Interpreting Your Report
Comments
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My training is in diagnostic radiology and not pathology. I have a good understanding of the path that comes back on image guided biopsies but I have no training that will help you interpreting reports with this kind of detail. My apologies.
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I have my biopsy tomorrow and just received my mammo/US report. First mammo ever due to right breast pain and dark nonspontaneous discharge. I am a prepare for the worst and hope for the best person so any insight you can provide would be much appreciated!!
Imaging Report:
PARENCHYMAL PATTERN: The breasts are heterogeneously dense, which may obscure small masses.
FINDINGS: There are benign-appearing punctate and layering calcifications bilaterally. No suspicious morphology or distribution. There Is a 1.4 cm equal density circumscribed oval mass in the lower central right breast. Targeted bilateral ultrasound performed to evaluate the aforementioned clinical findings and right mammographic finding. At the right breast 6:00 position 4 cm from the nipple, there Is a 1.4 x 0.5 x 1.2 cm oval hypoecholc parallel mass with predominately circumscribed margins, no internal vascularlty or posterior shadowing. At right breast 5:30 position 2 cm from the nipple, there is a probable cluster of cysts measuring 0.6 x 0.3 x 1 cm. Evaluation the retroareolar right breast demonstrates normal breast tissue without suspicious intraductal or parenchymal masses.
Evaluation of the retroareolar left breast demonstrates normal breast tissue without suspicious lntraductal or parenchymal masses.
IMPRESSION:
1. Indeterminate 1.4 cm mass at right breast 6:00 position 4 cm from the nipple, for which ultrasound-guided biopsy Is recommended for further evaluation.
2. Probable benign right breast mass, possibly representing a cluster of cyst.s, at right breast 5:30 position 2 cm from the nipple, for which six-month follow-up is recommended pending aforementioned biopsy results.
BIRADS CATEGORY 04-SUSPICIOUS FINDING: Biopsy Should Be Considered
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what significance is there to the qualifier of "predominantly" circumscribed? Also, does size have any impact on the probability of benign mass?
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"What significance is there to the qualifier of "predominantly" circumscribed? "
Better than irregular, not as good as completely circumscribed.
"Also, does size have any impact on the probability of benign mass?"
Size doesn't matter, shape does.
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Hello,
You helped me a few weeks ago with my mammo results, and I had the biopsy and it came back as "consistent with a fibroadenoma." However, this was written on the radiologist's report from the mammo:
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
I have an appointment March 10 for the tomosynthesis. Can you please explain what the above means? And, will the tomosynthesis reveal if the new lesion is cancer or a fibroadenoma? Or would I still need a biopsy to confirm either?
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The purpose of the clip is to prove that what was biopsied, is the same as the thing that was seen on imaging. So after the clip is placed, all the images are compared and we look to see that the clip is inside or at least right next to the original finding. It sounds like they need a few more images to make sure of that.
If the clip is somewhere different than the original finding then there were actually two masses present and you will need a second biopsy.
Are your reports already posted somewhere here in the forum? I'd need to review them.
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Thank you, djmammo for getting back to me so quickly. I will post the mammo results here so that you don't have to go back to check for them....sorry that it is a little long.
CLINICAL INDICATIONS: S6-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 questionabl e 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 a n 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 th e right lesion although it is hard to tell with certainty as the lesion was breast appreciated on the MLO view and that only a late ral 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 bre ast to assess clip position in respect to the newly seen lesion on mammogram. This can be done on the same day as the next v isit with the surgeon for the biopsy result. This will have to be arranged by the treating surgeon.
BI-RADS IVB
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Sounds like they just want to document clip placement, a requirement for MQSA. They don't sound concerned in that report.
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I’ve been thinking about this come back in 6 months to recheck Recommendation that lots seem to get. What can actually change in say a nodule that they say is probably benign. It seems like such a short amount of time. Doesn’t most cancer grow very slowely
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What can actually change in say a nodule that they say is probably benign?
If we feel its benign (B3) the purpose of the followup is to show that there is no change, that its stable over time.
It seems like such a short amount of time. Doesn't most cancer grow very slowly?
We count on the fact that most cancers are slow growing. 6 months is long enough to show a change in appearance in something that might be a cancer, but short enough that any change that occured would not affect the overall prognosis.
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HI djmammo, thank you for your help. I really, really appreciate it.
Mudstick, I am so sorry you have a recurrence ((((HUGS))))
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thanks for explaining that to me
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djmammo thank you for all the information you've provided in the past. I did move forward with the excisional biopsy per my surgeon's recommendation. She called to inform me that is was DCIS, so I'm glad I didn't wait. I will meet with her on 3/5/20 for additional information and to discuss treatment. You're help has truly been appreciated
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Hi djmammo
I'm posting for my sister. She just had her first mammogram at the age of 40and is worried about the results. They would like her to come in for an ultrasound. We just found out about a year ago that our paternal grandmother was diagnosed with breast cancer at the age of 40. No other breast cancer history in the family that we know of. Here is her mammogram report.
