Unclear Wording - Asymmetry/Distortion "possible"
Hi everyone. I had my first mammo in 2021, when I turned 40, no issues or callbacks. I went back for my second in Dec of 2022 and 3 days before Christmas got the call that they needed to take more images and a diagnostic mammogram was required.
Mid-Jan 2023 I went in for my diagnostic - after waiting for the radiologist to review the outcome with me, they moved me to an ultrasound room and the radiologist performed an US as well. I'll paste what it says my report below, but she's sending me for a biopsy because she "doesn't like where it's located" - but my report isn't clear on what "it" is - it's a "possible" asymmetry/distortion - and I'm going a little crazy here because it feels like there's such a range of possibility.
The report from the original mammogram says "possible asymmetry." The report from the diagnostic mammo says "possible asymmetry/distortion." The US report says "possible architectural distortion felt to represent a correlate for the mammo." And then the final impression that says "asymmetry/distortion" without the possible but again no clarification.
Where the heck is "possible" on the probability scale? Is it architectural distortion or asymmetry or both? It's new compared to last year's baseline. I haven't had any breast surgeries or traumas that would imply it might be a lesio from one of those. But it feels like an asymmetry and an architectural distortion have FAR different potential outcomes when comparing the two - and I'm going batty trying to understand why they labeled it so inconsistently. And the US correlate has me worried. Of course it's BIRADS 4, but with no letter to quantify their confidence level.
They sent me to the breast surgeon first. He said in his notes that after reviewing the images and performing the breast exam, he feels that a biopsy is required. I have my biopsy scheduled for this Thursday (and I have literally not slept in the 3 weeks since the mammo and US) and it will be sometime next week I get results.
Anyone else see this type of thing on their report? And what did it turn out to be?
Report:
Call back for possible left breast asymmetry.
Digital spot compression, 90 degree lateral, and rolled craniocaudal views of the left breast were obtained with CAD interpretation. Digital breast tomosynthesis with C-View was performed. Comparison is made with prior breast imaging studies. There are scattered areas of fibroglandular density. Questioned possible asymmetry/distortion seen in the outer left breast 10 cm from the nipple persists on additional craniocaudal projections. It is not seen on the 90 degree lateral view and in retrospect not clearly identified on the MLO projection.
Targeted ultrasound evaluation of the left breast was performed, lateral breast, 10 cm from the nipple. At 2:00 10 cm from the nipple there is an ill-defined area of shadowing and possible architectural distortion measuring approximately 0.8 cm in size, felt to represent a correlate for the mammographic finding. Remainder of the lateral breast is unremarkable.
Impression: Indeterminant area of asymmetry/distortion in the lateral left breast with likely sonographic correlate at 2:00 for which breast surgery consultation and tissue sampling is recommended. Biopsy can be performed under either stereotactic or sonographic guidance.
Comments
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Dear waitingistheworst1981,
Welcome to the BCO community. We are sorry that these changes in your breast health have brought you here but glad that you reached out for help. You are right that waiting for answers is the worst. Most here will say the same. Here is a link to a resource page that tries to offer more information on Common Imaging Questions such as you have posed. We hope it might offer some clarification. Good luck with the biopsy and keep us posted on how things go and what you learn. We are here for you.
The Mods
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waitingistheworst1981, BIRADS 4 can be anywhere from a 5 - 95 % risk of malignancy which, as you said, really tells you nothing. Most cases of BIRADS 4 turn out to be benign. Biopsies are ordered because they are the only way of telling what the cell tissue looks like. All types of images on mammograms and ultrasounds could be benign or not which is why they do biopsies. You can tell by my diagnosis line how mine turned out but I have friends (who are not on this site) who received similar reports and ended out having fibroadenomas, cysts and other benign lesions. Thursday is coming soon and you will then have another short wait for the pathology report. Try to distract yourself by keeping busy, doing fun activities during down time, and staying away from Google. Best wishes for benign results and let us know how it turns out.
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Thanks to those who responded. I had my biopsy last Thursday and pathology came back today. I wanted to update for anyone else who might come across my post when falling down the Google rabbit hole after their own abnormal diagnostic appointments.
Unfortunately, I've joined the club no one wants to be in. The doctor called today to tell me that my biopsy shows Invasive Lobular Carcinoma. ER and PR positive, waiting on FISH results for HER2 as it came back equivocal. I don't meet with him until this Thursday to talk about a treatment plan and path forward, but he did say he's sending me for an MRI first to check the right breast as this kind of cancer is more likely to show up in both breasts rather than just one.
Good news is we caught this super early. I say a thankful prayer to the two radiologists (Dr. Den and Dr. Little) who didn't like what they saw in my diagnostic results and helped get this caught early. Prognosis is as good as it can be, so now I get ready to fight!
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Hi Waitingistheworst, I'm sorry that you have to join the rest of us here but I'm glad your radiologists were proactive. It sounds like your doctors are on top of things if they are sending you for an MRI since ILC is sneaky. I had IDC rather than ILC but also had to wait for FISH results which turned out to be "no amplification." Once you know what you are dealing with you and your doctors can make a treatment plan. Things somehow feel better when you are moving in a definite direction but there will be more waiting and maybe some unexpected surprises along the way.
When you know the treatment plan there are many different threads that deal with all kinds of relevant topics. It's very useful to get the input and support of others who have dealt with a similar diagnosis and treatment. Best wishes going forward!
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