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I’m not sure what to make of my report

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fiveoclock
fiveoclock Member Posts: 8
edited March 2021 in Waiting for Test Results

I was assigned a Birads 4, and without a letter I understand it to mean 23-34%ish. But there’s some unfavourable language in the report so I’m curious as to what anyone else’s take might be.

Findings: On additional mammography cases videos, the asymmetry in the outer right breast persists with lobulated margins. The asymmetry in the posterior outer left breast is effaced, likely overlapping breast tissue.

Complete bilateral breast ultrasound performed.

Right Breast:

9 o’clock position 6 cm from the nipple a heterogeneous lobulated hypoechoic nodule with posterior shadowing measuring 1.2 x 0.7 x 0.1 cm.

10:30 o’clock position 5 cm from the nipple a hypoechoic module which appears taller than wider measuring up to 7mm, indeterminate solid nodule versus a complicated cyst.

12 o’clock position 1 cm from nipple a heterogeneous hypoechoic nodule measuring 5mm, focal fat versus intramammary lymph node. It measures up to 5mm. No axillary lymphadenopathy.

Left Breast:

9 o’clock position 6 cm from the nipple a simple cyst measuring around 6mm.

2 o’clock position 4 cm from the nipple a benign appearing hypoechoic modular area measuring 8mm, likely focal fat lobule. No axillary lymphadenopathy.

Impression:

Persistent lobulated asymmetry in the outer right breast. Lobulated hypoechoic nodule at 9 o’clock position could be sonography correlate. Given the constellation of findings, recommend referral to Tertiary Care Centre for ultrasound guided core biopsy. Hypoechoic nodule at 10:30 o’clock position of the right breast, complicated cyst containing debris versus indeterminate solid nodule. It appears slightly taller than wider. This should also be targeted for Radiologist supervised second look ultrasound. Simple cyst in the left breast.

Birads 4.

Comments

  • moth
    moth Member Posts: 3,293
    edited March 2021
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    I think it's impossible to say but I know how tempting it is to speculate. Bottom line is imaging can't tell us everything. They use a 4 or more for everything that might need a biopsy (I believe you need a birads4 in the US to get insurance to pay for biopsy). Until the pathologist looks at the slides, I would try to forget about it.

    When is your biopsy scheduled? The waiting for it and the results is sucky. You need to find a good netflix show or podcast or something to get sucked into :D

  • fiveoclock
    fiveoclock Member Posts: 8
    edited March 2021
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    Thanks moth. No biopsy scheduled, yet, though my doctor put the referral in on Saturday or Monday. I’m in Ontario, Canada - I’m not sure what the wait time looks like currently. I hope to get a call within the next day or two.

  • moth
    moth Member Posts: 3,293
    edited March 2021
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    Hello fellow Canuck! Waving from sunny Vancouver :P

    Hope your snow crap is settling down & you hear from your clinic soon!

  • fiveoclock
    fiveoclock Member Posts: 8
    edited March 2021
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    Vancouver! Nice! Yeah we’ve got a ton of snow down and it’s awfully chilly, but Spring is just around the corner!

  • LivinLife
    LivinLife Member Posts: 301
    edited March 2021
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    Hey fiveoclock! Just hoping you get scheduled soon for the biopsy. Waiting is difficult indeed so as moth said find some relaxing and/or enjoyable ways to distract yourself until the biopsy and then again while waiting for results.... Best and please keep us posted..!

  • fiveoclock
    fiveoclock Member Posts: 8
    edited March 2021
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    This afternoon I noticed an appointment booked in my patient portal, for this afternoon. I was in the portal two or three times earlier waiting for biopsy to be scheduled and it wasn’t there, so I knew something was wrong. The appointment was for “bi second opinion mammo” and it told me what time to be there and how early to check in, So I called them, and they said it was just because the original pics weren’t from the hospital so they have a hospital radiologist review the images and that I didn’t have to be there. It was basically a work order assigning my pics to a radiologist who then has has 7-14 days to document their own findings. Then the radiologist books the biopsy. I guess that’s protocol? But then I’m thinking we might get a subcategory of A, B or C and I’m curiousto know what the radiologist thinks the likelihood something more sinister is happening.

  • LivinLife
    LivinLife Member Posts: 301
    edited March 2021
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    I had my first appointment with a surgeon (general surgeon). All my mammos, biopsies and MRI testing was done at that hospital. When I moved to where I was actually going to have surgery with a new surgeon they requested everything, including my biopsy slides, be sent (4 hours away). this is pretty normal - they want to see with their own eyes images, scans, tissue, etc. Otherwise they would want to repeat it and insurance would be unlikely to pay for all of that again so soon - let alone putting patients through more. I would consider this normal - deep breaths....they are doing their due diligence.... This is a good thing...

