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Interpreting Your Report

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

    What about the other descriptors?

    In general.....

    No internal flow on doppler interrogation- good

    Demonstrate posterior enhancement - good

    Does taller than wider mean the shape? Or position? - shape

    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?- the taller than wide mass = the area of arch distortion. this is the combination of findings we look for

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

    Axillary tail - that you will need to ask your surgeon

  • okangansummer
    okangansummer Member Posts: 5
    edited April 2020
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    djmammo

    Thank you for all of that addition info, it is so appreciated.

    I have been doing the most exhaustive reading on architectural distortion and does it not occur with cysts because they are liquid? Is there ever cases where it is in connection to complicated cysts? I read lots about scelorising lesion as well and know this could be a reason for another benign option versus a malignant optio.

  • minustwo
    minustwo Member Posts: 13,153
    edited April 2020
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    Okanagan - What WindingShores said on the other thread you started is right on. You need to be trying to distract yourself with long walks & movie binges. Too much research when you don't have all your testing done & your diagnosis confirmed is very stressful. We know, it's hard to wait.

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

    "...does it not occur with cysts because they are liquid?"

    Its because cysts have a sharp well defined borders.

    Is there ever cases where it is in connection to complicated cysts?

    AD is usually, cancer, radial scar (complex sclerosing lesion), surgical scars, and occasionally incomplete compression during mammography.

  • Nelsonfam05
    Nelsonfam05 Member Posts: 6
    edited April 2020
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    hi I’m new here! I had a mammogram and ultrasound on Tuesday and a biopsy on wed. I am awaiting results. Can I post my mammogram and ultrasound report her for your opinion?


  • Nelsonfam05
    Nelsonfam05 Member Posts: 6
    edited April 2020
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    Here is the report from my ultrasound and mammogram. I'm pretty worried and mentally preparing to hear the words you have cancer. I'm not really sure what to ask. I've looked up bits and pieces of this report online. Anyway any insight you have would be helpful in my processing of this report

    Report HISTORY: Palpable right breast lump 2D MAMMOGRAM COMPARISON: None. Baseline mammogram.
    TECHNIQUE: Composite 2D (C-view) full field mediolateral oblique (MLO) and craniocaudal (CC) views of both breasts with computer-aided detection (CAD). Composite full field mediolateral, spot compression MLO and spot compression CC views were also obtained.

    BREAST COMPOSITION: There are scattered areas of fibroglandular density.

    FINDINGS: There is a suspicious, spiculated mass in the inferior right breast measuring about 3.5 x 3.0 cm. On the MLO composite view, the patient also appears to have a second lesion about 5 cm superior to the dominant lesion, superior to the plane of the nipple. This secondary right breast lesion measures less than 1 cm. Additional note is made of a relatively prominent right axillary lymph node, measuring about 1 cm. 3D

    MAMMOGRAM COMPARISON: 2D Mammogram TECHNIQUE: Bilateral 3D digital breast tomosynthesis (DBT) images were obtained with compression. FINDINGS: There is a suspicious, spiculated mass in the inferior right breast measuring about 3.5 x 3.0 cm. Tomograms also demonstrate an adjacent 1.4 x 1.3 x 1.1 cm radiodense lobule. On the MLO composite view, the patient also appears to have a second lesion about 5 cm superior to the dominant lesion, superior to the plane of the nipple, and localizing laterally on the tomograms. This secondary right breast lesion measures less than 1 cm. Additional note is made of a relatively prominent right axillary lymph node, measuring about 1 cm.

    LIMITED RIGHT BREAST ULTRASOUND TECHNIQUE: Ultrasound imaging of the inferior and lateral right breast was performed, as well as the right axilla. FINDINGS: There is an irregular hypoechoic mass at the 7:00 position, corresponding to the dominant mammographic mass, measuring approximately 2.4 x 2.0 x 1.4 cm. This mass is highly suspicious for malignancy. At the 9:00 position, there is a superficial, hypoechoic oval lesion measuring 8 x 6 x 4 mm. This lesion is 2 echogenic to characterize as a simple cyst, but it appears avascular on Doppler imaging. A secondary site of malignancy is possible. A right axillary node measures approximately 2.5 x 2.3 x 1.4 cm, and has a partially effaced fatty hilum. This node may be a site of metastatic disease.

    IMPRESSION: 1. Suspicious inferior right breast mass, corresponding to the clinically palpable lump. 2. Indeterminate superficial lesion in the lateral right breast, possibly a complex cyst, although a secondary site of malignancy is possible. 3. Indeterminate right axillary lymph node also characterized, possibly a site of metastatic nodal disease.

