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Interpreting Your Report

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  • xoJennyPennyxo
    xoJennyPennyxo Member Posts: 2
    edited March 2018
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    Thank you RhondaJ!!

    I attached my most recent one to my previous post and sent my older 2 in a PM to him. 💛 praying for an answer.

  • rondeezee
    rondeezee Member Posts: 16
    edited March 2018
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    Fantastic! I am praying along with you for b9 results. Please let us know how things turn out

  • EPNYC
    EPNYC Member Posts: 3
    edited March 2018
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    Hi,

    I'm a 38 year of female with no family history of breast cancer. I went on Thursday, March 1 for a baseline mammogram/ultrasound with no complaints. Can you interpret my report?

    Bilateral mammography was performed including CC and MLO views. Additional imaging analysis was performed using CAD software. Digital breast tomosyntheis was performed and used in the interpretation of images.

    There are scattered areas of fibroglandular density

    There is a group of calcifications in the left upper breast.

    Additionally, there is a partially circumscribed partially of scattered mass in the slightly lower slightly innter left breast, which corresponds to a sonographic finding in the left 9:00 axis.

    Ultrasound:

    Left Breast:

    Sonographic evaluation of the left breast in its entirety was performed, including each of the four quadrants and the retroareolar region, in clockwise fashion. Images were obtained by the technologist and submitted for interpretation.

    The breast parenchyma demonstrates a heterogenous background echotexture (mixed fatty and fibroglandular)

    At the 12:00 axis 3 cm form the nipple there is a benign cluster of cysts measuring 1.2 x 0.4 and 1.3 cm and additional adjacent benign simple cysts measuring 7 mm maximally

    At the 9:00 axis 2 to 3 cm from the nipple is a 0.6 x 0.3 x 0.5 cm oval hypoechoic mass. no definite internal vascularity is seen. this corresponds with the mammographic mass.

    At the 1:00 axis 5 cm from the nipple there is a benign septated cyst measuring 0.3 x 0.2 x 0.5 cm

    Overall impression:

    The patient will be recalled for further evaluation of a grouping of calcifications in the upper outer left breast and a mass in the left 9:00 axis (seen on mammography and breast ultrasound)

    Reccomendation: additional imaging

    BI-RADS 0

    How worried should I be? I am going on Tuesday for the additional imaging.

    Thanks!

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    EPNYC

    Many times reports like this may seem intentionally vague, there are descriptions but no conclusions. This is because there is a fair amount of overlap between benign and malignant findings on mammograms and ultrasound and we try not to draw conclusions too early in the evaluation.

    Calcifications require hi res magnification views to make that decision. If they are clearly benign on those views they will leave them alone. If they look malignant, or if they are indeterminate in appearance they will recommend an outpatient biopsy.

    The mass is not described well enough to get a sense of what they are thinking at this point. Since a mammo and ultrasound were already performed I am not sure what additional imaging they want aside from an MRI which is jumping the gun at this point. I assume they will discuss an US guided bx for the mass to be done on the same day as the bx for the calcifications. This is not an unusual scenario. It makes for a long day but it gets it all over with in one visit.

    How worried should you be? I hear this question a lot. The best answer is you should only be worried if you are not having your symptoms evaluated.

  • EPNYC
    EPNYC Member Posts: 3
    edited March 2018
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    Thank you for replying. This was just a baseline mammogram/ultrasound and my OBGYN didn’t even want to send me because she said I was young, most likely with dense breasts and I don’t Any family h

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    EPNYC

    Around 75% of women with BC don't have a family history.

    Having your first baseline screening before 40 is a double edged sword. If you had no symptoms then you had your baseline 2 years earlier than recommended. If this turns out to be something bad, then you got a 2 year head start in treating it. Let us know what the biopsy(s) show.

  • cwf1018
    cwf1018 Member Posts: 3
    edited March 2018
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    Received callback from screening mammogram with a vague description of “indeterminate asymmetry on CC view only”. They did say it was compared to prior three years. It was 3D when priors were 2D. Couldn’t get an appointment for 11 days. I’m 47 and had a call back on the same Breast 5 years ago and diagnostics and US showed benign. I do not have any information from that problem just ran when they said benign return in a year. I almost feel like I would feel better if they saw a mass. I feel like in my research it could be nothing or invasive. Is it possible that it is good that the 3D only found it on the one view? It was CAD assisted if that matters. If they are commenting that it was compared to priors does this mean they suspect it is a developing asymmetry? How worried should I be? Feel like they just saw an asymmetry, assigned a BIRAD 0, and made no other comments even about size (they did give location). Is it possible that’s all they saw? To make it worse that Breast is slightly fuller which I can’t say is new or not. I’m just really worried

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    cwf1018

    It is much more worrisome if they say they see a mass in 2 views, then if they only see something vague in only one view.

