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Interpreting Your Report

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  • AlaskaGirl79
    AlaskaGirl79 Member Posts: 2
    edited March 2020
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    Thank you for your quick response!

    Yes, you are correct I'm assuming change based on what I was told with my previous mammo. They told me last year that noted was significant breast density only (which I've always had). So this feels like major change but you are correct without correlating that's not fully accurate.

    The ultrasound tech and radiologist told me, he came in while I was getting it done, that it could be not visualized due to challenge of differentiating between it and dense tissue in the area? Not sure exactly what that means but that's the reason for referral to breast surgeon and Birads 0 (incomplete) per the case manager.

    I did call yesterday when I realized that they never received them after requesting and as such weren't used to compare.

    I was under the impression that BI-Rads 3 meant probable benign but according to nurse case manager who informed me it was given to inability to compare microcalcifications clusters so a f/u was needed to assess change/difference and not assumption of probable benign calcifications?

    I’m Just confused overall. On the one hand it feels like they are not too concerned but than on the other hand it feels like they are.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2020
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    AlaskaGirl79

    Without the priors we dont know how old the current findings are. They could be new or old and stable. If nothing looks frankly malignant, trying to decide what it is and what to do is a fruitless mental exercise.

  • kalest
    kalest Member Posts: 2
    edited March 2020
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    can anyone shed some light on this report? Please and thank you so much. I have my biopsy scheduled but I am beside myself.


    Reason for Examination: 23-year-old female presents for evaluation of bilateral breast palpable lumps.

    Comparison: None currently available.

    Technique: Real time ultrasound imaging obtained of the right breast from 12:00 to 2:00 and left breast from 4:00 to 5:00.

    Findings:

    Right breast:

    At 1:00, 3 cm from the nipple, there is a 1.3 x 0.8 x 1.7 cm circumscribed hypoechoic mass which demonstrates slightly irregular margins. Color Doppler demonstrates no internal vascularity and there is posterior edge shadowing.

    Targeted sonography of the stranding tissues at 12:00 to 2:00 are normal.

    Left breast:

    At 4:00, 4 cm from the nipple, there is a 1.5 x 0.6 x 1.7 cm oval circumscribed parallel hypoechoic mass. Color Doppler demonstrates no internal vascularity.

    Targeted sonography of the surrounding tissues at 5:00 are normal.

    IMPRESSION:

    Impression:

    Palpable bilateral breast masses as described above in the 1:00 right breast and 4:00 left breast.

    Assessment: BI-RADS 4: Suspicious abnormality

    Recommendation: Recommend ultrasound-guided core biopsy of the palpable masses in the 1:00 right breast at 4:00 left breast.

    Results of the imaging study and need for biopsy were discussed with the patient. Biopsy has been scheduled pending approval and any insurance authorization necessary.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2020
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    kalest

    No reason to be beside yourself. The descriptions are enough to warrant a biopsy but none of the terms indicate they think its cancer. The vast majority of cancers have a very prominent internal blood supply and so far I have not seen a cancer in anyone below 29 y/o but you never know. Also, the fact that there are 2 similar findings, one in each breast lowers the pre-test probability of these being cancers.

  • kalest
    kalest Member Posts: 2
    edited March 2020
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    hi! Thank you for replying. Are you meaning they didn’t state they believe it’s cancer or the way it’s described does not indicate cancer? I am worried because there has to be some question or a biopsy wouldn’t have been ordered, right?

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2020
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    kalest

    "or the way it's described does not indicate cancer?"

    The description is enough to warrant a biopsy but none of the terms used indicate they think its cancer.

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited March 2020
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    kalest, guidelines for Radiologists recommend that they order a biopsy if they think that there is a 2% or higher chance that something might be cancer. What this means is that the majority of biopsies are done to rule out cancer, not because the Radiologist believes that the imaging shows cancer.

  • learningtoletgo
    learningtoletgo Member Posts: 5
    edited March 2020
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    Djmammo, could you please help me with my biopsy report? I am still awaiting complete path results to come back but wanted to know if the description of my breast mass would be considered more "taller than wide" in your opinion. I know that would lean towards a malignant finding.

    ULTRASOUND-GUIDED CORE NEEDLE BREAST BIOPSY AND POST CLIP MAMMOGRAM

    FINDINGS:

    Site A: Left breast 6 o'clock position 2 cm from the nipple there is a lobulated hypoechoic mass measuring 1.5 x 1.9 x 1.4 cm, this was targeted for biopsy.

    I know that the descriptor "hypoechoic" is not good but wanted your opinion. Does the 1.9 figure indicate "tall"?

    Thank you.

