Birad 4!!
I had my first mammogram on December 12th. It was pretty uneventful and didn't hurt as much as I thought it would, A few days later I got a call saying I had to come back for a diagnostic mammogram and ultrasound which I had done on December 23rd. Unfortunately, I have to have an ultrasound core needle biopsy on January 4th. I'm terrified!! My Mom died of breast cancer nearly thirteen years ago. I'm only 40! I don't know what i'll do if the results are positive. I'd love to get your opinions on my radiology report. I'd like to know if you think the mass being biopsied comes across as benign or malignant. I've copied my radiology report below.
DIAGNOSTIC RIGHT MAMMOGRAM WITH TOMOSYNTHESIS AND TARGETED RIGHT BREAST ULTRASOUND
HISTORY: Recall.
COMPARISON: Multiple prior exams.
VIEWS: Digital spot compression CC, spot compression MLO and true lateral tomosynthesis images of the right breast were performed at 1 mm increments with reconstructed 2D images.
The computer aided detection system was utilized.
Clinical breast exam in the past year: Yes.
BREAST DENSITY: Heterogenously dense fibroglandular tissue, which may obscure small masses.
MASS: The questioned mass is again seen at right 12:00. The questioned nodular density in the central to inferior right breast is less conspicuous on the additional mammographic imaging.
CALCIFICATIONS: No suspicious microcalcifications.
ARCHITECTURAL DISTORTION: No suspicious architectural distortion.
SKIN AND NIPPLE: Unremarkable
OTHER FINDINGS: None.
TARGETED ULTRASOUND
FINDINGS: Targeted ultrasound is performed in the right 12:00 and central to inferior right breast. At right 12:00, 5 cm from the nipple, the 10 x 5 x 7 mm hypoechoic mass likely corresponds to the mass seen on the mammogram. It is mildly lobulated in appearance. An ultrasound-guided core biopsy is recommended. At right 6:00, 2 cm from the nipple, the 3 x 3 x 3 mm hypoechoic mass is well-circumscribed in appearance. A follow-up targeted right breast ultrasound is recommended in 6 months. Scattered fibrocystic changes are noted. No other sonographic abnormality.
LIMITED DUPLEX DOPPLER: No internal vascular flow within the right 12:00 mass.
IMPRESSION: INDETERMINATE MASS AT RIGHT 12:00. AN ULTRASOUND GUIDED CORE BIOPSY IS RECOMMENDED.
PROBABLY BENIGN MASS AT RIGHT 6:00. A FOLLOW-UP TARGETED RIGHT BREAST ULTRASOUND IS RECOMMENDED IN 6 MONTHS.
IF THE ABOVE RECOMMENDED BIOPSY RESULT IS BENIGN, FOLLOW-UP RIGHT DIAGNOSTIC MAMMOGRAM AND TARGETED RIGHT BREAST ULTRASOUND ARE RECOMMENDED IN 6 MONTHS.
THE FINDINGS AND RECOMMENDATION WERE DISCUSSED WITH THE PATIENT AND TAYLOR FROM MS. PALAZZO'S OFFICE. THE PATIENT HAS BEEN SCHEDULED TO RETURN FOR THE RECOMMENDED BIOPSY PROCEDURE ON 1/4/2021.
RECOMMENDATIONS: Ultrasound guided core biopsy with follow-up right diagnostic mammogram and targeted right breast ultrasound in six months.
BI-RADS: 4, Suspicious. Under MQSA guidelines, results were provided to the patient.
Comments
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Hi Booknerd - sorry that you're having this scare. It's really impossible to say. BIRADS 4 means 23-34% chance of the lesion turning out malignant; or 66-77% chance of it being benign. https://breast-cancer.ca/4biads5/
Imaging can only take us so far and we simply will not know until the pathologist looks at your slides and figures out what the cells are.
Hope for the best, distract yourself as much as you can.
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A BI-RADs 4 is assigned by the radiologist whenever he/she assesses the risk of cancer, based on the appearance of the imaging, to be anything more than 2%. Anything with a >2% risk is recommended for biopsy. So basically if a radiologist feels that a biopsy would be advisable, then a BI-RADs4 will be assigned. Most often when a radiologist recommends a biopsy, it is to rule out cancer, not because cancer is suspected. This is why such a high percentage of BI-RADs4 biopsies are benign, as moth mentioned.