    BI-RADS CATEGORY: 5, highly suggestive of malignancy RECOMMENDATION: Ultrasound-guided biopsy of the dominant, inferior right breast mass. ***** Final *****

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2020
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    Nelsonfam05

    After reading the description I agree with their conclusion. I suspect the path may come back IDC. They may want to biopsy that node too. An MRI will likely follow.

  • Nelsonfam05
    Nelsonfam05 Member Posts: 6
    edited April 2020
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    what does IDC mean

  • Nelsonfam05
    Nelsonfam05 Member Posts: 6
    edited April 2020
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    I figured it out.

  • Nelsonfam05
    Nelsonfam05 Member Posts: 6
    edited April 2020
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    why would the mass be larger on mammogram vs ultrasound

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2020
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    Nelsonfam05

    When comparing measurements taken with two different digital modalities know that they will never match exactly. The physics of US, mammo, MRI are all different so they look at different aspects of a mass.

  • Tdiiulio
    Tdiiulio Member Posts: 2
    edited April 2020
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    I amlooking for help interpreting my ultrasound report. I did have biopsy and am waiting on those results. Some places say moderate concern and other places say high suspicion for malignancy. I feel confused

    Study Result

    Impression

    BREAST DENSITY AND RISK STATEMENT:

    The patient has heterogeneouly or extremely dense breast tissue and and elevated lifetime risk of

    breast cancer secondary to the Tyrer-Cuzick risk assessement model. Consider genetic screening

    if applicable and adjunct screening whole breast ultrasound and/or screening breast MRI as

    clinically indciated.

    LIMITED ULTRASOUND OF LEFT BREAST AND AXILLA: 4/2/2020

    COMPARISON:

    Comparison is made to exams dated: 5/9/2014 mammogram and 6/17/2011 mammogram.

    FINDINGS:

    Color flow and real-time ultrasound of the left breast 2-4 o'clock, 11 o'clock, and axilla regions were performed. All representative images including gray scale of the real time examination were reviewed.

    Accession #

    MA-20-0040063

    MA-20-0040066

    There is a 1.4 cm x 1.4 cm x 0.7 cm oval mass with a lobulated and circumscribed margin in the left breast at 11 o'clock 6 cm from the nipple with the long axis parallel to the skin. This correlates as palpated and with mammography findings. Color flow imaging demonstrates that there is vascularity present and an adjacent vascularity.

    There also is a 0.4 cm x 0.4 cm x 0.2 cm oval mass with a circumscribed margin in the left breast at 3 o'clock middle depth 7 cm from the nipple. This oval mass is hypoechoic. This correlates with mammography findings. Color flow imaging demonstrates that there is no vascularity present.

    There is no sonographic correlate for the palpable concern in the left breast 11 o'clock 8 cm from the nipple.

    A left axillary lymph node is visualized, normal in size and appearance, fatty hila maintained.

    ULTRASOUND IMPRESSION: SUSPICIOUS ABNORMALITY - MODERATE CONCERN BUT NOT CLASSIC FOR MALIGNANCY

    No sonographic or mammographic correlate a reported prior palpable concern in the left breast 11o'clock 8 cm from the nipple. Negative imaging results should not deter further evaluation or biopsy of a clinically suspicious finding.

    The 1.4 cm x 1.4 cm x 0.7 cm oval mass in the left breast at 11 o'clock is consistent with a solid mass and is at a high suspicion for malignancy. An ultrasound guided biopsy is recommended.

    The 0.4 cm x 0.4 cm x 0.2 cm oval mass in the left breast at 3 o'clock middle depth is probably benign. Follow-up left mammogram and ultrasound in 6 months are recommended to demonstrate stability.

    Results were given to the patient at the completion

    OVERALL STUDY BIRADS: 4c High suspicion of malignancy

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

    Any new solid mass needs a biopsy.

    Long axis parallel to the chest wall in general is a good sign. Benign lumps can have a blood supply. Personally I like to know if a mass has posterior shadowing or through transmission on US as this helps me make a decision, but that feature is not mentioned here. Let us know what the biopsy shows.

  • Nelsonfam05
    Nelsonfam05 Member Posts: 6
    edited April 2020
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    thanks! The biopsy did come back as IDC. I haven’t gotten to read the report and in all honesty didn’t understand anything after the word cancer.

  • Tdiiulio
    Tdiiulio Member Posts: 2
    edited April 2020
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    @djmammo thank you for your feedback. I was expecting a biopsy was just surprised at a 4C, maybe they didn't mention everything in the report? Or it does look like they attached a couple images. Trying not to put too much stock into the BiRad rating.

