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Focal asymmetry not seen on ultrasound but present in mammograms

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lee74
lee74 Member Posts: 10
edited February 2023 in Not Diagnosed But Worried

Hello! I'm so confused after reading my report. It's very generic compared to others I'm seeing posted here. That actually annoys me. I'm not overly worried but I'm not, not worried either.

I'm scheduled for a biopsy next Tuesday. I'm not thrilled about the thought of that.

I've always had dense breasts. If I remember correctly I was told I had cysts about 10 years ago. I switched providers and do not recall those being discussed after any appt. I generally get a call back for an ultrasound of both breasts and sent on my merry way.

My last mammogram was 1/2019. Then w Covid and losing both my ob/gyn and family Dr I fell behind. I wanted a day off work last month so I scheduled my mammogram w the local breast center since I still do not have a family physician. Fully expecting to be called back. Which I was. I went last week not a worry in the world because this is normal for me.


Then I get my diagnostic mammogram and she says I still want you to get the ultrasound. So I do. Still not concerned nor am I really listening to details. She states I have several cysts. Mentions sizes but I don't recall-because I think ok well I've had those before. Then she leaves to talk to the radiologist and returns asking me to schedule a biopsy. Instant fear and blank mind hit.

I see most focal asymmetries are benign but I also read they are normally a birads 3 I'm listed as a 4 no subcategories listed Anyone else have a focal asymmetry only show up on the mammogram? I'm confused that it's not seen in the us I'm irritated that no dimensions nor specifics are listed. Any insight is appreciated. Oh and I am getting a new primary care dr Friday because he has to actually order the biopsy.


Impression

Focal asymmetry in the right breast 12 o'clock is suspicious.

Recommendation:

Stereotactic/tomosynthesis guided core biopsy of the right breast is
advised
from a lateral approach.

BIRADS:
BIRADS - CATEGORY 4

Suspicious Abnormality. Biopsy should be considered at this time.

OVERALL ASSESSMENT - SUSPICIOUS

A letter of notification will be sent to the patient regarding the
results.

Narrative

EXAMINATION:
DIAGNOSTIC DIGITAL RIGHT BREAST MAMMOGRAM WITH TOMOSYNTHESIS; TARGETED
ULTRASOUND OF THE RIGHT BREAST, 1/19/2023 9:44 am

TECHNIQUE:
Diagnostic mammography of the right breast was performed with
tomosynthesis.
2D standard and 3D tomosynthesis combination imaging performed through the
right breast. Computer aided detection was utilized in the interpretation
of
this exam.; Targeted ultrasound of the right breast was performed.

Views: Right CC spot compression and right MLO spot compression views with
tomosynthesis

COMPARISON:
Multiple prior studies, the most recent dated December 16, 2022

HISTORY:
ORDERING SYSTEM PROVIDED HISTORY: Abnormality of right breast on screening
mammogram
TECHNOLOGIST PROVIDED HISTORY:
Reason for exam:->Abnormality of right breast on screening mammogram

FINDINGS:
Right diagnostic mammogram: Breast tissue is heterogeneously dense which
may
obscure small masses. The patient returned for further evaluation of a
focal
asymmetry in the right breast 12 o'clock. The focal asymmetry persists on
today's images.

Right diagnostic ultrasound: Targeted right breast ultrasound was
performed
utilizing high-resolution, real-time scanning. There are scattered simple
and complicated cysts of varying size. The mammographic abnormality is
not
as well seen sonographically.

Comments

  • jelson
    jelson Member Posts: 622
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    can you have your previous mammo and ultrasound results transferred to this new facility so they can evaluate if there have actually been changes of concern.

    good luck with this.