  • fiveoclock
    fiveoclock Member Posts: 8
    edited March 2021
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    Thanks for your reply. It is a good thing. I got the report from this radiologist this afternoon, and I'm upgraded from a 4 to a 4C. Whereas the first radiologist suggested ultrasound guided core needle biopsy, this radiologist is suggesting tomosynthesis first, followed by targeted ultrasound (not sure what this is) and then the ultrasound guided core needle biopsy.

  • 2019whatayear
    2019whatayear Member Posts: 468
    edited March 2021
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    It sounds like the doctor wants to take some images and do a quick ultrasound before doing the biopsy. Once the biopsy is over then they also do a mammogram to make sure they can see the little clip they put in where they biopsy as well

  • fiveoclock
    fiveoclock Member Posts: 8
    edited March 2021
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    Thanks for explaining that, 2019 - it helps

  • zebra_co
    zebra_co Member Posts: 35
    edited March 2021
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    fiveoclock, Is your biopsy scheduled yet? I hope you get all your questions answered by your medical team

  • fiveoclock
    fiveoclock Member Posts: 8
    edited March 2021
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    Thanks @Zebra_co - it was just scheduled today, actually! March 19th - which is two whole weeks away. :( I'll go in the morning for a 3D mammogram and another ultrasound (to try to get a better look at another possible area that may be suspicious - they're not confirming what they already see, from my understanding). Then in the afternoon I go back for the biopsy. Because I'm in Ontario, we actually see results in our patients portal the moment they're available, so I'll be able to see results myself I'm guessing by Monday or Tuesday of the following week.

  • LivinLife
    LivinLife Member Posts: 301
    edited March 2021
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    Yikes fiveoclock - on 4 to 4C - that sounds concerning.... Glad they are doing due diligence then with additional scanning prior to biopsy.... Good that you'll be able to see results right away too - the waiting is so hard though sometimes getting the results without a provider to talk with right away can be harder for some folks.... Thanks for the update... Try to enjoy your weekend!

  • fiveoclock
    fiveoclock Member Posts: 8
    edited March 2021
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    Because my tests were done at an outside centre and not the hospital, the images were transferred to the hospital and reviewed by their radiologists and I got this report:

    MAMMOGRAM:

    ACR C: The breast tissue is heterogeneously dense, which may obscure small masses.

    There is an equal density single view asymmetry seen within the middle to posterior third of the right outer breast on the CC mammogram with no definite correlate identified on the MLO view. There is an additional area of questioned architectural distortion within the middle third of the right central breast along the posterior nipple line only seen on the CC view, however this may be positional.

    There is no worrisome mass, area of architectural distortion or calcification seen within the left breast.

    ULTRASOUND:

    Is note static ultrasound images are of limited diagnostic quality.

    Corresponding with the mammographic finding at the 9:00 position 6 cm from the nipple is an ill-defined hypoechoic mass which measures 12 x 7 x 10 mm. Appearances are indeterminant and tissue sampling is warranted.

    Findings within the right breast include:

    1. Right breast 10:00 position 5 cm from the nipple,? Complicated cyst measuring up to 7 mm

    2. Right breast 12:00 1 cm from the nipple likely complicated cyst measuring up to 5 mm

    Findings within the left breast include:

    1. Benign-appearing cyst at the 9:00 position 6 cm from the nipple measuring up to 6 mm

    2. Likely complicated cyst at the 2:00 position 4 cm from the nipple measuring up to 7 mm

    There is no worrisome adenopathy depicted within either axilla.

    IMPRESSION:

    43-year-old female with an indeterminant mass seen within the right breast for which ultrasound-guided core biopsy is recommended for definitive diagnosis. At the time of the patient's return I would suggest right breast tomosynthesis for further assessment of the above-described questioned architectural distortion, followed by right breast targeted ultrasound and ultrasound guided core biopsy. This will be arranged by our department.

    For the other likely benign findings described above, further management recommendations will be made pending right breast biopsy results.

    BI-RADS 4C

    Now my ultrasound guided biopsy is scheduled for March 19th following a 3D mammogram and another ultrasound. I just want to know, already. I’ll be okay if it’s cancer, but I just want to know. I don’t know if I should be preparing for a diagnosis or preparing that I won’t be diagnosed. I don’t know what to do with myself. The waiting sucks

  • LivinLife
    LivinLife Member Posts: 301
    edited March 2021
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    That's a lot of info fiveoclock.... I really can't offer feedback - just don't know about these kinds of things... hopefully others will jump in at some point. Try not to perseverate too much on all this - as hard as that is.....