  • Jettie
    Jettie Member Posts: 63
    edited April 2020
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    its been a while since i was on this thread and djmammo did an awesome job of translating my reports, when i had no idea what they said. As you can see from my signature, treatment is underway. So i just wanted to take a moment and say thank you again.

    image



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

    You are very welcome. Good luck on your journey.

  • sushu
    sushu Member Posts: 1
    edited April 2020
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    Hi - I had a lumpectomy about 6 years ago that ended up being atypia hyperplasia. Because of that, I've had both an anual mammagram and a breast MRI - every 6 months I'm tested. My last mammo was clear, but the MRI I just had showed some concern (details below). I am having a guided MRI biopsy on Monday, but am having a bit of anxiety this time around, having been through the testing, lumpectomy, etc.

    Any guidance is appreciated.

    Thank you!

    IMPRESSION:

    1. Right Breast - BI-RADS 1 - Negative. No evidence of malignancy.
    2. Left Breast - BI-RADS 4 - Suspicious. Grouping of small foci of enhancement at the central retroareolar tissues of the left breast. Of these, a focus of enhancement at the anterior third, retroareolar tissues (L1) measuring 8 mm in size, has
    increased in size since the prior MRI. Recommendation is for tissue sampling.
    3. Left breast-BI-RADS 3-probably benign. 2 other foci of enhancement in the central retroareolar tissues (L2 and L3) are very small, and could represent background enhancement, even if they are new since the previous examination. There is one other
    small focus of enhancement in this general region that is stable since the prior exam (L4).

    RECOMMENDATION:
    1. MRI guided biopsy of the left breast, for lesion L1. If biopsy results are benign without atypia, then follow-up MRI can be obtained in one year. If results are malignant then consideration should be made for tissue sampling or image guided clip
    placement for L2 and L3.

    Electronically signed by: Ruby Chang, MD (3/5/2020 11:27 AM)
    WKSTN: INTELERADRCG

    Narrative

    MRI OF THE BREAST WITH AND WITHOUT CONTRAST: 3/4/2020 4:09 PM



    PREVIOUS STUDY: Breast MRI 1/16/2019



    HISTORY: 57-year-old female, history of left breast atypical ductal hyperplasia status post excision in 2013. Elevated lifetime risk of breast cancer, 34%.




    TECHNIQUE:
    1. Dedicated breast coil; 1.5 Tesla magnet.
    2. Axial VIBE T1 non fat saturation images.
    3. Axial T2 images with fat saturation.
    4. Axial VIBE T1 images with fat saturation
    5. Dynamic multiphase T1-weighted axial images with fat saturation and intravenous Gadavist contrast (8.5 mL). 1.5 mL of Gadavist discarded.
    6. Sagittal VIBE T1 post-contrast images with fat saturation.
    7. Axial diffusion weighted images.
    8. Data analysis and post processing utilizing Cadstream.



    FINDINGS:



    RIGHT breast findings:



    The breast parenchyma demonstrates scattered fibroglandular tissue tissue, and there is mild background parenchymal enhancement.



    No suspicious masses or areas of abnormal enhancement.



    There is no significant lymphadenopathy noted.



    LEFT breast findings:



    The breast parenchyma demonstrates scattered fibroglandular tissue tissue, and there is mild background parenchymal enhancement. Post surgical changes of the left breast are again identified without associated enhancement of the surgical scar, stable.



    The central left breast tissues demonstrate a few new foci of enhancement, when compared with the previous MRI of 2019. 4 discrete foci are most prominent on the MIP images, 3 of these being of interest since they are different than what was seen on the
    previous MRI. These 3 foci measured together span 1.7 cm TR by 0.8 cm AP by 0.7 cm SI.



    L1: 8 mm ill-defined nonmass-like focus of enhancement (axial series 5, image 66) showing increase in size since the previous examination. This is at the central retroareolar tissues, 3.4 cm posterior to the nipple. This lesion shows a mixture of type
    II and type III enhancement kinetics.



    L2: Tiny 3 mm focus of enhancement (axial series 5, image 60) that is 8 mm posterior and 7 mm inferior from L1. This is small enough that it may represent background enhancement.



    L3: Tiny 2.5 mm focus of enhancement that is 1.7 cm medial and 0.8 cm posterior to L1. This could also represent background enhancement.



    L4: 4 mm focus of enhancement (axial series 5, image 66 that is 1.6 cm posterior lateral to L1, and this focus of enhancement is stable since the previous exam.