  • lee74
    lee74 Member Posts: 10
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    Jelson,

    • Thank you for your reply.They do have my previous mammograms and ultrasound report. The might be missing one but it would have been my first one years ago. They have the recent ones. That was why they took so long between my first mammogram with them and contacting me with the results. They were waiting for the records transfer. So I am assuming there was a difference from the 2019 one and now.
  • cookie54
    cookie54 Member Posts: 702
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    Hi lee74, Sorry that you are dealing with having a breast biopsy I understand how stressful that is! So yes I see your point regarding the report not being very descriptive. However that varies depending on the radiologist that is reading the study or the overall findings. Sometimes when there is a general area that look asymmetric there is not a specific mass to measure. Where your cysts measured on your mammo? Ultrasound is a good second look at things but there are times when the tissue is dense that can make it difficult to see things also. If your not happy with the report you can request another radiologist to review or another outside opinion. This is definitely a common occurrence when ultrasound doesn't display the area of concern as well and sometimes vice versa. So it's important to at least try to use both imaging modalities even MRI at times.

    Sounds to me that either way the biopsy is needed and it sounds like they know exactly what they are going for. Approach and position is in the report which is good. I hope something I said helps calm your frustration a little. The whole process from imaging to biopsy then waiting for results is stressful. I hope it all goes smoothly for you and you get benign results! Best wishes, hugs.

    Andrea


  • lee74
    lee74 Member Posts: 10
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    Thank you for you kind words. Yes the cysts were measured. I recall her saying different numbers as she was measuring but at the time I was in the mindset that everything would be dismissed and I’d be sent home w my letter that states I have dense tissue come back next year. Because that has been the routine for so many years. Lol. I am happy with the center so far. Just frustrated because I am a researcher by nature. So I like to know all the details. Lol. I want to know exactly what I’m looking at next week. I am going to call today to make sure my new primary dr has access to everything tomorrow. Maybe he will have access to more details to put my mind at ease.

  • lee74
    lee74 Member Posts: 10
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    ok. So I’m confused after reading and reading. If this focal asymmetry has never been seen on previous mammograms should it be called a developing asymmetry? Maybe that’s why it’s a Birads4 instead of 3. I went to the new family dr and unfortunately he wasn’t able to see my mammogram reports from previous years. He requested them but it was Friday so I won’t have any clarification until Monday at the soonest and that’s pointless since the biopsy is Tuesday AM. (Deep sigh)

  • maggie15
    maggie15 Member Posts: 953
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    lee74, Imaging interpretation is not perfect and can vary some by radiologist. Only a biopsy can determine if an area is benign or not. My mammograms over 2.5 years started with birads 0 architectural distortion, birads 2 asymmetric density does not persist, birads 2 stable asymmetric density, and birads 4c increased asymmetric density with fine microcalcifications all in the same location in the breast. When I had an ultrasound guided biopsy the radiologist (and I) could see a sizeable tumor. He was surprised and wondered aloud who had read the "stable asymmetric density" mammogram; it turned out to be him. My breast surgeon was of the opinion that there was an abnormality all along and while it would have been better to have had surgery before the tumor became invasive my prognosis was not dire.

    Hindsight is 20/20 and a biopsy will give you the answer you need. I hope it goes well and you get benign results!

  • cookie54
    cookie54 Member Posts: 702
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    lee74, I understand as I am a researcher also. I'm sure the radiologist will be happy to show you the area of concern on Tuesday. Either way you need a biopsy ,I always say there is nothing like the certainty of a tissue biopsy. At this point that is the only thing that would ease my mind and I hope it eases yours too.


  • lee74
    lee74 Member Posts: 10
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    maybe I’ve been misunderstood. I’m not questioning or doubting the need for the biopsy. I’m not excited for a biopsy or anything but I’m glad it’s being done. I want to know more of what we are dealing with. I want to be more prepared in case the news is the worst. I’m upset that other reports are way more detailed. I would feel much better going into Tue with more details. It’s my fault for not asking more when I was there but I was thrown back because I generally do the follow up US and am told-you just have dense tissue. I was expecting that last week so my mind was not prepared to ask questions plus I had to get back to work. I had planned to ask my family dr questions but since he didn’t have access to the old reports I couldn’t ask him. It’s just my nature to be frustrated with vagueness. One more week and I should have my pathology back on mychart and can move forward however it may be. I am not overly concerned/worried that it will come back bad but that’s why I wish I had more details so I could be better prepared for the results on mychart. I do have a list of questions to ask Tue. But that’s soooo far away. Hahaha. Thanks again everyone

  • lee74
    lee74 Member Posts: 10
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    Broke out in hives yesterday. I was so worried they’d postpone me. But they didn’t 😁 Biopsy done. Now the waiting game. It went well. Just a little sore. My breast feels so heavy too. I hope I don’t swell too much. I’m sure I’ll be bruised by nightfall. I bruise when people look at me wrong. 🤪 I’ll be glad when my fingertips regain feeling. Lol. My hand went numb when they were doing the procedure. Felt asleep but it’s weird that the tips are still numb. Going to lay down and try to nap. Thanks for the support.

