BI-Rads 4 MRI - So scared
I’m 43 years old with very dense, fibrocystic breasts. My mom had breast cancer at age 40, she had a mastectomy on her left side and has been cancer-free for 33 years. I have been monitored closely because I seem to have a lot of cysts and fibroadenomas. Can someone look at my MRI and tell me their thoughts? What is weird is it looks like the mass in question has been shown on my ultrasounds since 2017. Are they just being extra cautious? I have been called back a few times for calcifications and lumps, but never a Bi-Rad 4. I’m trying to stay calm, but I’m so scared
2022 MRI
Addendum
Signed by Virginia M Molleran, MD on 1/11/2022 3:11 PM** ADDENDUM: #1 **
ADDENDUM 1/11/22
ASSESSMENT:
BI-RADS CATEGORY (4) suspicious. Biopsy should be considered.
RECOMMENDATIONS:
Right Diagnostic breast ultrasound if there is no sonographic correlate for the right breast mass, then MRI guided biopsy may be required.
Left: Return to annual mammogram schedule due in June 2022
Left: Routine screening breast MRI in 1 year
Electronically Signed by: Virginia Molleran, MD, 1/11/2022 3:11 PM
Study Result
Impression
Potentially new 6 x 5 x 4 mm mass at the 11:00 position of the right breast. Ultrasound is recommended for further evaluation.
No MRI findings concerning for malignancy on the left.
ASSESSMENT:
BI-RADS CATEGORY (4) suspicious. Biopsy should be considered.
RECOMMENDATIONS:
Right Diagnostic breast ultrasound
Left: Return to annual mammogram schedule due in June 2022
Left: Routine screening breast MRI in 1 year
Electronically Signed by: Virginia Molleran, MD, 1/10/2022 5:09 PM
Narrative
** ORIGINAL REPORT **
MRI-BREAST BIL W/WO CON performed 1/10/2022 8:53 AM
INDICATION FOR EXAMINATION: Z91.89: Other specified personal risk factors, not elsewhere classified
Additional order information:-> 43-year-old with family history of breast cancer in her mother at age 40. History of a left breast excisional biopsy for fibroadenoma 1996. Patient is BRCA mutation negative.
COMPARISON: Bilateral breast MRI performed 12/5/2019, 9/25/2017. Mammography and ultrasound performed 6/30/2021 and prior.
TECHNIQUE:
Multiplanar T1 and T2 weighted images were obtained prior to and post uneventful intravenous injection of Contrast Medication(s):
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION
Amount Administered = 12 mL. The color-flow dynamics, maximum intensity projection and time intensity curves are reviewed. The images were obtained using a dedicated breast coil on a 1.5 Tesla or greater magnet.
FINDINGS:
There is mild background enhancement bilaterally.
BREAST COMPOSITION:
Extreme fibroglandular tissue.
RIGHT BREAST: There is an irregular heterogeneously enhancing mass with mildly increased T2 signal at about the 10:00 position the right breast in the posterior third measuring 1.5 x 0.8 x 0.7 cm, best seen in its entirely on STIR images (sagittal image 60 and axial image 61). This is not significantly changed compared earlier studies and probably correlates with the mass at the 10:00 position 5 cm the nipple on previous ultrasounds.
Multiple asymmetrically prominent foci of enhancement are seen in the upper right breast. This is similar to 2017.
There is a 6 x 5 x 4 mm irregular enhancing mass at the 11:00 position in the middle third with mildly increased T2 signal (axial image 64 and sagittal image 72). This is not clearly present on the earlier studies
There is no evidence of abnormal chest wall, pectoralis or axillary enhancement.
2020 Ultrasound
FINDINGS: There are abnormalities at 1:00 3 cm from the right nipple, 3:00 2 cm from the right nipple, 10:00 5 cm from the right nipple, 11:00 3 cm from the right nipple. These are stable and unchanged from several prior exams.
The lesion at the 1:00 3 cm from the right nipple measures 6 x 3.2 mm, at 3:00 2 cm from the right nipple measures 6.9 x 3.1 mm, at 10:00 5 cm from the right nipple measures 16.2 x 8 mm, at 11:00 3 cm from the right nipple measures 6.6 x 4.9 mm. The abnormalities remain stable and unchanged for over 2 years and further follow-up is therefore not indicated.
ASSESSMENT:
BI-RADS CATEGORY (2) Benign
Comments
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I'm not expert enough to reflect on anything specific. I'd just say that birads 4 is the lowest required for insurance to pay for a biopsy. I think it's fair to think of it as:
Birads 4: Doctors don't think it's cancer but they can't rule it out without a biopsy and want to be safe rather than sorry
Birads 5: Doctors think it's cancer but can't confirm it without a biopsy
I don't know what's in your doctor's head, but cautiousness could totally explain it.
You have the hopeful example of your mother surviving, and know that treatments have progressed even further since she was treated. Even if it is cancer, the odds for cancer detected by screening (as yours was) of being early stage is very very high. Early stage means that odds are that a person will get to die of something else.
It's scary for sure but hang in there - you have plenty of reasons to be clearly-eyed optimistic.
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The only way to know for sure is to have the biopsies. However, the lesion seems to be really small. Thank God they found it though, right? I know it's so scary right now, but maybe it isn't cancer, and, if it is, you will find all the answers on these boards. You can get thru it. You really can.
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As Salamandra said ' I'd just say that birads 4 is the lowest required for insurance to pay for a biopsy". That's exactly what I was thinking. And it's only an ultra sound that he is recommending at this point.
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