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Interpreting Your Report

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  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    LDepp71

    Birads 2 by definition means there are only benign findings seen, no suspicious findings. If they thought it was cancer it would not have a Birads 2, there would have been a recommendation for more imaging or a biopsy.

  • Great914
    Great914 Member Posts: 4
    edited March 2018
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    Hi, I am new to this sight. I was recently called back in for a diagnostic mammogram and ultrasound. My mom was diagnosed at 49. They told me that I need a biopsy ( scheduled for March 23)and labeled me as a Bi-rad 4b.... I believe due to pleomorphic calcifications with branching patterns. Here is the report:

    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 .

    THE FINDINGS AND RECOMMENDATIONS WERE DISCUSSED WITH THE PATIENT AND SHE WAS PROVIDED A WRITTEN SUMMARY AT THE TIME OF HER EXAM. FINDINGS AND RECOMMENDATIONS WERE ALSO COMMUNICATED TO DR. HEIDMANN VIA WEB-PAGE BY DR. TUMER ON 3/1/2018 AT 3:45 PM.

    BI-RADS CODE:4-SUSPICIOUS ABNORMALITY-BIOPSY SHOULD BE CONSIDERED
    FINAL REPORT
    THE ATTENDING RADIOLOGIST INTERPRETED THIS STUDY WITH THE RESIDENT
    WHOSE NAME APPEARS BELOW, AND FULLY AGREES WITH THE REPORT
    AND HAS AMENDED THE REPORT WHEN NECESSARY:

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

    I'm hoping that someone can help me understand this and give me a realistic perspective on if this could really be malignant. Any help is greatly appreciated!!!

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    Great914

    Their description of the calcifications sounds like they are suspecting DCIS. All the other findings are benign cysts.

  • Great914
    Great914 Member Posts: 4
    edited March 2018
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    Thank you

  • Nicky28
    Nicky28 Member Posts: 2
    edited March 2018
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    thank you for this info. I just joined tonight but it looks like you are fantastic help on here.

    Are u able to tell me if there is more than one area of architectural distortion in the same breast along with a intramammory lymp node noted and heterogeneously dense breasts does the chance of it being cancer increase? I am waiting on an appointment with a surgeon.

    Thanks in advance


  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    Nicky28

    Architectural Distortion is a finding on a mammogram not a diagnosis.

    Although AD can be an early sign of cancer there are other things that can cause this appearance on a mammogram including incomplete compression during the acquisition of the mammogram image. The mere presence of an intramammary lymph node does not effect the chances unless it is itself abnormal. Dense breasts can make it difficult to tell what is causing the AD. If there are two areas both will have to be evaluated with spot compression images and ultrasound.

    Can you copy/paste the report that mentions all this?

  • rondeezee
    rondeezee Member Posts: 16
    edited March 2018
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    Hi djmammo,

    Is it safe to assume that if the radiologist or PCP did not phone you on the day of your MRI that they found nothing of concern? I had my first MRI yesterday morning and was told that if the radiologist saw something of concern, he/she would notify my PCP immediately. Also of note, my recent mammogram and ultrasound were performed at the same site so they have immediate access to those records. A day and a half have gone by and I have not heard from my PCP and I see that the report is pending in the electronic portal. I'm nervous. Please advise.


    Thanks.

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

    Never read anything into how long it takes to get a radiology report. It could be something very simple like the doc who is supposed to read it had a flood in his basement and had to run home. Could be anything.

    Do you have old studies from elsewhere that would have to be sent for? That's the #1 reason for a delay in breast imaging reports in my experience.

  • rondeezee
    rondeezee Member Posts: 16
    edited March 2018
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    Hi djmammo,

    All studies for the past 10 years were done on site where the MRI was done. The report is pending in the electronic portal

  • cwf1018
    cwf1018 Member Posts: 3
    edited March 2018
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    Had diagnostic and US today and the findings were thankfully benign. I don’t have the report yet and will post when I do. The information here has been so helpful

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

    Thank you. Your input is greatly appreciated :)


    Lis

  • Miss_Vickie
    Miss_Vickie Member Posts: 3
    edited March 2018
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    Hi DjMammo....here are my various reports on my left breast thus far.  I hope you can make heads or tails out of them.  I have a biopsy scheduled this Wednesday on my left breast and a diagnostic mamm and u/s on my right breast because their radiologist said he saw something on that breast.

