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Feeling confused and concerned

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Hi there,

I’m a recently turned 40 year old woman in Colorado, USA. I went in on April 10 for my screening mammogram and was called back due to a focal asymmetry in my left breast at 3 o’clock posterior depth, approximately 7cm from nipple. There was no mass noted in the screening mammogram.

This morning I went in to follow up (after two weeks of Covid- awful!) and had a diagnostic mammogram and ultrasound. The mammogram did show the asymmetry in question. The tech showed it to me, and it’s really small in appearance, at least according to my untrained, optimistic eyes. :)

They were unable to locate it on the ultrasound. The radiologist mentioned it may be a lymph node but couldn’t definitively say. He did say he wasn’t terribly concerned and that we could follow it in 6 months time or biopsy it and that he recommended to go for the biopsy. I agreed to move forward with it and scheduled for next Friday, May 12.

I am confused, I guess, as it what it could be, as there was no mass seen on either the mammogram or ultrasound. I’ve read about DCIS and IDC but am unsure if either of these could be a possibility.

The radiologist gave me a BI-RADS 4. Is that for insurance to cover the biopsy itself? Would it have been a 3 if I rejected the biopsy and just did the 6 month follow up?

Did I do the right thing here moving forward with the biopsy?

I’m worried as I’m a stay at home mom and care for my young son who has cerebral palsy and epilepsy.

Here is the copy/paste of my report from today. Thank you all so very much for your kindness, information, advice, and support. I mean that. Thank you.

Study Result

Impression

New left breast focal asymmetry without sonographic correlate.

BI-RADS 4: Suspicious

RECOMMENDATION:
Biopsy of the left breast with tomo guidance.

Findings and recommendations were discussed with the patient at the time of the exam.

The American Cancer Society, US Preventive Services Task Force, American College of Radiology (ACR) and the Society of Breast Imaging agree that the most lives are saved by starting annual mammograms at age 40. Catching more cancers early by starting yearly screening at age 40 - rather than less frequent or later screening - increases the odds of successful treatment and can preserve quality of life for women. The ACR supports the American Society of Breast Surgeons recommendations that women start getting annual screening at age 40. The American College of Radiology is pleased that the American Society of Breast Surgeons has reaffirmed their support of this most sensible approach.

This examination was interpreted by a fellowship trained Breast Imaging Radiologist.

WS: CEDENLAH-IMG755
DICTATED BY: (removed for their privacy) Date: 05/03/2023 11:19 MT
TRANSCRIBED DATE: 05/03/2023 11:43 MT

Narrative

LEFT DIGITAL DIAGNOSTIC MAMMOGRAM WITH TOMOSYNTHESIS AND 
TARGETED LEFT BREAST ULTRASOUND

INDICATION: Left breast focal asymmetry recall.

COMPARISON: 4/10/2023 and additional exams dating back to 2020.

TECHNIQUE:
Diagnostic mammographic views were obtained per departmental protocol.
Tomosynthesis images were obtained.
Computer-aided detection (CAD) was utilized in the interpretation of this examination.
Targeted Left breast ultrasound.


MAMMOGRAM:
There are scattered areas of fibroglandular density.

Focal asymmetry persists with spot compression imaging. This is new since the 2020 mammogram.

ULTRASOUND:
Physician-directed targeted left breast ultrasound was performed.

There is no solid or cystic mass or suspicious sonographic finding seen in the mammographic area of concern at 2:00-4:00, 7 cm from the nipple.

Comments

  • cookie54
    cookie54 Member Posts: 658
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    @maggieh3 Sorry you find yourself here with a questionable mammo. I think since this is a new area of concern that was not seen in 2020 it's worth a biopsy. It states it is still seen on the magnified spot compression view. It is a good thing they don't see a definitive mass but probably better to err on the side of caution. Many breast biopsies do turn out to be benign but early detection is the key. Bi-RADS 3 is a probably benign category so yes if they are recommending a biopsy it needs to be a Bi-RADS 4.

    • BI-RADS 3 (probably benign): ≤ 2% malignancy risk
    • BI-RADS 4A (low suspicion): >2% to ≤10% malignancy risk
    • BI-RADS 4B (moderate suspicion): >10% to ≤50% malignancy risk
    • BI-RADS 4C (high suspicion): > 50% to < 95% malignancy risk
    • BI-RADS 5 (probably malignant): ≥ 95% malignancy risk

    Try your best to stay off Dr Google because that could really send you down a rabbit hole and stress you out. Sending positive vibes and good wishes for a negative biopsy.

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,747
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    cookie’s post said it well, especially about firing Dr.Google. Insurance coverages vary though the common thresholds for covering biopsies is BI-RADS 4 or 5. However, I don’t believe whether or not one has a biopsy or even has medical insurance would change how BI-RADS is calculated as that is a pathology/medical evaluation. I will add that since part of the evaluation involves interpretation by a radiologist or other doctor, some interpretations of biopsy samples can differ. Take care

  • salamandra
    salamandra Member Posts: 736
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    "The radiologist gave me a BI-RADS 4. Is that for insurance to cover the biopsy itself? Would it have been a 3 if I rejected the biopsy and just did the 6 month follow up?"

    I would assume yes. That is based on reading about the experience of other women here. Insurance will cover only for a 4 or 5. Since you wanted a biopsy, he had to give it a 4. Since he gave you the option of waiting and monitoring, my assumption would be he would have labeled it a 3 if you had rejected the biopsy option.

    I think you did the right thing. If it's something, you'll be glad you caught it. If it's nothing, you'll be glad they can mark it off in their charts/records and you can go back to a regular mammogram schedule.

  • flowergirl1975
    flowergirl1975 Member Posts: 54
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    Yes definitely get a biopsy! I had a BIRADS-4b and it turned out to be DCIS with microinvasion. If your biopsy shows that its nothing then at least you have peace of mind. If on the off chance it is something, well then you caught it early. As far as the biopsy itself goes it's not a bad procedure, I had little pain. Best wishes to you, hopefully its nothing :-)