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Interpreting Your Report

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  • faith33
    faith33 Member Posts: 5
    edited October 2022
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    I'm so scared, sad and anxious. I'm 28 years old, I have a 2 years old and I'm still breast feeding. My baby started to like more my left breast. Then I felt my out-upper breast tissue weird so I went to my gynecologist. She checked me and said that she want's concern but she sent me a ultrasound. I went to an specialist breast cancer image center (my mom is a breast cancer patient and she was diagnosed there) they checked both breasts and armpits. I have a lump in the same breast since I was 13 years old. I told the technician and she checked it too. The doctor there told me that it was a benign fibroadenoma and my breast tissue was just that, my normal breast tissue BIRADS 2. Well, I'm so anxious so I went for a second opinion in a normal image center, at first the technician said that he couldn't see anything after around 10 minutes he did. He didn't check my armpits. He was asking question like if I drink coffee or if the first place said that was fibroadenoma or fibrocystic. Now in the report says that I have dense breast tissue and two heterogeneous masses, the sizes and that's it. No more description BIRADS 4. The first report has a perfect description and why that lump is benign. First report was in July, second was on September. I went back to my gynecologist and she said that I shouldn't put the second repot over the first report because they are specialist and they can't be that wrong. She referred me to a breast specialist/surgeon to take out the fibroadenoma for my peace of mind and she don't look so concern about the second report. My mom is a breast cancer patient but her genetic test is negative. I'm so scared! :(


    My first report is:

    complete Ultrasound OF BOTH BREASTS AND AXILLA: 7/6/2022

    FINDINGS:

    CLINICAL: Right breast lump.

    No prior exams were avallable for comparison.

    Color flow and real-time ultrasound of both breasts four quadrants, retroarecar, and axilla regions were performed.

    Gray scale Images of the real-time examination were revlewed.

    On the right, at the 4 o'clock position, 3 cm from the nipple, an oval hypocholc mass is noted measuring 9 x7 x 11

    mm, correlating with the palpable region of concern. This mass is oriented parallel to the skin and demonstrates

    smooth borders, consistent with a benign fibroadenoma

    No suspiclous findings.

    No significant abnormalities were seen sonographically In the left breast or elther axilla.

    IMPRESSION: BENIGN

    BIRADS II

    There is no sonographic evidence of malignancy.

    Follow-up with ACR/ACS guidelines

    Yasmeen A. Qureshi M.D.



    Second report:

    TECHNIQUE: Sonographic images of right breast all four quadrants and retroareolar region

    performed.

    FINDINGS:

    Right Breast :

    Two masses each measuring 1.4 x 1.4 x 1.4 cm (heterogeneous)located in 10:00 position. and 1.0 x 0.8× 0.9 cm (heterogeneous )located in 4:00 position. . Sonographic evaluation of remainder of right breast

    demonstrates dense parenchyma parenchyma echotexture.

    IMPRESSION:

    BIRADS CATEGORY IV

    1. Two masses measuring 1.4 x 1.4 x 1.4 cm (heterogeneous)located in 10:00 position. and 1.0 x 0.8 x

    0.9 cm (heterogeneous )located in 4:00 position.

    Recommendations :

    1. Surgical consult.



  • parakeetsrule
    parakeetsrule Member Posts: 605
    edited October 2022
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    It sounds like they are taking them out simply for your peace of mind. The reports can be different simply because a different radiologist looked at it. I'd agree with your doctor that the specialist breast center would probably be more accurate, hence the very detailed description. The second report could be more vague and Birads 4 simply because they don't have as much experience and don't know what they are looking at.
  • sharpermiller
    sharpermiller Member Posts: 2
    edited November 2022
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    Hello, I’m hoping you can help me understand my recent 10/24 mammo & ultrasound results.Thanks

    TECHNIQUE: Bilateral diagnostic digital tomosynthesis mammogram with integrated computer aided detection technology performed.