    Diagnostic Mamm of Left Breast:

    SCREEN BILAT.

    SPOT MAGNIFICATION OF LEFT BREAST:

    The left breast is heterogeneously dense, which may reduce the sensitivity of mammography.

    The spot magnification demonstrates a group of mildly pleomorphic microcalcifications in the far posterior aspect of outer portion of left breast. A stereotactic biopsy, is advised.

    ASSESSMENT:

    Category 4: Suspicious

    Recommendation

    Stereotactic biopsy of the left breast. CONCLUSION: Stereotactic biopsy of microcalcifications of left

    breast, is recommended. Suspicious abnormality - Biopsy recommended. ACR Class IV.

    >>>>>>>>>>>(diagnostic Mamm of Left Breast at my local hospital/cancer center)<<<<<<<<<<<<

    There is a 10x4mm cluster of coarse heterogeneous calcifications in the 2-3 o'clock posterior third (15cm from nipple) that is mildly suspicious.

    There is a 1 mm cluster of 3 coarse calcifications at left 3 o'clock posterior third (14 cm from nipple).

    There is a 5x1 mm cluster of coarse heterogeneous calcifications  at left 6-7 o'clock posterior third (13mm from nipple).

    The two smaller calcifications clusters appear similar to larger cluster.

    Assessment:  Suspicious Bi-Rad 4

    Suspicious (Bi-Rad 4) abnormality of left breast.  

    Recommendation:  Stereotactic biopsy of the left breast at 2-3 o'clock poserior third calcification cluster.

    >>>>>>>>>>>MRI w. Contrast at my local hospital/cancer center<<<<<<<<<<<<

    ...demonstrate 5x21mm suspicious heterogenous calcifications in the ductal distribution at 3:00 far posterior third.  A stereotactic biopsy was recommended but the patient apparently desires MRI before biopsy.  

    Siemens 1.5 Tesla MRI Scanner

    Heterogeneous fibroglandular tissue

    Background Parenchymal Enhancement: Mild

    No suspicious mass or enhancement, Axillary Lymph nodes: Normal.  Internal Mammary Lymphy Nodes: Normal.

    Bi Rads  Category 1 - Negative. No MRI evidence of malignancy.

    The MRI radiologist called me a few hours after my exam said that he suspects low to intermediate grade of DCIS and to get it out within the month.  



  • leeser
    leeser Member Posts: 4
    edited March 2018
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    Hi, 

    I have an ultrasound report as follows; INCOMPLETE IMPRESSION; NEEDS ADDITIONAL IMAGING.

    the 8mm oval mass is indeterminate. it is unclear if this finding corresponds to the questioned mammographic finding. (no significant masses, calcifications or other findings are seen in either breast on mammogram) findings were compared to mammograms dated 8/2015, 5/2012.

    oval mass in left breast at middle depth with indistinct and circumscribed margin . Hypo echoic with no vascularity.  Doctor called the solid mass an "anomaly" and I will be getting an MRI. No other info on my report. I am 53 year old and in excellent health.  No history of cancers in family. I have heterogeneously dense breasts. I thought an MRI is reserved for high risk patients. Please give me some feedback. Thanks

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

    The negative MRI is good news. If there were an significant invasive cancer present it should have shown up. MRI will show DCIS in many cases but not all.

    On the mammogram the calcifications were described as coarse and clustered, classic DCIS is fine calcs in a branching pattern. Although it still could be DCIS, things like AHD and other atypias can present like this.

    When all the calcifications look the same on a mammogram, a stereo of one group is often considered sufficient to diagnose all of them. Let us know what they find.

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

    Personally if this was a new nodule I would have recommended an US guided bx. I believe it may actually be less expensive than the MRI and give you a definitive answer plus with marker placement it would tell you if it corresponds to the mammo finding. On the other hand the MRI will tell you if there are one or two nodules present (i.e. one seen on US and one seen on mammo).

    "High Risk" as regards MRI refers to a screening mri which is different from a diagnostic mri which is done to evaluate findings on other imaging or for pre-op evaluation of a known cancer.