Bilateral CC and MLO with tomosynthesis and bilateral exaggerated CC views were obtained. This is a baseline exam. The breast parenchyma is composed of heterogeneously dense fibroglandular tissue.
A 14 mm lobular mass in the 1-2:00 position on the right breast is identified at 7 cm from the nipple. In the medial left breast on the CC view there is 10 mm elongated asymmetry 6 cm from the nipple, thought to be localized superiorly based on the tomosynthesis images making this 10:00 position. No areas of architectural distortion or suspicious microcalcifications are seen.
Impressions:
1. Right breast: 14 mm lobular mass in the 1 to 2:00 position at 7 cm from the nipple. Recommended further evaluation with ultrasound.
2. Left breast: 10 mm elongated asymmetry at the 10:00 position 6 cm from the nipple for which further evaluation for targeted ultrasound recommended.
3. BI-RADS category 0 bilaterally. Incomplete. Need additional imaging evaluation.
Any help with this is appreciated!
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Hi,
Is there anyone who can answer questions about pet scans? Besides radiation pneumonitis it states “several small mediastinal lymph notes without abnormal FDG activity, likely reactive." “Patchy sub pleural opaciities in the anterior right lung with moderate FDG activity, likely representing changes of radiation pneumonitis. I had this done due to rib pain and now on the2nd scan it lists diminished right fifth rib uptake suggest healing nondisplaced fracture. There seem to be a lot of uncertainties and also there were irregularities in the procedure itself in that the technician wrote down my glucose level on the report but they never tested it before the injection. The injection syringe had at least a third of a clear gel inside when it was removed. Should I be worried this could have impacted the results? Should I get a second opinion? The doctor suggested a repeat of the test in six months.
I am also experiencing a very itchy neck with no rash about a month now. moisturizer doesn’t seem to help
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Hello. I had a diagnostic mammogram BIRADS 0 same as my screening mammogram. Ultrasound reported BIRADS 4, suspicious. It states "There is an oval hypoechoic mass with indistinct margins measuring 6x5x3 mm in the retroareloar right breast at 8:00. No suspicious lymph nodes are identified in the right axilla sonographically. Suspicious of malignancy.
A biopsy was conducted guided by ultrasound three days later.
Please interpret.
Thank you for your kind support and help to all the women:)
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Can you copy and paste the report in its entirety?
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I'm 53 and have had annual 3D mammograms for several years with no findings until this year. I was called back due to new focal asymmetric density and microcalcifications. Here is the report from the diagnostic mammogram and ultrasound performed last week:
MM MAMMO TOMO DX-RIGHT RIGHT DIAGNOSTIC MAMMOGRAM AND TARGETED RIGHT BREAST ULTRASOUND
History: Call back for calcifications and asymmetry.
Low Dose full field Digital Breast Tomosynthesis examination was performed with 2D and 3D acquisitions.
FINDINGS:
Comparisons: February 25, 2020.
Breast Density: There are scattered fibroglandular densities.
There is a medial breast cluster of microcalcifications which persist with magnification. These are punctate and clustered.
The right lateral breast focal asymmetry disperses with compression.
Targeted right lateral breast ultrasound:
10:00 location, 7 cm from the nipple centered echogenic horizontally is nonvascular non-shadowing nodule measures 9 x 6 x 11 mm.
Subareolar echogenic horizontally oriented nonvascular non-shadowing nodule measures 14 x 9 x 13 mm.
9:00 location, 8 cm from the nipple center echogenic nonvascular non-shadowing 4 x 4 x 6 mm nodule. IMPRESSION:1. Indeterminate right breast microcalcifications.
2. Echogenic right breast nodules.
RECOMMENDATION: Consider biopsy of the microcalcifications ACR Classification: Bi-Rads Category 4. Suspicious finding.
COMMENTS: The false negative rate of mammography is approximately 10%. A negative mammography report should not preclude biopsy if clinically indicated. Any palpable mass should be aspirated, biopsied or followed clinically.
BI: 4
FU: B
DY: BMy questions:
- Since the nodules are non-vascular, non-shadowing, are they likely benign?
- What is the meaning of "FU: B" and "DY: B"?
Thanks for any insight you're able to provide!
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thank you for your quick reply. Ultrasound is tomorrow. What does itmean by lobular mass? Is that the location of the mass or shape of the mass? What does it mean by elongated asymmetry?
Thanl you!