    FINDINGS:

    Breast tissue is heterogeneously dense. Marker has been placed over palpable lump in the posterior lateral aspect of the left breast. Adjacent to the marker

    is an irregular somewhat spiculated lesion. No suspicious calcifications.

    On initial right cc view is a 1 cm density slightly medial to the nipple and 3.4 cm deep on CC tomosynthesis image 18/66. However, on spot tomosynthesis compression views and 90 degree tomosynthesis images it does not persist.

    Diagnostic left breast ultrasound:

    Sonography of the palpable lump in the 2 o'clock position, 9 cm from the nipple demonstrates an irregular, hypoechoic, solid lesion measuring 1.3 x 1.2 cm with

    macrolobulation. IMPRESSION:

    Highly suspicious lesion corresponding the palpable lump in the 2 o'clock position of the left breast. BIRADS 5, left breast. Biopsy recommended.

  • cookie54
    cookie54 Member Posts: 718
    edited November 2022
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    Hi, Sorry you had an abnormal mammo and US that warrants a biopsy. Seems by report the palpable lump you feel on the left was seen on mammo as a spiculated lesion and again on US. Also they thought there may have been a breast density on the right but after magnification views of that area it was normal. (" it does not persist"}. Best wishes with your biopsy ,sending positive vibes for a negative result. Take care.


  • sharpermiller
    sharpermiller Member Posts: 2
    edited November 2022
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    Thank you

  • syfleming
    syfleming Member Posts: 2
    edited November 2022
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    Hi everyone, I was asked to come in for a biopsy on December 7th after having an ultrasound. The news of needing a biopsy completely ruined my Thanksgiving and I don't know how I'm going to get through a very busy week and a half of work. I've hardly eaten or slept since. I've been nonstop Googling every single word of my ultrasound and a lot of mind-wandering and lurking down lots of rabbit holes. This forum is my only source of peace. Any thoughts on my recent ultrasound would be greatly appreciated.

    Mammogram Finding: There is a mass with indistinct margins at the upper outer right breast. No associated Architectual distortions or microcalcifications

    Ultrasound Right breast Hypoechoic mass with partially indistinct margins measures 0.4 x 0.9 x 0.9 cm. There is absent internal vascularity. Mass correlates with mammographic findings.

    BI-RADS ASSESSMENT CATEGORY 4 SUSPICIOUS

    Recommendation

    1. Right breast ultrasound guided biopsy

    2. Obtain prior studies for comparison

    3. Bilateral axillary clinical follow

  • alicebastable
    alicebastable Member Posts: 1,945
    edited November 2022
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    syfleming, Most Birads 4 are benign. And I suggest doing fun things before your biopsy - and after. I did, and four years later, I remember the fun much more than the medical appointments, tests, procedures, and surgeries.

  • cookie54
    cookie54 Member Posts: 718
    edited November 2022
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    syfleming, I'm sorry your holiday was ruined by biopsy news. We all know how easy it easy to go down a rabbit hole of dark thoughts but that causes needless anxiety. You have to keep yourself as busy as possible and do something that relaxes you. As Alice said so many Birad 4's are benign, irregular hypoechoic masses are very often benign. The range of Birad 4 rate of malignancy is broad from 3-94 %. Plus the fact that your mass has no internal vascularity , malignant breast masses tend to show increased vascularity.

    So try to remain optimistic and not worry yourself sick. I have had numerous breast biopsies over the years. I always told myself whatever is there I can't change but I can change the way I look at things. We hope for the best but mentally prepare for the worst. I hope that time moves quickly for you and you received good news! Hugs.

  • syfleming
    syfleming Member Posts: 2
    edited November 2022
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    Thank you so much! I appreciate you. I really needed to read your response. One more week of waiting for this darn biopsy. Big hug back!