  • acnort
    acnort Member Posts: 1
    edited May 2020
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    I’m hoping to get some help here. I found a “lump” a few weeks ago. My Doctor examines and ordered a mammogram and an ultrasound. I went for those Wednesday and was told that I had a couple suspicious spots, that could be shadows or could be small masses. I was scheduled for an ultrasound guided core needle biopsy for today. I went to my appointment and was told by a different radiologist that there was nothing he could see for a biopsy. I’m relieved, but very confused as how I can feel a spot and had a technician and radiologist say that there were two places on Wednesday and today there’s nothing. I don’t know what to do or who to believe.

  • robinorbit
    robinorbit Member Posts: 23
    edited May 2020
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    Hello djmammo:

    I have a few questions about findings from my recent 3D mammo screening (below in italics). I'm 55, post-menopausal, do not take hormones, and this was a routine screening. I'm scheduled for diagnostic mammo and US on June 5. This abnormality is reportedly new since last mammo 2018. I've never had any mammo call backs and no family breast cancer history.

    Radiologist states they saw on both CC and MLO a "nodular asymmetry with ill-defined margins and a punctate calcification measuring approximately 7 mm." My questions about this would be:

    --Does it appear that "a punctate calcification" means just ONE calclification rather than an asymmetry that is in general showing punctate calcification?

    --Does it appear that it's the asymmetry itself that is 7 mm, and not the calcification?

    --Does this appear to mean that the calcification appears fto be INSIDE the nodular asymmetry?

    --Is there any specific risk associated from one punctate calcification located in or near a nodule or mass? (And I have read your other posts, so I understand that it hasn't yet been established that this is an actual nodule or mass.)

    Thank you so much for any assistance you can provide.

    Sincerely,

    robinorbit


    IMPRESSION:


    Left breast nodular asymmetry. Further evaluation with 3-D diagnostic mammogram and ultrasound
    is recommended.

    BI-RADS Category 0: Incomplete: need additional imaging evaluation. Sutter Women's Imaging will
    contact the patient for follow-up.

    RECOMMENDATION:

    1. The American College of Radiology and the Society of Breast Imaging recommend annual
    mammograms for most women beginning at age 40, and continuing as long as a woman is in good
    health. However, breast imaging frequency may vary depending on individual risk factors. Please
    consult your primary physician to discuss your level of risk and coordination of optimal
    management of your breast care.
    2. A negative mammogram examination does not preclude further evaluation or biopsy of any
    clinically suspicious lesion(s).

    Electronically Signed by: RADIOLOGIST 5/20/2020 2:59 PM

    Narrative

    PROCEDURE: MAMMO SELF REQUESTED DIGITAL SCREEN W TOMO BILAT, 5/15/2020 12:52 PM

    HISTORY: Screening

    COMPARISON: 4/11/2018

    TECHNIQUE: BilateralCC, MLO images were obtained.3-D imaging was performed. The study was
    reviewed with computer aided detection (CAD).

    FINDINGS:

    The breast tissue is heterogeneously dense, which may lower the sensitivity of mammography.
    Bilateral asymmetries are noted. A nodular asymmetry with ill-defined margins and a punctate
    calcification measuring approximately 7 mm is now seen in the posterior third lateral left
    breast on CC view and at nipple level on MLO projection (3-D CC slice 20, MLO slice 19). No
    other significant interval change.

  • djmammo
    djmammo Member Posts: 1,003
    edited May 2020
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    robinorbit

    -Does it appear that "a punctate calcification" means just ONE calcification rather than an asymmetry that is in general showing punctate calcification?

    yes

    --Does it appear that it's the asymmetry itself that is 7 mm, and not the calcification?

    7mm refers to the nodular assymetry

    --Does this appear to mean that the calcification appears to be INSIDE the nodular asymmetry?

    yes

    --Is there any specific risk associated from one punctate calcification located in or near a nodule or mass?

    depends in the size and shape of the calc. large and smooth is better than small and irregular. If there is only one it could just be in an early stage and only one calc has formed. There can be calcs in both benign and suspicious massses.


    I would not jump to any conclusions until the US is done. That's where a more specific diagnosis is usually made.

  • djmammo
    djmammo Member Posts: 1,003
    edited May 2020
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    sushu

    I don't see the words "irregular enhancing mass" anywhere in the report. The findings described can go either way along the continuum from benign enhancement to ADH to DCIS but usually not IDC without an actual mass. We did many biopsies for these kinds of findings. They just take a while and can be uncomfortable to lay there without moving through it all. Good luck.