  • grl06c
    grl06c Member Posts: 10
    edited March 2018
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    Hi djmammo,

    Thank you so much for what you do! I was hoping to get some feedback on a report. I am having a biopsy done on Friday but still have not received feedback by my radiologist on what the report was referencing to in terms that I can understand. I felt like the report was pretty vague in terms of describing what was found, but maybe I am missing something. Thanks so much in advanced!

    "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. Thank you so much in advance for your help! This has been a stressful time and I am just trying to better understand my situation.

  • leeser
    leeser Member Posts: 4
    edited March 2018
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    Thanks for your answer!  I guess I am mad because there is no BIRADS on the report, I never got a letter about the results and I have no idea if this mass is mostly benign or something else. The rd actually called the mass "a thing" which did not help me feel any better.  What are the odds a new mass in a post menopausal woman is benign. 

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2018
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    grl06c

    If you transcribed the report(s) exactly then I am unimpressed with their dictation style, content, and organization. They are mixing mammo, US and general x-ray terms willy nilly. I will spare you the details but I would use this to show residents the wrong way to dictate a breast imaging report.

    There is one finding and this is the small nodule on the left. A limited number of descriptors were used but they are all benign descriptors. No malignant adjectives were used. The lymph node is normal in size.

    The part I agree with is the conclusion. A new solid nodule + family history = biopsy. No brainer. May still be benign but this is the correct conclusion and recommendation.

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

    "Needs additional imaging" is by definition BIRADS 0. No diagnosis should be inferred from a B0, just that there is a need for more pics.

    "I have no idea if this mass is mostly benign or something else" and neither does the person reading the study as indicated by the conclusion that the finding is "indeterminate". The descriptors used however are all benign ones. There is no mention of spiculation on mammo or shadowing on US which is certainly comforting. No idea why someone would call it an "anomaly". Odd choice of words.

    The incidence of breast cancer increases with age. A new solid lump in a post menopausal patient has to be viewed with more suspicion than a young cycling woman. The MRI should clarify things.

  • leeser
    leeser Member Posts: 4
    edited March 2018
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    Thanks again!  I'm encouraged by the wording and your interpretation. Just a waiting game now to get this MRI scheduled as soon as insurance approves it.

  • grl06c
    grl06c Member Posts: 10
    edited March 2018
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    Thank you djmammo. That is word for word what the report said. I obviously do not know the correct terminology for the reports, but I did feel as though it didn't include much compared to other reports I have seen from members on this forum. The surgeon who is doing my procedure also found a few errors in the report and had his med school student who is studying under him call and complain. It felt nice that someone was just as upset as I was about this other doctor's lack of effort (or at least that is what it felt like from my perspective). I understand the radiologist works on many reports per day, but this is impacting my entire life right now. Thanks for your input! You are so appreciated!

  • Lboquist
    Lboquist Member Posts: 1
    edited March 2018
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    I have a situation where I had an ultrasound on my right breast and the radiologist saw a 12 mm lesion without defined margins. He told me it was not a cyst and recommended a core biopsy. The biopsy was the vacuum assisted type and he took 10 samples from the tumor. My pathology test came back as benign (3 weeks ago). I got a call on Monday from my doctor's nurse saying that they radiologist now believes I should have an excisional biopsy and he does not agree with the pathology results. My doctor has reviewed the pathology and the other tests and is unsure about his recommendation for further testing. Do you have any idea? And why would he come back 3 weeks after the biopsy with this? Here is the pathology report- it doesn't seem to show anything suspicious going on:

    FINAL PATHOLOGIC DIAGNOSIS:
    Right breast, 2 o'clock, core biopsy:

    - Breast parenchyma with intraductal papillomas and fibrocystic changes including usual ductal hyperplasia, cyst formation, fibrosis and apocrine metaplasia.

    - No microcalcifications identified.

    - No atypical hyperplasia, in situ or invasive carcinoma identified (see comment).


    COMMENT:

    A smooth muscle myosin heavy chain stain is performed on a section of the right breast biopsy at 2 o'clock, and it is positive in myoepithelial cells surrounding the irregular-appearing ducts, which

    is against the presence of invasive carcinoma and consistent with the above diagnosis.