    Here is a secret about screening mammograms. Don't tell anyone else.

    Screening exams consist of 4 basic views (plus a sweep if its a 3D) and are read in batches of 10 to 100 at a day depending upon how busy the breast imaging dept is. The speed with which they are read depends upon the individual radiologist, and how many are called back each day depends on their "diagnostic threshold" which is related to their overall level of suspicion and their experience.

    If a rad sees an asymmetry that was not present previously, that patient will be called back regardless of what they think is causing that appearance. A mass has to be ruled in or ruled out. There is nothing that frightens a radiologist more than saying "its probably nothing, come back in a year" and then finding out its now a significant cancer at the time when the patient comes back 2 years later after missing their next yearly routine screening.

    Bottom line: Yes it could be nothing. I would not worry until after the diagnostic workup is completed. Keep that appointment and keep us in the loop.

  • cwf1018
    cwf1018 Member Posts: 3
    edited March 2018
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    Thank you so much for your insight. I’ll try not to worry and will post my results when I get them. I now know to ask for them instead of running even if it’s good news

  • tinytoes1
    tinytoes1 Member Posts: 3
    edited March 2018
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    Can you please help my interpret my ultrasound report. I have had several biopsies since I was 45, but all are benign. My first was atypical Lobular Hyperplasia on the same breast and around the same area that this new nodule is. I had an excisional biopsy around 6 years ago.

    Findings: In the region of the patient's mammographic density, 4 cm from the nipple 1 o'clock position, there is a hypoechoic nodule measure 10mm. It has increased through transmission. There is some irregularity associated with its rim and vascularity is demonstrated on Doppler analysis.

    Impression: Hypoechoic nodule correlates with the patient's mammographic density. Although for the most part it has benign features, there is some irregularity to the rim of this lesion and there is some vascularity seen on Doppler ultrasound. Surgical consultation and biopsy is recommended. BI-RADS 4

    Thank you!!

  • RiRi11
    RiRi11 Member Posts: 70
    edited March 2018
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    Hello DJ

    I have been lurking on this site since viewing my US on Feb. 28th. Very informative, I can feel your love and support for everyone! I am a 42 yr old no family history of BC. I went for a routine Mammo and was sent for an US and core needle biopsy. What is concerning is birads 4C... Please, good or bad.. please share what you know/think of my report....

    Sonographic evaluation of the right breast in its entirety, was performed, including each
    of the four quadrants and the retroareolar region, in clockwise fashion.

    6:00-7:00, 2 cm from the nipple, 29 x 22 mm irregularly marginated hypoechoic nodule with
    acoustic shadowing
    No definite abnormalities noted in the right axilla.

    IMPRESSION:
    Irregularly marginated hypoechoic mass 6:00-7:00 right breast.
    R 92.2

    Recommendation: Ultrasound-guided core biopsy

    BI-RADS 4- Suspicious Finding(s) 4C- high suspicion for malignancy

    Thank you :

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    tinytoes1

    The most encouraging feature is the "increased through transmission". This refers to the way the sound waves interacts with the nodule. Sound can be reflected, transmitted or scattered.

    In the breast sound is transmitted through water like in cysts, and through solid masses whose cellular make up is uniform, organized and usually one cell type like a fibroadenoma or other benign entities. Sound is scattered in masses that have an irregular surface, and a cellular make up that is disorganized and non-uniform and this causes "shadowing" or "no through transmission" in the images. This is seen with IDC.

    Let us know how the bx goes.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    RiRi11

    The three most significant descriptors are "hypoechoic, irregular, and shadowing". Together these words make the nodule in question very suspicious and are the basis for the biopsy recommendation. The good news is they did not report any abnormality involving the lymph nodes on that side.

    4C is the highest level of suspicion within Birads 4. Birads 5 indicates the highest degree of suspicion and is used when the reader is fairly confident that a mass is cancer.

    Let us know how the biopsy goes.

  • RiRi11
    RiRi11 Member Posts: 70
    edited March 2018
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    thank you DJ! Thank you for giving us some direction during a difficult time! Im hoping i hear from the Dr this week (had the biopsy done 4p on Friday)

  • tinytoes1
    tinytoes1 Member Posts: 3
    edited March 2018
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    djmammo,

    Thank you. During the biopsy the surgeon said it looks like a Complex Cyst with an irregular margin. . He did a core biopsy on the solid area. My US stated that it had some vascularity. Can a complex cyst have vascularity if it is benign? I am also confused how a cyst can have increased through transmission and be hypoechioc?