  • djmammo
    djmammo Member Posts: 1,003
    edited May 2020
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    acnort

    This happens now and then. If the two exams were close together in time, only a week or two, the variables are the machine, the tech, and the radiologist. Was it the same machine and are they of equal quality? Was it the same tech each time or different? In our facility the breast US tech was board certified in breast ultrasound and did it every day. Those who are not certified and only do it now and then are not as proficient. There are settings on the machine that can make good things look bad and bad things look good so one has to know breast. Was it the same radiologist? At our facility the two of us did nothing but breast imaging period. Every day for many years. We can tell what's what on a breast study more confidently than those who only read occasionally. So if there were two different rads reading them, which had more experience in breast imaging? Also was the facility listed as a Breast Imaging Center of Excellence (BICOE) by the ACR? Certain standards that affect the above have to be maintained in order to get that certificate. If the exams were months apart and you are still cycling it might have been an actual hormone related change in your breasts that simulated a problem on that one study. Look at the reports and see what their explanation was. There should also be a recommendation for follow up or for a tie breaker exam of one kind or another.

  • robinorbit
    robinorbit Member Posts: 23
    edited May 2020
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    djmammo,


    Thank you so much for helping me better understand the mammo report! I really appreciated your clarifications and honestly haven't jumped to any conclusions except that it's too early to do so.


    I sincerely appreciate you.

  • Munalula1
    Munalula1 Member Posts: 3
    edited May 2020
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    I have a biopsy booked for Tuesday. The radiologist didn't not say much except that I'd need a biopsy to determine what this lump is and that my breasts are dense. I wish I had asked more questions. Please check out my report and help me understand what this means? Thank you.

    Indication: Newly found approximately 2cm lump at the 10 o'clock position in the right breast.

    Technique: Bilateral MLO and CC 2D mammograms. Bilateral MLO and right CC 3D mammogram. Bilateral breast ultrasound.

    Breast Density: Volpara D, 18.2% volumetric density.

    Findings: There are no previous images for comparison.

    The palpable lump at the 10 o'clock position in the right breast correlates with a 15mm round mass with mostly smooth margins. No other mass or architectural distortion is seen in either breast.
    There are no suspicious microcalcifications.

    Ultrasound examination of the lump at the 10 o'clock in the right breast shows a 15 x 14 x 9mm oval mass, 10cm from nipple. This has slightly lobulated margins. It is solid and heterogeneous but with small cystic areas. There is prominent vascularity within it on colour Doppler examination.

    No other sonographic abnormality is seen in either breast. There is no axillary lymphadenopathy.

    IMPRESSION:
    The palpable lump at the 10 o'clock position in the right breast is an indeterminate, mostly solid mass with cystic areas.
    Ultrasound-guided core biopsy is recommended

  • djmammo
    djmammo Member Posts: 1,003
    edited May 2020
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    Munalula1

    The biopsy is clearly indicated and should be an easy target at US.

    There are two scenarios with mixed cystic/solid masses. One is a cystic mass with solid elements that have blood flow. The other is a solid mass with blood flow that incidentally has a few cystic spaces in it. The first is suspicious and the second leans more toward the benign side.

    Fibroadenomas can present this way, and considering its size, its probably been there for a while. There are however no old studies for comparison to show if its stable or not so in this situation we always biopsy them.

  • jjjry
    jjjry Member Posts: 5
    edited May 2020
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    Mammogram Results and Very Alarmed

    I had a mammogram today. I can see in my health portal it was reviewed with

    Left Asym Per Dr. Name

    Then I see Bi Diagnostic Mammogram Bilateral W Contract and US Breast Complete Bilateral.

    What does these mean? To me it says they found an asymmetry and I will have to go back for more testing.

    My doctors have left for the day and I am very worried.

  • djmammo
    djmammo Member Posts: 1,003
    edited May 2020
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    jjjry

    Are you sure thats the report? It looks like the clinical history followed by billing information

  • Munalula1
    Munalula1 Member Posts: 3
    edited May 2020
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    Thank you djmammo for your reply. I can see why the need for the biopsy the way you’ve put it. I’ll update what the outcome is after my biopsy.

    Munalula

  • jjjry
    jjjry Member Posts: 5
    edited June 2020
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    Thank you for your reply. Yes. I did get a call back today.

    The nurse said there is a slight asym in the left breast from last years mammogram. I am scheduled for a contrast enhanced digital mammogram on Thursday. I am not familiar with this procedure. I feel worried. I was called back last year for additional mammogram and biopsy and all turned out fine.

    But, I have never had CEDM. Does this indicate greater concern from the radiologist?