  • maggie15
    maggie15 Member Posts: 953
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    lee74, Glad the biopsy is over. After mine I was given little ice packs to put in my bra to help with the bruising and swelling. You could make your own out of little baggies with water, twist tied and frozen. I wore a sports bra and even slept in it. I hope you get your results soon. Keep in touch!

  • alicebastable
    alicebastable Member Posts: 1,945
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    Lee74, do something fun between now and getting your results. I went to a concert the day (well, night) after my biopsy and had a great time! I did hold back on the arm waving on that side 😀. And i was tramping around a state park when i got my results. I still remember the fun of those two days much better than i remember details of the biopsy or phone call.

  • lee74
    lee74 Member Posts: 10
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    thanks for the tip Maggie! I have a friend in another state going Thru the biopsy process for second time this month today also. She tipped me off to some gel packs on Amazon. They arrived a little while ago. I'll be able to slip them in my sports bra nice and discreetly if I'm want them still tomorrow :) I'll be a wreck until they come back but hopefully the are back by Friday. 🤞🏻🤞🏻

    Alice-sadly. No time for fun here. Lol. I go back to work tomorrow. But I slept most of the afternoon today. It’s cold and snowy. Im not feeling well. Terrible headache and the fingers are still weirdly numb.

  • concernedaboutresults
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    Hi Lee74. I had a developing focal asymmetry when comparing my recent mammogram with my mammogram from early 2020. After a diagnostic mammogram and ultrasound with a rating of BIRADS 4c, I also needed a biopsy. Unlike your situation, they were able to see the asymmetry on ultrasound. Waiting for results is, for me, the most difficult part. I hope you get a benign result in your pathology report. The ice packs helped me a bunch! I agree with Alicebastable; finding something fun to occupy your mind is helpful. I had a friend visit from out of town, which took my mind off things for a bit. I also listened to some audiobooks. But, hopefully, work will keep your mind busy as well. Did your doctor give you any indication of when to expect the results?

  • lee74
    lee74 Member Posts: 10
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    Hi! Sorry you didn’t have benign results. I’m trying to stay optimistic and busy as odds are in my favor. But the wait is a struggle. 3-5 business days is what I was told. I’m hoping that’s stretching it to be safe. Nothing today. Work helps but it drug out so slow today. I checked my phone at least every 20 min :( Yes the ice helped last night and today. I haven’t been using it this evening. I feel pretty good but starting to get itchy again. Doesn’t help I had a slight reaction to the bandage. 🤦🏼♀️ Tomorrow I plan to work on some prepping for my craft I sell on the side. Thanks for the kind words of advice!

  • lee74
    lee74 Member Posts: 10
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    That was the absolute second longest wait of my life…first was when they first discovered cysts back in my 30s. Anyways. I can happily report it’s benign. I appreciate all the kind words and advice. I haven’t talked to the drs yet but read my results on mychart.

    Diagnosis:
    Right breast, 12:00, needle biopsy:
    - Fibrocystic changes with apocrine metaplasia, columnar cell change,
    lobular hyperplasia,
    microcysts and stromal fibrosis/hyalinosis.

    Comment: There is no histologic evidence of epithelial atypia or
    neoplasm.

  • maggie15
    maggie15 Member Posts: 953
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    Lee74, Wonderful news! Now you can enjoy the weekend.

  • lee74
    lee74 Member Posts: 10
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    Yes I am relaxed. I do have big questions about the lobular hyperplasia but for the moment I’m all good. That’s what counts today!

  • cookie54
    cookie54 Member Posts: 702
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    Oh that's great news lee74, happy for you!