  • JL80
    JL80 Member Posts: 1
    edited March 2020
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    This is my first mammogram (screening and diagnostic/us) at age 39. I am scheduled for a biopsy at MD Anderson next week for distortion that had no correlates from ultrasound and diagnostic mammograms. How worried should I be? Thank you.

    Baseline Mammogram

    3/9/20 Findings: Routine and tomosynthesis imaging was performed. The breast are heterogenously dense which may obscure small masses. There is questionable distortion in the inner central right breast on the 3-D images. There is questionable asymmetry in the upper central left breast at posterior depth. Further evaluation with diagnostic imaging is recommended directed towards the areas annotated on today's images. There is no other suspicious finding identified in either breast.

    Impression: Abnormal findings in both breast as discussed above. Additional bilateral diagnostic exam is recommended. The diagnostic image study should include: bilateral 3-D true lateral projections. Bilateral breast ultrasound, as deemed necessary. ACR BIRADS 0: Incomplete. Additional imaging evaluation is needed. ACR BiRads will be assigned pending the evaluation of additional diagnostic studies.

    3/13/20 Findings: Mammogram. Additional diagnostic views were obtained including bilateral ML 3-D tomosynthesis and spot compression views in the CC and MLO projections. An area of architectural distortion is again identified in the upper central aspect of the right breast middle third. The focal asymmetry described in the upper central left breast on the screening mammogram is less conspicuous on spot compression views.

    3/13/20 Finding - Ultrasound: Bilateral Complete Ultrasound was performed using a dedicated high-resolution probe

    RIGHT: There is no solid mass or other suspicious finding correlating with the architectural distortion seen on mammogram. A few small hypoechoic cysts are identified measuring 0.4cm cyst at 12:00, 4cm from the nipple; 0.7cm cysts at 12:30, 5 cm from the nipple; 0.6 cm at 7:00, 6cm from the nipple.

    Left: No suspicious finding identified. A few small cysts are present in the left breast measuring 0.5 cm cyst at 12:00, 7cm from the nipple; 0.3 cm cyst at 12:00, 6 cm from the nipple.

    Impression: Architectural distortion in the right breast without sonographic correlate, as discussed above. 3-D tomosynethesis guided stereotactic breast biopsy should be performed in the absence of clinical contraindication.

    ACR Bi-RADS 4: suspicious findings, tissues diagnosis should be performed in the absence of clinical contraindication.



  • djmammo
    djmammo Member Posts: 1,003
    edited March 2020
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    learningtoletgo

    As far as I know there is no convention to the order of the measurements. I would not assume "taller than wide" unless that is stated in the report.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2020
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    JL80

    See my reply to your PM

  • Sampson2013
    Sampson2013 Member Posts: 1
    edited March 2020
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    I have had multiple biopsies on both breast. Last June they completed a left breast biopsy with needle localization that indicated proliferative fibrocystic changes consisting of moderate intraductal hyperplasia, intraductal paillomas and a 2mm radial scar. I have gone for follow-up mammograms every 6 months. Last week during my follow-up they found amorphous calcifications in the upper, outter quadrant of the left breast and recommended a stereotactic biopsy. I had the biopsy on Tuesday and received a call yesterday stating that my results show non-proliferative fibrocystic changes consisting of mild ductal hyperplasia, fibroadenomatoid changes, apocrine metaplasia and numerous microcalcifications. Can proliferative breast changes turn into non-proliferative? Also, what is the difference between intraductal and ductal?

    Thanks!

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2020
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    Sampson2013

    I would direct non-imaging questions like these to your doctor or the pathologist that handled your case.

  • edj3
    edj3 Member Posts: 1,579
    edited March 2020
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    djmammo, not sure if you're in a hospital setting these days but take care during this pandemic. You're a real help to all of us.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2020
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  • Pct27
    Pct27 Member Posts: 1
    edited March 2020
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    To JL80 Was there any response to your post regarding your first mammo? I am in similar situation.

  • moderators
    moderators Posts: 8,184
    edited March 2020
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    Pct27, welcome to Breastcancer.org, although we're sorry you are here and worried. Just in case JL80 doesn't see your post, we suggest sending her a private message. To do that, click on her username, and under the information at the top, you'll see the option to send a private message. Sometimes is easier to connect with another member this way!

    Hope this helps! Please let us know if we can be of any assistance.

    The Mods

  • CalicoKitty2000
    CalicoKitty2000 Member Posts: 5
    edited April 2020
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    I have had nipple discharge from my right breast. Went in for a mammogram and ultrasound. I had an existing fibroidenoma that was diagnosed in the surgeons office via needle biopsy about 15 years ago. Since the hospital didn’t have those results, they really honed in on the fibroidenoma. I feel like they didn’t even get to what was causing the nipple discharge. I tried to tell her that was already diagnosed and I think the discharge is coming from either behind the nipple or slightly above. It is unilateral, single duct. Was clearish yellow and I made it bleed messing with it. Now it’s back to straw colored. It happened spontaneously on my period last month with much more cyclical pain. But it is less discharge (Has to be expressed not spontaneous) and pain overall than last month.

