant if it looked benign on imaging and came back malignant on pathology, or it looked malignant on imaging and the path result came back benign. Yours I assume is the latter. In the report of the biopsy procedure look for a comment on marker placement. Did the marker they placed at biopsy match exactly the location of the abnormality on mammogram and US? If they matched it is more likely than not that the biopsy was performed on the correct finding. If they did not correlate then the odds of it being a good biopsy go down.
If I remember correctly your findings were a bit vague, no convincing mass but areas or shadowing or distortion yes?There are two possibilities for this scenario. One is: the first impression of the imaging was wrong and it really is benign. The other is: it really is a cancer but it was not properly sampled. So at this point the question is what exactly did the path report say? Was it vague like "cores contain normal appearing breast tissue without suspicious features" or more definite like "cores show portions of a benign fibroadenoma" or other specifically named benign entity? If it is a description of some non-specific normal breast tissue there are a few procedural options: re-biopsy, or surgical excision for diagnosis. Sounds like the are contemplating an excisional biopsy which is perfectly reasonable in this setting.
I don't recall if you had an MRI. If you didn't it might be time to have one. If you did have one, and it showed something abnormal, an MRI guided biopsy might be next. It will show the marker placed at biopsy and you can see its relation to any abnormal finding on the MRI images which will be of additional help in deciding concordance. If you had an MRI and it was completely negative then maybe the biopsy really is benign.
I know that's a lot to digest but there are many things to consider here and this is a decision matrix used every day in a breast imaging practice.
Let us know what happens next for you.
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The original wording on my diagnostic mammo/ultrasound was:
Sonography:
"Sonographic examination of the right outer breast demonstrates a focus of hypoechoic, shadowing breast parenchyma, measuring 2.5 cm, I'll-defined, with possible associated architectural distortion."opinion:
"Focus of Sonographically abnormal breast parenchyma at the 9-o'clock position of the right breast, 12 cm from the nipple, with I'll-defined margins and posterior acoustical shadowing, in the region of vaguely increased breast parenchyma density..."The biopsy report says:
Pathology demonstrated remote hyalinized fat necrosis (3-4 mm) within fibrofatty tissue. No breast ducts or lobules and no calcifications present.
The histologic findings and the imaging findings are potentially discordant. Consultation with a breast surgeon and/or other appropriate medical specialist is recommended for evaluation and possible excisionsl biopsy.
It did say below all that in the supplemental info:
Prescription history: Breast mass, Abnormal mammogram
Supplemental history: Right breast mass at the 9 o’clock position, 12 cm from the nipple
Comparison; Right diagnostic mammogram and ultrasound 2/14/18
Technique: US Breast core biopsy Rt, Mammography digital Rt clip placement with cad
It says Uktrasound-guided of the right breast mass was performed. A total of 8 passes were performed with a 14-gauge Bard Biopsy needle. Somewhat fragmented samples were obtained. Each pass was noted to traverse the lesion, as indicated on stored Sonographic images.
Impression:
1. Technically successful US-guided right breast mas core biopsy
2. Post biopsy mammogram shows the biopsy clip to be in place and no immediate complicating
3. Pathology results pending
Your thoughts? Thanks...sorry so long! Am I correct in that I was expecting benign or malignant, and I got neither?
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"...remote hyalinized fat necrosis (3-4 mm) within fibrofatty tissue. No breast ducts or lobules and no calcifications present."
These findings are benign, but if cancer was suspected, then these findings are discordant. No glandular breast tissue is mentioned in this report only fat and fibrous tissue surrounding the fat necrosis.
Fat necrosis develops following surgery or other kind of injury that physically disrupts the breast tissue. Did you have any prior procedures or remember any trauma to this breast in the remote past? The area of fat necrosis is only 4mm so if the finding on imaging is larger than 4mm then it doesn't explain what is seen on imaging and would be discordant.
Let us know what the excisional biopsy shows.
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hi djmammo,
I have a question my biopsy report say nuclear grade 3, solid and cribform types with focal central necrosis and Microcalcifications.
Shouldn't there be another word besides necrosis? And solid and cribform? Not sure what that means.
Also I am ER+ 90% and PR + 90%. What does the 90% mean.
And Why is there no mention of HER testing? Is that not routine?
Thank you!
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The only “trauma” was the diagnostic mammogram! When she used the small plates with compression, it really hurt and has been hurting since (but less). The biopsy was a week later. I’ve had no other procedures on this breast.
I will definitely let you on the excisional biopsy...
Thanks
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Being a diagnostic radiologist those kinds of details from a pathology report are outside my area of expertise. I do know that more details will be available from additional tests done on the lumpectomy specimen. That may contain the additional info you are looking for.
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Djmammo, that’s ok. Thanks for responding. You are a valuable asset to us woman. Bless you for taking time to do what you do.
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djmammo, The following is my US findings. Please let me know if I have anything to worry about. The part that concerns me is the part labeled A. I think it is just a cyst, but it has some of the terminology you said is bad. They marked this Bi Rad 4 and have scheduled me for a US core biopsy on March 7.
ULTRASOUND FINDINGS: Targeted ultrasound of the posterior upper outer right breast at the 10:30 position 10 cm from the nipple in the area of reported palpable abnormality demonstrates homogeneous fatty tissue without focal mass or other significant finding. At the 9:30 position 1 cm from the nipple, there is a parallel hypoechoic mass with microlobulated margins that measures 7.2 x 3.0 x 6.6 mm, labeled A. This appears to be intraductal. There is some associated vascularity along the periphery and possibly internally. There is an immediately adjacent parallel, oval mixed echogenicity mass labeled B at measures 6.8 x 2.6 x 5.8 mm. There is no internal vascularity. There are some questionable internal anechoic spaces. At the 1:30 position 7 cm from the nipple, there is an 8 mm microcyst cluster. At the 2:00 position 7 cm from the nipple, there is a 6 x 2 x 5 mm cyst cluster. At the 1:30 position 5 cm from the nipple, there is a 7 x 2 x 5 mm anechoic cyst. There is a subcentimeter cluster of anechoic cysts at the 9:00 position 3 cm from the nipple in the right breast.