  • Recap
    Recap Member Posts: 4
    edited March 2018
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    'Sonographic evaluation of the right breast in its entirety, was performed, including each
    of the four quadrants and the retroareolar region, in clockwise fashion.'

    RiRi11-I am impressed by the standard opening wording of your report-it indicates to me they take seriously their techs doing a thorough comprehensive evaluation (and not skipping to the main event.)

  • Great914
    Great914 Member Posts: 4
    edited March 2018
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    Hi Dj,

    I am a 44 year old with a history of breast cancer ( my mother was diagnosed when she was 49). I recently went in for a call back mammogram and ultrasound. I happened upon this sight after they told me that I need a biopsy. Are you able to help me understand my report? It reads:


    ... baseline screening mammogram for further evaluation of a mass in the inner central right breast, as well as indeterminate calcifications in the lower inner
    right breast.

    COMPARISON EXAM(S): 2/20/2018.

    MAMMOGRAPHIC FINDINGS: Right 2-D and 3-D ML as well as diagnostic spot magnification views were obtained. There are scattered areas of fibroglandular density. Again demonstrated is a 0.5 cm mass in the central right breast (MLO view) which projected to
    the inner breast on the screening mammogram images. Patient was sent for targeted ultrasound of the central right breast for further evaluation. There is a 0.2 cm group of pleomorphic calcifications in the lower inner right breast, with suggestion of a
    branching distribution.

    RIGHT BREAST ULTRASOUND: Sonographic evaluation of the central inner right breast was performed.

    At the 2:00 position 3 cm from the nipple, there is an oval, circumscribed, anechoic mass compatible with a benign simple cyst measuring 0.4 x 0.2 x 0.4 cm.

    At the 2:30 position 4 cm from the nipple, there is an oval, circumscribed, anechoic mass compatible with a benign simple cyst measuring 0.5 x 0.4 x 0.6 cm. This appears to correspond to the mammographic mass for which the patient was called back.

    At the 3:30 position 5 cm from the nipple, there is an oval, circumscribed, anechoic mass with internal septations, compatible with a benign cluster of cysts measuring 0.4 x 0.3 x 0.5 cm.


    IMPRESSION AND RECOMMENDATION:

    1. Suspicious 0.2 cm group of calcifications in the lower inner right breast. Stereotactic core needle biopsy is recommended.

    2. Benign right breast cysts, one of which corresponds to the mammographic mass .


    BI-RADS CODE: 4-Suspicious abnormality, biop
    4B-Intermediate suspicion
    Recommendation: Tissue Sampling



    Thanks



  • EPNYC
    EPNYC Member Posts: 3
    edited March 2018
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    So I went in today for my diagnostic mammogram. I have to go in for a mammogram guided biopsy for my calcifications. The radiologist told me that they were not linear (in a straight line) but not the shape that she knows its usually benign. She wants to rule out early cancer. She said we might as well use ultrasound guided biopsy for my mass since I am going to be here for the calcification. She said that its not perfectly circumscribed the mass but she can def. trace around it. This is how she described it. (I have a feeling if I didn't have the calcification, I probably would have been categorized as 3 and just come back to keep can eye on the mass) So, here I am, 38 years old and the gynecologist didn't even want to send me for a baseline mammogram, due to no family history and breast exam was normal with a BI RAD score of 4A.

  • Great914
    Great914 Member Posts: 4
    edited March 2018
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    Hi djmammo

    I am a 44 year old with a history of breast cancer ( my mother was diagnosed when she was 49). I recently went in for a call back mammogram and ultrasound. I happened upon this sight after they told me that I need a biopsy. Are you able to help me understand my report? It reads:

    ... baseline screening mammogram for further evaluation of a mass in the inner central right breast, as well as indeterminate calcifications in the lower inner
    right breast.

    COMPARISON EXAM(S): 2/20/2018.

    MAMMOGRAPHIC FINDINGS: Right 2-D and 3-D ML as well as diagnostic spot magnification views were obtained. There are scattered areas of fibroglandular density. Again demonstrated is a 0.5 cm mass in the central right breast (MLO view) which projected to
    the inner breast on the screening mammogram images. Patient was sent for targeted ultrasound of the central right breast for further evaluation. There is a 0.2 cm group of pleomorphic calcifications in the lower inner right breast, with suggestion of a
    branching distribution.

    RIGHT BREAST ULTRASOUND: Sonographic evaluation of the central inner right breast was performed.