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Quick question please, do radiologists only note on breast density when they 'are' dense? I don't see any reference to density on mine
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What does it mean by lobular mass?
I assume they meant lobulated . Basically a lumpy contour with smooth borders.
What does it mean by elongated asymmetry?
An asymmetric density on mammo: it is seen on one side but not the other.
Elongated means the same as in non-medical speak
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After finally having a biopsy on 3/3 I hadn't heard anything back from surgeon about results so I called office and a nurse said while the prelim report came yesterday they were waiting for the final results to call me. After some prodding and a time on hold she said doc was in surgery but that they found no cancer cells. If the final report agreed I'd be fine, if it was inconclusive i'd have to have another biopsy. Said someone would call me by friday. I wasn't happy no one called after a week to let me know I didn't have cancer, and unsure of why the "final results" could differ THAT much from the initial I called my newly favorite lady in medical records and got the initial report. Atypical ductal hyperplasia (and I guess the usual accompaniment, flat epithelial atypia, significant adenosis, microcalcifications,etc). The sample was sent to an academic medical center for consultation. I wonder why it needed consultation, and how/if this adh will affect how they want to deal with the other three masses they did not biopsy (all in same breast/ biopsied mass was 2.9 cm, the other three are around 1cm). the radiologist suggested 6 mo f/u if the biopsy was benign (and it is) but I assumed those were fibroadenomas....but then I assumed this one was too. is adh what the actual mass is called?
Ahhhhh....I have not been horribly worried, but I hate that this just continues. I just want to be done with it and say I'll come back in 6 months. Now I'll hopefully the addendum will come back by friday then I can wait for follow up with general surgeon ( who I don't like)... Then I'll want to be referred to an actual breast surgeon if I need a lumpectomy....ok. Thank whoever reads this for listening. I'm done crabbing. I'm also deeply grateful this is all I have to crab about. Any insight welcome.
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First off I want to apologize because I cannot get a copy of my report as they state it's still incomplete. On 2/22 I had a screening mammogram due to palpable lump in upper left breast, new finding on self breast exam of about 6 months, hard and appears fixed to breast tissue little mobility. I'm writing based on what I was verbally told. Kaiser uses the 3D Tomosynthesis for screening and diagnostic mammogram.
Screening Mammo results 2/22:
Left- Asymmetry in upper left breast between nipple line and arm pit, correlating with area of palpable mass.
Right- Microcalcifications possible artifact.
Recommendation: Diagnostic Mammogram with f/u ultrasound
Diagnostic Mammo/Ultrasound Results 3/2:
Right- Cluster microcalcifications confirmed in outer breast, nodule well circumscribed possibly surface, visible dimpling, asymmetry in upper right
Recommendation: f/u diagnostic ultrasound in 6 months Bi-RADS-3
Left- Asymetry in upper right breast between nipple and armpit, loose cluster microcalcifications, palpable mass correlated with area of asymmetry, ultrasound cannot visualize palpable mass but states it may be due to significantly dense breast tissue in area and two simple cysts noted in outer breast which may contribute to asymmetry.
Recommendation: Referral to breast surgeon for CBE of palpable mass and possible biopsy and genetic counseling referral. Bi-RADS-0
Questions:
1) I have had previous mammograms in Alaska but they did not have them for comparison but I verbally was able to tell them my previous mammogram was normal nothing noted on the screening mammogram. Is it concerning that there is such significant change in both breasts in 1 year? Also, why would they finalize without obtaining the known prior mammogram?
2) Is it common to see palpable mass on mammograms but not visualize on ultrasound?
3) Is it common to provide two different recommendations like that- one for each breast?
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"I have had previous mammograms in Alaska but they did not have them for comparison but I verbally was able to tell them my previous mammogram was normal nothing noted on the screening mammogram"
For me that would not be a substitute for having the actual images from your last study(s)
"Is it concerning that there is such significant change in both breasts in 1 year?"
You are assuming there was a change. Can't be sure without the priors.
"Also, why would they finalize without obtaining the known prior mammogram?"
Is it incomplete as you mentioned above because they are waiting for the prior studies?
Is it common to see palpable mass on mammograms but not visualize on ultrasound?
If a mass is only seen on one, it is usually seen on the US.
" Is it common to provide two different recommendations like that- one for each breast?"
Common to provide 2 different recommendations but we are told to assign only one Birads, and that would be the higher of the 2 numbers. (This is for statistical tracking for the reading radiologist) The exception is BrMRI where it is common to have a separate Birads for each breast.
If the current imaging center has not requested your old studies, you should call the center in Alaska and have them overnight a CD of all your images to you so you can personally bring them to your new center for comparison making sure the final recommendations include a comparison to those priors.
"One old study is better than two old radiologists" - me
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