    As part of Incyte Diagnostics' Quality Improvement Program, this case was reviewed by another member of our pathology staff.


    NRT:KPS:cml:C2NR


    MICROSCOPIC EXAMINATION:

    Histologic sections of all submitted blocks are examined by light microscopy. These findings, together with the gross examination, support the pathologic diagnosis.


    Immunohistochemistry:

    An immunohistochemical stain for smooth muscle myosin heavy chain is performed on a section of the right breast biopsy at 2 o'clock, with an appropriately positive control, to evaluate for the

    presence of invasive carcinoma. Irregular-appearing ducts are surrounded by smooth muscle myosin heavy chain- immunopositive myoepithelial cells, which is against the presence of invasive carcinoma.


    GROSS DESCRIPTION:

    Received in a formalin-filled container labeled with the patient's name, date of birth and additionally labeled "right breast" are multiple irregularly shaped fragments of pale

    yellow soft tissue measuring 2.6 x 1.0 x 0.4 cm in aggregate. The specimen is entirely submitted between sponges in 2 cassettes (A1, A2).

    na:NRT:cml


    ADDITIONAL NOTES:

    Immunohistochemical and/or in situ hybridization studies were performed on this case with the appropriate positive controls that react as expected. This test was developed and its performance

    characteristics determined by Incyte Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not

    necessary. This test is used for clinical purposes. It should not be regarded as investigational or for research. Incyte Diagnostics is certified under the Clinical Laboratory Improvement

    Amendments of 1988 (CLIA) as qualified to perform high complexity clinical laboratory testing.






    Diagnostician: Nicole R Turner MD

    Pathologist

    Electronically Signed 03/01/2018


    Lab and Collection

    Surgical Pathology Exam on 2/23/2018

    Narrative

    SPECIMEN(S): A RIGHT BREAST AT 2 O'CLOCK

    SPECIMEN SOURCE:

    A. RIGHT BREAST AT 2 O'CLOCK


    CLINICAL HISTORY:

    No preop or clinical information is given on requisition.


    FINAL PATHOLOGIC DIAGNOSIS:

    Right breast, 2 o'clock, core biopsy:

    - Breast parenchyma with intraductal papillomas and fibrocystic changes including usual ductal hyperplasia, cyst formation, fibrosis and apocrine metaplasia.

    - No microcalcifications identified.

    - No atypical hyperplasia, in situ or invasive carcinoma identified (see comment).


    COMMENT:

    A smooth muscle myosin heavy chain stain is performed on a section of the right breast biopsy at 2 o'clock, and it is positive in myoepithelial cells surrounding the irregular-appearing ducts, which

    is against the presence of invasive carcinoma and consistent with the above diagnosis.


    As part of Incyte Diagnostics' Quality Improvement Program, this case was reviewed by another member of our pathology staff.
  • worriedsick1229
    worriedsick1229 Member Posts: 2
    edited March 2018
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    Hi. I am new to this, never had an abnormal mammogram before and I am 51 years old. Had mammogram and ultrasound, both showing suspicous (overall) Birad 4, ultrasound guided biopsy recommended.

    Findings: There are scattered areas of fibroglandular density. On spot compression images of the left breast there is a persistent 8mm lobulated mass in the 10 o'clock-11 o'clock position anterior to middle depth. No architectural distortion or suspicious microcalcifications. Targeted ultrasound of the left breast at 10-11 oclock position 5cm from the nipple demonstrates a mixed echogenicity mass measuring 7x6x9mm. This contains central anechoic/cystic areas, however the periphery of this mass appears predomiately isoechoic/potentially solid. This has parallel orientation, somewhat ill-defined margins, and trace peripheral flow. This corresponds with the mammographic finding. Ultrasound of the left axilla demonstrates lymph nodes which are within normal limits in size an morphology. Impression: 9mm mixed solid and cystic mass left breast 10 o'clock-11 o'clock position 5 cm from the nipple.

    Please, any thoughts at all would be greatly appreciated. Thank you!

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

    The path report is benign. If the Rad involved really felt strongly they were biopsying a cancer, they would call the path result “discordant” and recommend it be removed. It happens a few times a year in a busy practice.