    At the 2:00 position 3 cm from the nipple, there is an oval, circumscribed, anechoic mass compatible with a benign simple cyst measuring 0.4 x 0.2 x 0.4 cm.

    At the 2:30 position 4 cm from the nipple, there is an oval, circumscribed, anechoic mass compatible with a benign simple cyst measuring 0.5 x 0.4 x 0.6 cm. This appears to correspond to the mammographic mass for which the patient was called back.

    At the 3:30 position 5 cm from the nipple, there is an oval, circumscribed, anechoic mass with internal septations, compatible with a benign cluster of cysts measuring 0.4 x 0.3 x 0.5 cm.


    IMPRESSION AND RECOMMENDATION:

    1. Suspicious 0.2 cm group of calcifications in the lower inner right breast. Stereotactic core needle biopsy is recommended.

    2. Benign right breast cysts, one of which corresponds to the mammographic mass .

    BI-RADS CODE: 4-Suspicious abnormality, biop
    4B-Intermediate suspicion
    Recommendation: Tissue Sampling

  • Lfern
    Lfern Member Posts: 2
    edited March 2018
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    Hi! I just got my results from my mri. My mom had breast cancer at 42 so when they saw something on mamo they sent me for mri. The results say there is an oval mass with heterogeneous enhancement measuring 6mm in the inferior region centrally. Corresponding module on T1 with mildly increased T2 signal. It was also a category 4 but not specified abc. I didn’t feel like it was a very descriptive report. But Nothing I found sounds too great, somethings I can't seem to find when I search it. I know can be known without further testing but any info would be greatly appreciated. I am scared obviously and don't have any appointments for a WEEK which just gives me more time to make my self crazy!!! thanks so much fur any info!!

  • RiRi11
    RiRi11 Member Posts: 70
    edited March 2018
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    I received a call from the radiologist that did my biopsy. Its cancer. He told me to finda Breast Surgeon. My full pathology report is not available yet.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    RiRi11

    See if you can find a surgeon that does exclusively breast surgery in your area. The fellowships trained ones will likely have had some training in plastic surgery for a better cosmetic result.

    There are several web sites that will help you find a breast surgeon, this is just one to get you started (I have no affiliateion with this organization) https://breastcancersurgery.com/breast-cancer-surgeon/

  • RiRi11
    RiRi11 Member Posts: 70
    edited March 2018
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    thank you DJmammo. I called Memorial Sloan Kettering, they wont give me an appointment until my report is complete. I’m hoping tomorrow.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    RiRi11

    You will be in excellent hands there. Great reputation. Best of luck.


  • nyatlla
    nyatlla Member Posts: 2
    edited March 2018
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    Greetings all and thanks for your support through these months. I have been reading for information and support for a while. I have a question I hope @djmammo (OMG you are a Godsend) and anyone in the community can answer. Something keeps nagging me about my reports.

    I had an abnormal screening mammogram due to new asymmetry in the middle lower right breast center, mlo view only. Went back for the diag and ultrasound and again shown on only the mlo but faint and nothing was on the ultrasound. Due to sister dying of BC at 35 (I am 41 and was undergoing IVF treatment), the radiologist sent me for an MRI because she wrote "MRI RECOMMENDED TO EXCLUDE AN OCCULT MALIGNANCY. "

    Did the Mri: report:

    "Glandular tissue is moderately dense without dominant mass or cyst. No suspicious adenopathy is seen. The area of mammography asymmetry interiorly in the right breast demonstrates normal signal intensity compared to the remainder of the breast. Confluent focus of glandular tissue seen interiorly on sagittal sequence 3, image 24 possibly corresponds to the mammographic findings based on the location and configuration. This does not demonstrate any abnormal enhancement on correlation with post contrast imaging, sequence 8 images 94. There is significant background enhancement on post contrast imagine which limits mammogram sensitivity. No suspicious focus of enhancement is identified. Non breast findings: none.

    Impression:

    1. No MR evidence of malignancy

    2. Tissue confluence seen in the inferior right breast demonstrates isointense appearance on MRI relative to the remainder of the glandular tissue and does not demonstrate any suspicious enhancing characteristics. The mammography asymmetry most likely represents coalescent normal glandular tissue.

    Recommendation: Assuming there is no interval chance in physical exam, a six-month follow up right mammogram would be recommended. Mammographic tomography at that time may also be helpful. However, if clinically preferred considering the family history of a sister with premenopausal breast cancer, stereotactic biopsy may be attempted if a focal asymmetry is demonstrated on tomographic imaging of the breast. ACR 3 probably benign findings.