  • stefanie1121
    stefanie1121 Member Posts: 6
    edited December 2022
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    Good morning,

    I am in desperate need of information from someone other than google. I had a biopsy done a week and just received the final results which might as well be in sand script for all the sense it makes. The only thing I was told by my doctor was to meet with a surgeon. i am hoping someone here can better explain the following results as my appointment with the surgeon is in 4 weeks!

    Final Diagnosis

    A. Right breast, upper outer quadrant, stereotactic vacuum-assisted core biopsy:

    : Focal atypical ductal hyperplasia (ADH) in a background of multifocal flat epithelial atypia (FEA) and columnar cell change with luminal calcifications.

    : The surrounding breast tissue shows focal sclerosing adenosis with calcifications and numerous calcifications present within benign lobules.

    BIRADS: 4

  • quietgirl
    quietgirl Member Posts: 165
    edited December 2022
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    BIRADS 4 means the findings are suspicious but not classified as cancer Hyperplasia means that there are more cells than usual and they are no longer lined up in just the 2 layers. (that’s from American cancer society)



    This means that ADH is not yet a pre-cancer, although it is linked to an increased risk of getting breast cancer later on.

    If ADH is found on needle biopsy, more tissue in that area usually needs to be removed to be sure that nothing more serious is also present in the breast. The tissue that is removed is looked at under the microscope, and if nothing more serious is found, no other treatment is needed.


    not sure any of that helps or not but it makes sense you were referred to a sur

  • maggie15
    maggie15 Member Posts: 997
    edited December 2022
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    stefanie1121: I understand your frustration when the only feedback you get is "meet with a surgeon." My PCP admitted he really didn't know enough to explain anything to me.

    ADH and sclerosing adenosis are benign conditions which are associated with a higher risk of developing breast cancer. They have referred you to a surgeon for an open biopsy (usually done under local anesthesia) where a larger amount of tissue than the needle biopsy specimen is removed for more accurate testing. While sclerosing adenosis itself is benign it sometimes hides cancer cells nearby. If nothing more is found you are in the clear. Otherwise another surgery might be scheduled.

    BIRADS 4 lesions are more likely to be benign but they have to check to make sure. Waiting is really hard, but try not to let it ruin your holidays. Best wishes for good results!

  • stefanie1121
    stefanie1121 Member Posts: 6
    edited December 2022
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    Maggie15 thanks for replying. When I took my scans for a second opinion the breast center found a second spot near the first that the imaging center missed. Since they found spot 2 after the biopsy was scheduled they only biopsied spot 1.

    While I don't have a family history of breast cancer I do have a family history to other cancers that spread. I know all cancers are different. My mom passed away from cancer in January then my uncle in February preceded by my dad and grandpa so to say I am a little sensitive is an understatement.

    Google is an evil tool for medical information. I really dont know how I am going to wait 4 weeks to talk to the surgeon. How long after the consultation will have to wait to even get the surgery? I am not good with uncertainty. Good bad or indifferent I like my facts upfront so I can plan accordingly.

    I apologize for ranting but no one in my life seems to be taking this seriously and rather brushing it off by saying oh its nothing you will be fine. I obviously don't want a bad diagnosis but I am entitled to be terrified given my families tendency to grow cancer cells.

  • stefanie1121
    stefanie1121 Member Posts: 6
    edited December 2022
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    quietgirl, how long did you have to wait between the intial meeting of the surgeon to your surgery date?

  • maggie15
    maggie15 Member Posts: 997
    edited December 2022
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    stefanie1121: I'm sorry about your family and glad you are asking questions. Sclerosing adenosis / radial scar is found in only 1/1000 mammograms so doctors who are not specialists often don't know much about them. I was put on surveillance for abnormalities, an older protocol, and two and a half years later my tumor which had been hidden by radial scars showed up. Having a surgeon do an excisional biopsy as is happening in your case is the most up-to-date protocol.