From your report, I believe it's the combination of hypoechoic and mildly-lobulated that is driving the recommendation for a biopsy. That could be a description of a malignant mass, but it could also describe various benign conditions. From the imaging it's impossible to know exactly what it is, and that's why the biopsy is necessary. What is positive on your report are the terms "No suspicious microcalcifications", "No suspicious architectural distortion" and "No internal vascular flow". To my understanding, if any of those things were associated with this mass at 12:00, that would increase the risk that the mass might be cancer, so the absence of all 3 is a good sign. That said, the only way to know for sure is when the tissue from the biopsy is examined under a microscope.
Good luck with the biopsy. I've had lots of biopsies over the years and I've found ultrasound guided core biopsies to be the easiest because you can lie down relatively comfortably rather than being contorted with your breast in a machine. Just be aware that the core needle is loud - it sounds like a staple gun!
Try not to worry - which I'm sure is hard given your family history with your mother - but you are not your mother and this is a completely separate and different situation. Let us know how it goes.
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I cannot really add to what moth and Beesie have said. Just want to welcome you and say I'm glad you found us here. There is so much support and information on this site as I'm sure you've seen already. Please let us know how the biopsy goes and certainly once you get results... You'll be undergoing that right around the corner now - it will be here and over before you know it. do what you can to distract, enjoy and relax during the waiting times (now and while waiting for results) as difficult as that can be....
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Hi BookNerd80,
Going through this after losing someone to breast cancer is so hard. I was 20 when my mother died from breast cancer and 39 when I was diagnosed. The feelings and fear were intense.
Well, hopefully for you it ISN'T cancer, but I'm here to tell you that even if it is, it's definitely not your mother's cancer. Mine turned out to be early stage and very treatable.
Take care of yourself and hang in there.
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I don’t have much experience with this but wanted to post to tell you that you are in my thoughts and prayers for a benign diagnosis. My ultrasound and diagnostic mammogram are also BIRADS 4. ((HUGS)) to you and to us all.
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Hi everyone,
Sorry I haven't posted in a few days. Everyone's reaponses have meant so much to me! I had my biopsy this morning. Now, the waiting game begins.
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Booknerd - I'm so sorry you are going through this. Wishing you the best. Please keep us updated on your results.
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Hi there, going thru the same, ultrasound a birads 4a, tomorrow morning I have core needle biopsy so glad to get that over with and then the waiting game.
auratba
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auratba, Booknerd had her biopsy in early January and unfortunately never returned to tell us the results. Usually when that happens, it means that the results were benign. Hopefully your's will be too! Good luck tomorrow!
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Hi... as a palliative oncology nurse, being here is both 'meh, whatevs, same old' combined with 'I'm flurping petrified!' I'm going out of the area for follow up.
Normal screening mammo in April, with lots of density, but no call-back. 4 weeks later developed spontaneous serosanguinous discharge from single duct in left breast. Not constant, but daily, and during the night. No lumps, bumps, or external changes. Without a follow-up appt I was referred for ultrasound. Results are Bi-RADS4, without a letter, and including the verbiage "probably a papilloma".
I requested a CD of the imaging. Last night while reviewing the imaging, I noticed that there was also something significant in my right axilla (armpit)... significant enough that the u/s tech marked it, and checked it for vascular activity, and it lit up like fire!
My questions are, what the heck is going on with my right breast, and why was it not even addressed in the report? Also, I've not yet come across a Bi-RADS4 post with stories similar to mine (the discharge)... is this a more prevalent finding when malignant?
(I may cross-post this is I discover a more appropriate thread)
Thanks, anyone
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Welcome NurseLiz! I am not one of the knowledgeable medical folks on here so really can't answer your questions? I have seen a number of people with somewhat similar stories come back with a papilloma as you mentioned.... I hope that's true in your case.... As far as the report - not related to breast cancer though I've had my own issues with important things not being included in reports... it's maddening! I am of two main beliefs about that - one is medical folks are just overworked, too busy, etc. etc. and rushing to get reports out is part of the reason for omission - not intentional. I also believe sometimes things are intentionally omitted so as not to worry patients until there is a real concern - such as when they want to monitor things more before making a concern more official. Not sure what to make of that in your case... may be more the former? Either way I'd be asking questions... have you contacted the radiologist about this yet?
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BookNerd....any update?
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BookNerd has not signed in since January and only made two posts. I am hoping that like most people who post while they are undergoing imaging or biopsies that everything turned out well and we never hear from them again. Not that we wouldn’t like to hear from her but those who turn out not to have bc often cease posting.
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