    Mammogram

    CLINICAL INDICATION: discharge from the right nipple

    Digital mammography was performed on the GE Essential Digital Mammography Unit. Images were processed with and without iCAD. iCAD markers, if present, were reviewed.

    Bilateral digital diagnostic mammograms were performed. Additional lateral view of the right breast was obtained to evaluate the asymmetry seen in the right subareolar region. The examination shows a sharply defined, 2.1 x 1.7 cm density in the right breast at about the 5 to 6 o'clock position in the

    subareolar region. No other similar lesions can be seen in the rest of the breasts. There is the presence of scattered fibroglandular tissue in both breasts.


    Ultrasound

    CLINICAL INDICATION: Asymmetry seen on mammograms

    Real-time targeted ultrasound examination of the right breast was performed at the 6 o'clock position, 3 cm from the nipple. The examination shows a sharply defined 2.0 x 1.4 cm hyperechoic lesion with horizontal disposition and some through transmission. This is most likely a fibroadenoma.

    IMPRESSION: Asymmetry in the right breast appears very likely to bea fibroadenoma as described. Follow-up ultrasound examination in six months is recommended to confirm its benign nature.

    (BI-RADS CATEGORY 3: PROBABLY BENIGN FINDING - Short term follow up needed)

  • okangansummer
    okangansummer Member Posts: 5
    edited April 2020
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    I posted on another thread too and I so appreciate any of your help. I'm distraught, as I'm sure otherS are. Needle biopsy is Wed. This was my first mammogram. I just never thought all of this would happen. I'm 42. I have been reading so much and going crazy. Could the one in question maybe just be wrong and, why do I have cysts only on the right upper breast? Is it common to have a mix of simple cysts and then a malignant one? Or is it more in my favour that the one is not malignant. Could past mastitis cause any of this? I breastfed for 8 years, and had mastitis once in there, but I can’t remember which breast. Also, the architecture distortion seems to worry me the most, is that always reported? Can it happen with regular cysts? Is it sometime just described as distortion?I'm sorry for all the questions and that'sthis was also posted on another part of the forum.


    The breast tissue is heterogeneously dense which may obscure small abnormalities.

    FINDINGS:

    Diagnostic right breast mammography:

    Compressive and MLO and a lateral view demonstrate persistent architectural distortion within the posterior upper right breast. CC view localizes subtle architectural distortion to the axillary tail. The area of concern is approximately at the 10 o'clock position. It is approximately 6 centimeters lateral to the nipple.

    The small oval mass within the slightly lower outer right breast localizes to the 8 to 9 o'clock position at an anterior depth, within 2.5 centimeters of the nipple.

    Targeted right breast ultrasound:

    There are multiple simple cysts within the outer right breast from the 8 to 12 o'clock position. 1 at 9 o'clock, closer to the nipple measuring 8 millimeters corresponds to the smaller oval mass seen mammographically.

    In the area of concern in the posterior upper outer right breast axillary tail, there is an irregular taller than wide 6 x 7 x 6 millimeter hypoechoic mass with no internal flow on Doppler interrogation. It does demonstrate posterior acoustic enhancement. It could be cystic or solid.

    A few other oval masses with posterior acoustic enhancement and internal hypoechogenicity are seen but there wider than tall and oval, at the 8 o'clock and 10 o'clock position.

    IMPRESSION:

    Taller than wide 7 millimeter hypoechoic mass at 10 o'clock within the posterior right breast corresponds to the area of architectural distortion. Recommend urgent ultrasound-guided fine-needle aspiration/biopsy. It could be solid or cystic. A requisition must be submitted to general hospital.

    Other scattered oval hypoechoic masses are wider than tall and appear more benign. These could represent complicated cysts with internal debris. These could be assessed at the time of the biopsy, and further aspiration or biopsy recommended if felt suspicious by the radiologist.

    Background of other simple benign cysts in the outer upper right breast.

    RECOMMENDATIONS: As above.

    BIRADS:

    Right breast: BI-RADS 4 Suspicious Abnormality RESULTCODE: BR-4


  • cdc1682
    cdc1682 Member Posts: 2
    edited April 2020
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    Ugh. BiRads5. I think mine is bad bad but I'm here for your take on it. This is the mammo and US report.

    Two very large tumors, one in right breast with a satellite friend, the other in right armpit in node.