    Things tend to move more slowly than we would like in the breast cancer world. My core needle biopsy was 3 weeks after my suspicious mammogram and lumpectomy 5 weeks after the biopsy pathology came back. I sure wanted that cancer out of me immediately but, as my doctor said, it's less of an emergency than a heart attack or stroke. Vent if it makes you feel better; all of us here have been in similar situations and are willing to listen. The one advantage of the slow pace is that if you need further treatment you have time to research your options.

    I didn't worry as much as I might have since I have no family history of cancer, but I turned out to be the first. I would suggest calling the surgeon's office and ask to be put on the waiting list in the event there is a cancellation. All the best!

  • stefanie1121
    stefanie1121 Member Posts: 6
    edited December 2022
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    I am on the cancellation list currently and plan on calling every morning to check in.

    I cant get a definition on luminal calcifications. Do you have any info?

  • maggie15
    maggie15 Member Posts: 997
    edited December 2022
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    Luminal calcifications are calcifications inside the milk ducts.

  • bbam1982
    bbam1982 Member Posts: 1
    edited February 2023
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    Reason For Exam

    (US Breast Limited Left) LEFT

    Report

    BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM

    LEFT BREAST DIAGNOSTIC TARGETED ULTRASOUND

    CLINICAL HISTORY: 41-year-old patient presents for bilateral diagnostic mammogram due to left breast lump for the past 2 months with pain. Patient also demonstrates left breast nipple inversion for the past 2 months. No symptoms reported the right breast. The patient denies personal or family history of breast cancer or prior breast procedures.

    COMPARISON: None. This is a baseline mammographic evaluation.

    FINDINGS: Both breasts are composed of scattered fibroglandular densities.

    There are no suspicious mammographic masses or calcifications in the right breast. An area of apparent asymmetry in the right upper breast anterior depth demonstrates effacement on spot compression MLO view and changes configuration on exaggerated CC lateral view in the right breast 90 degrees view reflective of focal overlapping fibroglandular tissue/structures.

    There is increased density irregular spiculated mass in the left breast upper outer quadrant middle depth. There is asymmetric left breast nipple inversion and possible slight increase skin thickening.

    Targeted sonographic evaluation of the left breast demonstrates a hypochoic irregular antiparallel shadowing mass with echogenic rim in the left breast upper outer quadrant 1:00 axis, 3 cm from the nipple with appearance of surrounding distortion of the breast parenchyma. This mass represents a sonographic correlate for mammographic mass.. In addition, there is a additional hypochoic irregular mass at the 1:00 axis, 5 cm from the nipple measuring 0.8 x 0.5 x 0.8 cm which is located approximately 0.75 cm from the 1:00 axis, 3 cm from the nipple mass.

    In oblique measurement including both masses measures 3.5 × 1.0 cm.

    There are multiple prominent left axillary lymph nodes demonstrating cortical thickness with one in the left axilla the 1:00

    axis, 11 cm on nipple measuring 1.4 x 0.6 x 0.8 cm and demonstrating diminished central fatty hilum and eccentric cortical thickness measuring approximately 0.39 to 0.4 cm. Additional prominent lymph nodes are also identified in the left axilla but 1:00 axis, 14 cm from the nipple in close proximity to the axillary vein.

    IMPRESSION:

    1. Left breast 1:00 axis, 3 cm from the nipple hypochoic mass is highly suspicious for malignancy. Ultrasound-guided

    Report

    biopsy is recommended.

    An additional 1:00 axis, 5 cm from the mass is located approximately 0.7 to 0.8 cm from the index mass and is suspicious for a small satellite lesion.

    1. Multiple prominent left axillary lymph nodes are suspicious for malignancy. Recommend ultrasound-guided axilla lymph node located at the 1:00 axis, 11 cm from the nipple.
    2. No mammographic evidence of malignancy in the right breast.

    RECOMMENDATION: Left breast ultrasound-guided biopsy and left axilla ultrasound-guided biopsy as detailed above.