    THE GYN sent the MRI report to a breast specialist. I went and they did their own ultrasound and through clinical exam (the nurse and dr.) found nothing (that was 12/20/17). I then started having pain in the breast--I think I injured myself with a boogie board in the pool but it took a while to connect the dots. Anyway... I did a lot of self exams...like way too many. Ended up seeing a therapist due to it. Then 1/30 went back to the clinic due to the pain. Again, full ultrasound and nothing. Told to take evening primrose and vitamin E. Pain is still there. Then left the left breast. Now the right breast still hurts. Cant touch it or anything. It hurts all day everyday... I am not sure if it was from the touching a month ago or if the tissue is growing? I know I sound super crazy, but is that what they are looking for in six months--follow up 5/15/18? Like if the tissue is going to grow?

    Should I still be worried about occult malignancy the mammo radiologist mentioned after the MRI? Would the MRI miss cancerous cells? Like is the tissue the mammo picked up possibly malignant but the MRI couldn't tell? I hope I am saying that correctly. And would that cause pain? It feels like someone is biting my breast right in that area and it radiates and ripples up like heat.

    I feel the report is pretty thorough and he clearly responded to the mammo report.

    I just don't want to show up at the breast place again and have them like lady calm down and come back in six months.... But I also don't want to do that and come back they're like...yeah you're level 4 now.

    Thanks for any help.

    And yes I am getting help for my anxiety. Seeing a therapist and NOT touching the breasts.

    Edited to add that I went for the yearly mammo with not pain, lump or symptoms.


  • moderators
    moderators Posts: 8,229
    edited March 2018
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    p.s. We agree ^^^ "@djmammo (OMG you are a Godsend)" per nyatlla.

    nyatlla, sounds like you are well managed. We can't answer your questions, but it does sound as though you are in a good place, with your physicians listening to your concerns.


  • grl06c
    grl06c Member Posts: 10
    edited March 2018
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    Hi! Recently I had a 3d mammogram and ultrasound done in order to check up on a lump I felt 6 months ago. 6 months ago they told me they could not see it on the 3dmammogram or ultrasound, however this visit (to a different radiologist) went differently. This time they said they could see it on both. I guess I am concerned about the changes that the lump has possibly made, which is making my brain go straight to cancer. I was also wondering if you could help me interpret my ultrasound report. I felt like it was vague, but maybe I am missing something:

    "Findings: Right breast shows dense breast tissue and dilated ducts. Area of palpable abnormality shows a soft tissue density with well-defined borders with no internal vascular flow. Identified measuring 1.3 x 1.0 x 0.7 cm. No other solid cystic right breast lesion is identified. There is a 0.7 cm axillary lymph node.

    Left breast shows dense breast tissue and dilated ducts. There is a soft tissue density and o'clock (I think this is a typo) position which appears to represent normal breast tissue visualized on the 3d imagine.

    Impression: The right breast 7 o'clock position palpable abnormality corresponds to a solid, well-defined soft tissue density. Due to patients' strong history of breast carcinoma, the solid tissue density visualized by ultrasound, and the density being palpable a surgical consult and breast biopsy is recommended.

    BI-RADS 4: Suspicious finding."

    I am 30 years old. I am currently trying to get scheduled with a surgeon. Thank you so much in advance for your help! I have been so insanely stressed and haven't had a doctor talk to me about anything. Unfortunately my PCP has been horrible.

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    nyatlla

    That's basically a normal MRI report. They don't see anything that looks like cancer plus they think they see the reason for the mammo finding and its a dense patch of normal tissue.

    MRI is very sensitive for breast cancer, so sensitive that the negative ones are very reliable. Would the MRI miss cancerous cells? Cancer cells can only be seen under a microscope. Would it miss a cancer that is large enough to be seen as a visible asymmetry on a mammogram? No.

  • nyatlla
    nyatlla Member Posts: 2
    edited March 2018
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    Thank you for commenting. And WE ALL appreciate your work. Thank you.

  • LDepp71
    LDepp71 Member Posts: 2
    edited March 2018
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    Hi djmammo,

    I'm 47 with a family history of breast cancer. My mother diagnosed at 52 with DCIS and diagnosed at 59 with Stage 4 Metastatic BC. I was having mammograms w/call backs for US from age 38 to 41. Then started having 3D Mamgrms. My last report states:

    The Breast are heterogeneously dense. Benign appearing calcifications are again noted within the right breast posteriorly. Mild stable benign nodular features are noted bilaterally. No definite significate changes are seen.....Bi-Rad 2.

    I have not had an MRI, but strongly considering it. I would like to know what you think about my last results.

    Thank you