    Biopsy scheduled for Tuesday. Pretty freaked out right now.

    Findings:
    This procedure was performed using tomosynthesis. Computer-aided detection
    was utilized in the interpretation of this examination.
    The breasts have scattered areas of fibroglandular density.

    Mammo Digital Diagnostic Bilat w/ Tomo
    Right
    Mass: There is a 71 mm oval mass with indistinct margins seen in the outer
    central region of the right breast in the middle depth. The mass
    correlates with the palpable mass reported by the patient. Associated
    features include nipple retraction and skin thickening. Ill-defined focal
    asymmetry extends from the anterior margins of the mass to the subareolar
    region, concerning for possible infiltration. There is a satellite lesion
    measuring approximately 15 mm along the inferolateral margins of the mass.



    US Breast Right Limited
    Right
    Mass: There is a 78 mm x 61 mm x 68 mm irregularly shaped, non-parallel,
    hypoechoic mass with microlobulated margins seen in the right breast at 9
    o'clock. The mass tracks to the retroareolar region. There is a similar
    appearing satellite lesion measuring 14 x 10 x 17 mm at 08:00 o'clock, 9
    cm from the nipple which measures approximately 7 mm from the margins of
    the primary mass which is favored to represent the same process.

    Lymph Node: There is a 64 mm x 53 mm x 53 mm lymph node with
    microlobulated margins seen in the right axilla.

    Left
    There is no evidence of suspicious masses, calcifications, or other
    abnormal findings in the left breast.

  • okangansummer
    okangansummer Member Posts: 5
    edited April 2020
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    Thank you. Sooooooo much. It seems that one spot has a few of the non favourable terms, I'm a mess....- what does it mean if there is no Doppler flow on interrogation?


    the radiologist did not go over anything, the ultrasound tech came and told me I was done and she had what she needed and my dr would follow up. I phoned my dr this morning and then he phoned and told me, but was sooo vague and then I asked for the report to be emailed. It wasn’t my regular doctor

  • msmarie
    msmarie Member Posts: 72
    edited April 2020
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    @djmammo - just wanted to circle back from my post Feb 18, 2020.

    Mammo Report: "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."

    My cancer team felt it best to have an excisional biopsy, so I did in March. Thankfully BENIGN!

    Here's what I had: "Extensive hemosiderin-containing macrophages. While not common, hemosiderin-containing macrophages have been recognized as mimickers of microcalcifications on high res mammography. No microcalcifications identified. No evidence of malignancy."

    I did have a large hematoma in 2019 after my lumpectomy, I suspect that injury may have contributed to this issue.

    Thanks for your help! MM

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2020
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    CalicoKitty2000

    They need to see your prior studies and reports

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2020
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    okangansummer

    "Taller than wide 7 millimeter hypoechoic mass at 10 o'clock within the posterior right breast corresponds to the area of architectural distortion."

    This description is suspicious. Let us know what the biopsy shows. Don't worry about the rest of the findings at this point.

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2020
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    cdc1682

    The B5 is warranted. They may also biopsy the abnormal lymph node too. After the path comes back an MRI will likely be performed. Keep us in the loop.

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2020
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    MsMarie

    Good news. That's a new finding since the introduction of tomosynthesis.

  • okangansummer
    okangansummer Member Posts: 5
    edited April 2020
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    djmammo

    Thank you so very much! I edited my post to be in line line with the findings only 😊

    What about the other descriptors?

    No internal flow on doppler interrogation

    Demonstrate posterior enhancement

    Does taller than wider mean the shape? Or position?

    The other thing I note is that the architectural distortion

    Isn’t in the ultrasound report - does that mean it was not observed with the ultrasound? It just states at the end in the findings that it corresponds?

    Is there anything about the position that would be another cause for concern or not concern?

    Axillary tail

  • minustwo
    minustwo Member Posts: 13,153
    edited April 2020
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    Okanagan - As DJ said - "Don't worry about the rest of the findings at this point". He can only respond to what your reports say not what your breasts feel like. Yes it's VERY hard to wait for ongoing tests & results.

    BTW - are you in the Okanagan valley - Washington or Canada? Beautiful country.

  • okangansummer
    okangansummer Member Posts: 5
    edited April 2020
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    Thank you, MinusTwo

    I’m grasping, and I completely understand. I’m trying desperately to find ways to make it better

    I’m in BC, the very beautiful Okanagan!

  • cdc1682
    cdc1682 Member Posts: 2
    edited April 2020
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    Yeah thanks. They're biopsying both areas.

    I'm being told they fully expect to be treating me for cancer in the coming weeks, even without the confirmation of paths. Most likely chemo prior to surgery.

    Just hoping it's treatable and it responds how it should. 🤞