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BI-RADS 4 Hypoechoic mass with increased flow

Good morning, yall! This is my first post and I've been doing lots of research because that's what I do when I'm anxious. For well over a year, I've gotten random spots on my breasts that become abscessed. I'm terrible about being proactive on medical care so I've ignored it, figuring it's from a bra rubbing wrong or something but it continued to happen, even in areas that aren't getting 'friction'. I finally went to the doctor and they treated me for internal staph infection, which didn't help. The doctor then ordered a diagnostic mammogram with ultrasound, which is my first mammogram. I am 41 years old. I've received my report on my health portal and follow up with my doctor on Tuesday, which suddenly feels so far away. I'm sure he'll just go over results and order a biopsy.

Technique: Limited directed ultrasound of left breast was performed

Findings: At the 6:00 position of the left breast in the superficial subcutaneous skin there is a elongated hypoechoic area with increased flow measures 3.9 cm in length by 4.7 mm in thickness.

Impression: Consider further evaluation with biopsy of the superficial hypoechoic mass with increased flow left breast at 6:00 position.

My mammogram report read the same pretty much with added Assessment: BI-RADS Category 4 Consider further evaluation with biopsy.

Is anyone familiar with a report like this? I've read many others, which seem much more specific. I'm thankful it's just the one spot, which is the area that is currently abscessed, but naturally, I'm now a bit anxious about it.

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Comments

  • maggie15
    maggie15 Member Posts: 551

    @melintn , I'm sorry that you have to deal with the stress of a biopsy recommendation. Your observation that there is not as much detail as other reports is correct. BIRADS 4 in general means anywhere from 5% - 95% chance of malignancy, quite a wide range. However, the chances are very good that you will have a benign result.

    Waiting is hard but an inevitable part of the breast diagnostic process. A breast abnormality is not a medical emergency like a heart attack so it takes time to get appointments and then the results. It's easier said than done but try not to worry about the worst case scenario. Keep busy to try to distract yourself. Let us know the eventual result. I hope you get good news!

  • melintn
    melintn Member Posts: 9

    Thank you for your reply. Tomorrow I'll be seeing my PCP and he'll go over the results and order the biopsy, I'd imagine. The timing couldn't be better as the spot is hurting more than previously. I'm hoping he will at least drain it, as I leave for a mission trip on Thursday and I don't want it hindering the work that I need to get done. With the position of it (underside), there is constant pressure on it and radiating pain at times that feels like needles poking inside of me. With this being a continual issue, I'm at the point I just want an answer as to the cause so that it can be prevented in the future. Yes, the waiting is the most difficult. Tomorrow, I'm hoping to get more details besides the vague report I've received.

  • maggie15
    maggie15 Member Posts: 551

    @melintn , I hope your PCP is able to do something to relieve the pain before you leave on your mission trip. There is usually a bit of a wait when scheduling a biopsy (sound familiar?) since they often use ultrasound or mammography to guide the needle.

    I used to live in Ardmore TN. I've lived many places over the course of my life but that was one of my favorites. Thanks for the update and hopefully you'll get more details tomorrow. All the best for a successful mission trip!

  • melintn
    melintn Member Posts: 9

    Well, my pcp didn't receive my results but luckily, I had them on my phone from the patient portal from where I had the imaging done. He did say "That's an odd report", as he read it. He sent a referral to a surgeon, as he thinks it's best to have this 'spot' removed. I showed him a photo of the active spot/abscess/whatever and he sent in a different antibiotic to the pharmacy to try. So now I wait for the surgeon to call to set up the first appointment. I just wish I knew why this keeps happening, on my breasts only. It's not just the pain that affects me, but it's kinda gross as it's continually expelling fluid and has an odor. I was hoping he'd drain it, lance it, something but I suppose patience is a virtue, that I need to learn.

    Thank you for the well wishes! We head out in the morning to the Appalachia. I've got bandages packed and gauze. I looked up Ardmore and it looks like a lovely little town!! I am a bit further north but in a small town as well.