    It takes a week for path to come back sometimes, other times the sample is sent to an outside lab which adds another week or two. The Rad May have been off one of those weeks. Could be any reason for the timing.

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

    The majority of the words used to describe the nodule are benign adjectives. Since its new it should be biopsied no matter what it looks like.

    What was the Birads? That will tell you their thoughts on how sure they are it’s benign or not.

  • worriedsick1229
    worriedsick1229 Member Posts: 2
    edited March 2018
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    Hi djmammo! Thank you so much for taking the time to answer back. Birad 4 is what they have on report, but not a, b, c like I have seen on other women's reports. Would that give you an opinion which way it is? They have put me off until next Friday for biopsy and I am going crazy with the unknown.

  • Ozarkgirl
    Ozarkgirl Member Posts: 5
    edited March 2018
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    Hello DJMammo!! I find myself here again looking for advice and your expertise. I had a MRI yesterday due to being high risk. In November I had a fairly large radial scar removed from my lower right breast. The MRI showed a 13mm irregular-shaped oblong enhancing mass that demonstrates a mixture of enhancement kinetics including type III washout kinetics in the lower left breast. Could this possibly be another radial scar or should I begin to worry? They classified it has BIRAD 4. I'll follow up with an ultrasound although I haven't scheduled it yet.

    Thank you in advance for your advise and knowledge -- you ease so many minds and hearts with your words.

  • Lorick
    Lorick Member Posts: 3
    edited March 2018
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    Hi. I just joined today. I'm hoping you can put this into perspective for me. I had my first mammo early this week (and a sono, which I have had before) The radiology report mentions a Hypoechoic mass that is 6cm from my nipple. It does not have well-delineated margins and is taller rather than wide. The radiologist seemed concerned and said that the mass was "worrisome." He suggested a core needle biopsy.I am trying to get an appointment with a breast health center near me. When I spoke with the breast center they said the radiology report was confusing and they wanted to take more images. I picked up the report and it said that I had a Birad (?) score of 3. I think that was the confusing part. There were multiple Fibroadenomas and cysts and well, which is where the 3 must have come from. Or is it possible that the the 3 is actually true? Thank you

    • ked
      ked Member Posts: 4
      edited March 2018
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      I'm writing because I've received what looks like a less-informative report from the radiologist, along with a BIRADS category I've not seen mentioned on any of these posts.

      In late February, I had a mammogram and was asked to come back for u/s due to dense breast tissue that could make mammography less diagnostic than usual.

      This week, I had the ultrasound.  The radiologist's report includes only a few sentences.

      _____________________________

      Findings: 

      Sonography of the entire right breast was performed.  At the 2 o'clock position 10 cm from the nipple is a 11.8 x 7.5 x 10.3 mm hypoechoic nodular lesion of indeterminate etiology.  No other focal solid or cystic lesion is identified in the left breast parenchyma.

      Sonography of the entire left breast was performed.  No suggestion of solid or cystic lesion is identified in the left breast parenchyma.


      Impression:

      Indeterminate 11.8 mm hypoechoic lesion 2 o'clock position right breast 10 cm from the nipple.  Follow-up with ultrasound-guided biopsy is recommended.

      BIRADS category 4D: SUSPICIOUS-DENSE

      _____________________________

      Possibly there's more to the report and I haven't received it yet?  When I spoke with the radiologist (on the phone, before receiving any written report), I'd thought he said "hyperechoic", but obviously those words could be easily mistaken on the phone.  In that conversation, he described the mass as oblong and well-defined, not stellate and (I think) not shadowed.  None of that appears in the report I picked up today, though.  Can anyone offer some context here?  Does the 4D category exist?  Is it 4D as in worse-than-4C, or 4 D-as-in-dense?


      I have a biopsy scheduled for the coming week, so maybe there's no point in asking.  Whatever it is, it is regardless of what I'm aware of right now.  But I'm anxious.  I have a grade-schooler and a pre-schooler.  I want to coach rec league teams for them this summer--or at least cheer at all their games.  I'll appreciate any guidance you can offer.


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

      On MRI Radial Scars can show both benign and/or malignant features so a follow up mammo and US will be necessary to distinguish from other entities.