    BI-RADS CATEGORY: 5 "Highly Suggestive of Malignancy - Appropriate Action Should Be Taken"

  • kaynotrealname
    kaynotrealname Member Posts: 410
    edited February 2023
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    Hi Bbam! I'm so sorry you find yourself here first of all but did you have a question about your report?

  • adamm
    adamm Member Posts: 5
    edited February 2023
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    any interpretation help on this report for my mom. Previous bc in 2003. Really worried need to choose lumpectomy(biopsy) or mastectomy soon.

    A

    DIAGNOSIS

    CALCIFICATIONS RIGHT BREAST:

    • SMALL GROUPS OF DETACHED FLOATING ATYPICAL CELLS AND NECROSIS, CANNOT RULE OUT MALIGNANCY IN THIS LIMITED SPECIMEN.
    • DETACHED CALCIFICATIONS IDENTIFIED.
    • FAT NECROSIS, FOCAL
    • SCLEROTIC TISSUE WITH MILD CHRONIC INFLAMMATION
    • NO BREAST TISSUE IDENTIFIED

    B

    NO CALCIFICATIONS RIGHT BREAST:

    • SMALL GROUPS OF DETACHED FLOATING ATYPICAL CELLS AND NECROSIS, CANNOT RULE OUT MALIGNANCY IN THIS LIMITED SPECIMEN.
    • NO BREAST TISSUE IDENTIFIED

    Comment:

    Both the specimens show small groups of detached/floating epithelial cells and necrosis. There is absence of breast acinar and ductal structures. There is sclerotic tissue with focal chronic inflammation. Detached calcifications are noted in specimen A.

    History of prior breast carcinoma in right breast is noted.

    In this limited material malignacy can not be ruled out. Clinical/imaging correlation is required.

    SMALL GROUPS OF DETACHED FLOATING ATYPICAL CELLS AND NECROSIS, CANNOT RULE OUT MALIGNANCY IN THIS LIMITED SPECIMEN. DETACHED CALCS IDENTIFIED. NO BREAST TISSUE IDENTIFIED.

  • anne32
    anne32 Member Posts: 1
    edited February 2023
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    What does "skin enhancing lesion" mean on an MRI?

  • cookie54
    cookie54 Member Posts: 718
    edited February 2023
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    Hey anne32, Mri is performed before and after injection of contrast. If a skin enhancing lesion is reported it means there was a lesion seen prior to contrast that now enhances on the post contrast images.

  • elamom
    elamom Member Posts: 37
    edited February 2023
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    Hi,

    Just wanted to see if anyone has any insight on my latest ultrasound. The only thing the report says is that there is a focal region of irregular shadowing without internal vascularity on the left breast 3:00 retroareolar region. I know the lack of vascularity is a good thing, and I am really not too concerned about this.

    I have to schedule an MRI as the next step.

    I am high risk and had surgery on the other breast last year for a fast growing fibroadenoma.


    Also, this did not show on the diagnostic mammogram I had the same day. I have extremely dense breasts.

    image



  • bribugsmomma
    bribugsmomma Member Posts: 4
    edited April 2023
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    I received the following ultrasound report with a Birads 5. I’m scheduled for 3 biopsies on Wednesday. My doctor hasn’t really said much other than we have to wait for the results. I know from reading here that it doesn’t look good. The report is lacking a lot of the descriptive words that I have seen posted on a lot of reports and I would appreciate any help in determining what I might be dealing with.