  • melintn
    melintn Member Posts: 9

    I went to see the surgeon yesterday and he has me coming back tomorrow morning for another ultrasound so that he can be there and see it live. He did say to expect a possible needle biopsy, which I do hope he does. He said my symptoms resemble granulomatous. In my research, I see that granulomatous is diagnosed by ruling other things out so that's where we're at today. 🤷‍♀️

  • maggie15
    maggie15 Member Posts: 551

    It would be good to have a biopsy since that is the only way to determine what is causing the symptoms. Let us know how it goes. Hopefully it will be benign. I hope your mission trip was successful.

  • melintn
    melintn Member Posts: 9

    I'm normally pretty (too much) passive but I think I'm going to insist on a biopsy tomorrow and not 'we might do one'.

    And thank you so much! The trip was our first, and lifechanging. I pray it was for those we ministered to but for myself, my husband, my daughter in law and my teen daughter, it opened our eyes and has caused much contemplation and a growth and hunger that I pray never ceases to exist within each of us. I wish I could share the stories but I know this isn't the place for it. 😀

    I'll update tomorrow!

  • melintn
    melintn Member Posts: 9

    Just returned from my appointment. The surgeon looked at the inflammed spot on ultrasound and said it is at surface level now so no biopsy was done. He said to continue the last two days of doxycycline and do warm compresses. I'm thankful that he isn't concerned, but I do wish I had answers as to why I keep getting abscessed spots on my breasts only. I'll be more proactive and be sure to be seen with each spot that comes up, instead of self treating at home, in order to eventually get answers. Until I get some sort of diagnosis, I don't know how to prevent it from happening, and it seriously affects me. Thank you, Maggie, for talking me through this!!

  • maggie15
    maggie15 Member Posts: 551

    I'm glad the surgeon decided the inflamed spot was not worth a biopsy but you do have a real problem. Just by chance yesterday I saw an article on granulomatous mastitis by Tami Burdick who published a book Diagnosis Detective: Curing Granulomatous Mastitis. GM mimics breast cancer but can be caused by a certain bacteria or have no identifiable cause. It sounds like what you have been dealing with.

    https://www1.racgp.org.au/getattachment/7673db4c-2b2a-4222-aa56-475025ee15b1/Granulomatous-lobular-mastitis.aspx

    It's rare and having had a few rare conditions myself I know how hard it is to find someone to diagnose and treat since few doctors are familiar with it. I don't know where in northern TN you are but possibly some big cancer centers such as Vanderbilt, U of Kentucky Lexington and Wake Forest may have a breast specialist who deals with this.

    All the best finding a diagnosis and a treatment!

  • melintn
    melintn Member Posts: 9

    Thank you, Maggie. I now have a new spot, less than half an inch from the last spot of concern. It's super inflammed and almost to the point of pussing. I was able to get an appointment with my pcp for today at 1, so hopefully once he sees how quickly this is reoccuring, he'll send me to some sort of specialist. The whole bottom of my breast is now red and scarred and to wear a bra or have any sort of pressure on it hurts quite badly. Last night I started to run a slight fever and I'm not sure if it's related. I'm unsure if I still have a fever, as I am still drinking my morning coffee. I do hope, in a way, that I have a fever when I get to the doctor so that maybe they'll do more to figure this out. It's just painfully frustrating. I'll update after my appointment today.

  • melintn
    melintn Member Posts: 9

    So I went to my pcp today and after reviewing the images and reports, he thinks it might be hidradenitis suppurative. He gave me a 20 day run of doxycycline and a steroid shot. He'd sending in a referral to a dermatologist. Both of the 'suspected' diagnosis sound like I'm in this for the long haul, but I'll just be happy to put a name to it so I can then process and deal.

  • maggie15
    maggie15 Member Posts: 551

    I hope the dermatologist is able to figure out the cause. HS doesn't look much easier to cure than GM, but HS seems to occur in regions other than the breast. I hope you get an appointment soon.

  • melintn
    melintn Member Posts: 9

    I'm hoping so too, Maggie. The spot has opened now and is draining but it's now a big open hole and a 'tunnel' that is under my breast. Thankfully, I found a Facebook group for HS and I'm %99.