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Rjmjt120,
Your pathology report is pretty standard for DCIS.
Solid and cribiform are subtypes of DCIS.
Necrosis refers to debris from cells that have died, and suggests a faster growing cancer, consistent with the grade 3 assessment.
The 90% for ER and PR means that of every 100 cells in the sample tested, 90 (i.e. 90%) have estrogen and progesterone receptors.
HER2 testing is not normally done on DCIS.
http://breast-cancer.ca/dcis-grypes/
I'd suggest you drop by the DCIS forum on this discussion board if you have other questions about your DCIS.
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"A" is described as being in a duct so it could be a papilloma which would need to be removed after the biopsy, benign or not. "B" is not described well enough to hazard a guess. The rest sound like cysts. I assume they will be biopsying both A and B.
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djmammo, yes they are biopsying both A & B. I will post the results when I receive them. Thank you for your help.
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thanks so much Bessie!
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Please help intepretting the following: had the following year over year result, what might that mean...
Oct 2016: the breasts are composed of scattered fibroglandular tissue. there is a small low-density nodule in the axillary tail of the right breast of the MLO view which is ovoid in shape measuring up to 7 mm which has the appearance of a benign intramammary lymph node.
now fast forward to Feb 2018 and this is what the report says:
the breasts are composed of heterogenous fibroglandular tissue. In the posterior lateral right breast above the nipple line on the MLO view there is a nodular asymmetry. there is an additional 1 view nodular asymmetry in the mid central right breast on the CC view which cannot be delineated on the MLO imaging. These nodular asymmetries are most conspicuous on tomosynthesis.
I am now going for a diagnostic mammogram w/US March 29, that was the earliest they could get me in... do I need to worry and push to get in sooner?? thanks for any help.
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Did the person reading your recent study have your old study in their possession when they read it? If they didn't these two studies need to be compared to see if they are talking about the same finding as they use different descriptions of location. If they did have them, there is no mention that the studies were compared.
Give them a call and ask them these questions to make sure.
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Thanks djmammo, yes they had both studies as they were done at the same place and they do mention the comparison at the very beginning of the report. I only copied the right breast section of the report as in both the left are normal... thoughts?
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no that is all I have....
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Hello djmammo,
I am so glad I found your post! Can you please tell me your thoughts on my ultrasound report when you have a chance. I did a lot of research and I found good and bad and have been really worrying.
Findings: In the region of the patient's mammographic density, 4 cm from the nipple 1 o'clock position, there is a hypoechoic nodule measure 10mm. It has increased through transmission. There is some irregularity associated with its rim and vascularity is demonstrated on Doppler analysis.
Impression: Hypoechoic nodule correlates with the patient's mammographic density. Although for the most part it has benign features, there is some irregularity to the rim of this lesion and there is some vascularity seen on Doppler ultrasound. Surgical consultation and biopsy is recommended. BI-RADS 4
Thank you very much!!
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hello, im 31 andI’m scheduled for biopsy on 3/12/18 but was hoping for some help interpreting my radiology report from my mammogram and ultrasound a few days ago after finding a non painful lump in my breast.
Focused ultrasound of the right breast at 4oclock 3cm from the nipple middle depth demonstrates a 1.2 x 0.7 x 1.1cm oval shaped hypoechoic mass with circumscribed margins. There is no significant internal vascularity. The mass is oriented parallel to the skin and demonstrates partial shadowing and possible ductal extension. Birads 4
Any info is greatly appreciated! Thank you
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Hi there! I'm new to all of this, and of course scared.
I've heard that mammograms and breast US are best if looked at side-by-side, so I would like to post my latest one and then send you the other 2 for comparison. I would be ever so grateful for any information that you may be able to provide as my new PCP hasn't been very helpful to try and explain it to me. It all started when I noticed what seemed like lumps along the sides of my breasts. At that time my PCP checked me and felt lumps as well. She sent me in to get a diagnostic mammogram and US in Nov 2016. Both came back negative and said to come back after age 40 (I was 30). Fast forward to March of 2017 where I received a Bone Density Scan to see if a tumor in my sternum was benign (so far so good) but during that test it showed a mass in my left breast. That's when I had a Dx Mam & US. Mamm was negative but US picked up a swollen lymph node?? They told me not to worry and to go back in 6 months. Unfortunately I had a change in insurance so I didn't make it to my 6 mos but just had a dx mamm done a little over a week ago that came back negative. I am now waiting to be scheduled for an US. I'm worried and scared of what i do not understand. I would appreciate any help that I can receive. Thank you so much!
Left Diagnostic Digital Mammogram: February 23, 2018 - Accession#:
15MA20180016385
PRIOR STUDY COMPARISON: April 25, 2017, bilateral diagnostic digital mammogram
performed at
Adventist Health Glendale. November 16, 2016, bilateral diagnostic digital mammogram
VIEWS
Spot compression CC, spot compression MLO, MLO, and CC view(s) were taken of the
left breast
FINDINGS There are scattered fibroglandular densities. There are no masses, calcifications, or
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Hi xoJennyPennyxo,
You may want to post your mammogram repor so that Djmammo may assist you in interpreting what it means. Praying that your upcoming tests will result in b9 findings.
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