    FINDINGS: Right: Detailed sonographic evaluation of the right breast does not show suspicious cystic or solid masses, or architectural distortion. There are multiple cysts scattered in the right breast, the largest measuring 2.7 x 1.3 x 2.3 cm in the 11 o'clock axis. There is no evidence for right axillary adenopathy. Left: Within 12 o'clock axis of right breast, there is a solid hypoechoic mass with irregular margins and showing intrinsic vascular flow, measuring 1.8 x 1.2 x 1.7 cm. Within retroareolar 6 o'clock axis of left breast, there is a solid irregular hypoechoic mass measuring 2.0 x 1.1 x 1.9 cm and also showing intrinsic vascular flow, with posterior acoustic shadowing noted. There is associated nipple retraction related to this mass. Multiple scattered cysts are noted in the left breast including a 1.1 x 0.7 x 1.0 cm cyst in 2 o'clock axis demonstrating possible intracystic mass or debris. There is indeterminate left axillary lymph node with short axis diameter of 0.7 cm but which shows asymmetric cortical thickness measuring up to 0.3 cm.

  • stuckinohio
    stuckinohio Member Posts: 11
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    I had my biopsy…just waiting on results but wanted opinions on my scans. I wish I had found this group earlier because I’ve spent so much time trying to decipher these!

    BREAST COMPOSITION: D - The breasts are extremely dense which lowers the sensitivity of mammography.

    FINDINGS: Tomosynthesis Findings: A skin marker was placed over the symptomatic site at 1:00 middle third RIGHT breast. Underlying the skin marker is a new, irregular, ill-defined, noncalcified, hyperdense, nonmasslike asymmetry. There are no significant new findings in the LEFT breast.

    Ultrasound Findings: RIGHT breast ultrasound of the symptomatic site at 1:00 4 cm from nipple reveals irregular, ill-defined, hypoechoic, vascular, nonshadowing, nonmasslike infiltrative hypoechoic tissue. Best estimate of size is 37 x 31 x 16 mm correlating with the Tomosynthesis findings and is suspicious. There is no RIGHT axillary lymphadenopathy.


    what does infiltrative mean on ultrasound? I struggled to find that descriptor in all the articles I read.

  • obsolete
    obsolete Member Posts: 333
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    Greetings & empathy go out to you while you're waiting & wondering. I had been told sonography is not meant to be patient friendly. Some 3 concerns stand out, although non-masses could be simple normal tissue enhancement or could beDCIS.

    • irregular (margins)
    • vascular (blood flow)
    • hypoechoic (tissue)

    My understanding of "infiltration" is an invasive growth pattern. See link below for reference. Best wishes!

  • obsolete
    obsolete Member Posts: 333
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    DUCTAL CARCINOMA IN SITU
    "A microlobulated mild hypoechoic mass with ductal extension and normal acoustic transmission is considered the most common feature in sonographically detected DCIS."


    https://radiopaedia.org/articles/ductal-carcinoma-in-situ

  • stuckinohio
    stuckinohio Member Posts: 11
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    thank you for the reply! DCIS is what I’ve been anticipating getting diagnosed with if it is malignant based on what I read.

  • obsolete
    obsolete Member Posts: 333
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    RADIOGRAPHIC FEATURES:. IDC

    "By ultrasound the radiographic features of IDC ("an infiltrating and malignant proliferation of neoplastic cells in the breast tissues"):

    • ill-defined
    • hypoechoic mass
    • hyperechoic angular margins
    • posterior acoustic shadowing: 71% in grade 1
    • posterior enhancement: 45% in grade 3
    • ductal extension may be seen: represents extension of the mass into the surrounding parenchyma
    • branched or spiculated pattern
    • microcalcification
    • https://radiopaedia.org/articles/invasive-breast-carcinoma-of-no-special-type-1?lang=us

  • obsolete
    obsolete Member Posts: 333
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    "INVASIVE LOBULAR CARCINOMA OF THE BREAST" (ILC)
    "The most common sonographic appearance is that of a heterogeneous, hypoechoic mass with angular or ill-defined margins and posterior acoustic shadowing. ill-defined heterogenous INFILTRATING area of low echogenicity with disproportionate posterior shadowing is one of the sonographic characteristics of invasive lobular carcinoma."


    https://radiopaedia.org/articles/invasive-lobular-carcinoma-of-the-breast