BI-RADS 4 after being given the clear, feeling scared.
Hi, I’m 36F — I posted here before with a lot of IBC related fears. I have bad health anxiety and everyone here was so kind. I was given the clear by my doctor, but my left breast remained persistently swollen, painful, and red. My doctor told me she felt that this was too ambiguous and we should get an MRI to finalize things.
My left breast is fine, but they found something in my right breast. The last time I had that imaged was in February via ultrasound, but I know MRI is more sensitive than ultrasound. I’ve had a bilateral mammogram before too, but that was last year
Below is my report. Just looking for some support.
FINDINGS:
The amount of fibroglandular tissue is C: Heterogeneous fibroglandular
tissue. The background parenchymal enhancement pattern is A: Minimal. The enhancement pattern is symmetric. A fiducial overlies the left 3 o'clock periareolar breast at site of the skin related lesion. There is no suspicious underlying enhancement within the breast parenchyma at site of the fiducial. Please note that evaluation of the actual skin would be below the resolution of breast MRI.
In the right superior breast posterior depth is indeterminate nonmass enhancement measuring 1 cm (series 31201 image 57). Biopsy is recommended.
There is no
additional dominant suspicious mass or non-mass enhancement in either
breast. There is no skin thickening. The nipple areolar complexes are
symmetric. There is no suspicious adenopathy in the visualized axillary regions or along the internal mammary chains.
IMPRESSION :
INDETERMINATE RIGHT BREAST ENHANCEMENT FOR WHICH BIOPSY UNDER MRI GUIDANCE
IS RECOMMENDED.
NO SUSPICIOUS ENHANCEMENT WITHIN THE BREAST PARENCHYMA AT SITE OF THE SKIN RELATED LESION. AS REPORTED ABOVE, EVALUATION OF THE ACTUAL SKIN WOULD BE BELOW THE RESOLUTION OF BREAST MRI. THE NEED FOR FURTHER MANAGEMENT OF THE SKIN RELATED LESION WILL NEED TO BE CLINICALLY DETERMINED.
BIRADS: 4: SUSPICIOUS ABNORMALITY - BIOPSY SHOULD BE CONSIDERED.
RECOMMENDATION: MRI guided right breast biopsy x1. Clinical follow-up for
the left breast skin related lesion.
I’m nervous and just looking for some support. I know sometimes this happens— findings in the breast you didn’t expect. Thank you ❤️
Comments
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Greetings & empathy go out to you while you're frustratingly wondering & waiting. It's very difficult to guide someone with a highly complicated ambiguous overall presentation (including a skin related lesion).
However, a non-mass enhancement could be simple normal related tissue or it could possibly be in situ or pre-cancerous tissue, for example. Only those doctors seeing your images & examining your biopsy tissue would be able to comment intelligently.Re. your recent thread:
https://community.breastcancer.org/en/discussion/comment/5848804#Comment_5848804
On this topic you may need to seek a new 2nd/3rd opinion from an unrelated new source.There may or may not necessarily be a palpable mass for a BC diagnosis. Sometimes clinical findings are overlapping. Possibilities could also relate to infection, hypersensitivity reactions or chronic inflammation on your skin lesion.
For comparison, see below on typical MRI features. Best wishes 🥰
PURE DUCTAL CARCINOMA IN SITU: A RANGE OF MRI FEATURES
https://www.ajronline.org/doi/full/10.2214/AJR.07.3779MRI FEATURES OF DUCTAL CARCINOMA IN SITU
https://radiologykey.com/mri-features-of-ductal-carcinoma-in-situ/MRI FEATURES OF INFLAMMATORY BREAST CANCER
https://www.ajronline.org/doi/full/10.2214/AJR.10.61570 -
Thank you very much for your reply. It does seem that the issue in my left breast has resolved; I sought three separate opinions on it and it’s not enhancing on MRI. The biopsy came back as an infection.
But the enhancement is surprisingly in my right breast, so it is a good thing that the issue with my left breast pushed me toward the breast MRI!
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Flower, a blessing in disguise. It's wonderful your other breast issues finally resolved. Here are more detailed possibilities (LCIS = in situ). Your upcoming biopsy should give you some answers. Best wishes!
LOBULAR CARCINOMA IN SITU OF THE BREAST: CLINICAL, RADIOLOGICAL, AND PATHOLOGICAL CORRELATION
"Conclusion: LCIS can have associated imaging abnormalities, most commonly grouped amorphous calcifications on mammography, a shadowing, avascular, irregular, hypoechoic mass on US, or heterogeneous non-mass-like enhancement with persistent enhancement kinetics on MRI."
https://www.ncbi.nlm.nih.gov/pubmed/23498988THE RADIOLOGICAL FEATURES, DIAGNOSIS AND MANAGEMENT OF SCREEN-DETECTED LOBULAR NEOPLASIA OF THE BREAST: FINDINGS FROM THE SLOANE PROJECT
https://www.ncbi.nlm.nih.gov/pubmed/27060553If anyone is found to have LCIS, "over the last decade, there have been a substantial number of re-excision cases due to resection margin involvement by LCIS."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929262/FEATURES OF PURE LOBULAR CARCINOMA IN SITU ON MAGNETIC RESONANCE IMAGING ASSOCIATED WITH IMMEDIATE RE-EXCISION AFTER LUMPECTOMY
"The majority of nonmass LCIS lesions in our study showed a regional, focal distribution, or heterogeneous internal pattern..."
"Nonmass LCIS lesions or moderate-to-marked background parenchymal enhancements on MRI can result in an underestimation of the extent of the lesions and are associated with subsequent re-excision due to resection margin involvement."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929262/IMAGING SPECTRUM OF LOBULAR CARCINOMA IN SITU AND CORRELATION WITH PATHOLOGY FINDINGS
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590558/0 -
@obsolete Thank you so much for this information. All of it sounds so scary. Do you know if MRI-guided biopsies are also timed with your menstrual cycle, the same way the diagnostic/screening breast MRIs are? Sitting with this uncertainty for a month seems challenging.
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It could also potentially be a benign papilloma or a benign complex sclerosing lesion, as further examples. You can do this, Flower. The waiting is the hardest. In the interim, you may wish to ask a nurse navigator at your hospital about your questions or a nurse in your doctor's office.
If you read the following link, it explains some possibilities further. Just food for thought while you're waiting. Hugs.NONMASS ENHANCEMENT ON BREAST MRI: REVIEW OF PATTERNS WITH RADIOLOGIC-PATHOLOGIC CORRELATION AND DISCUSSION OF MANAGEMENT
https://www.ajronline.org/doi/full/10.2214/AJR.14.12656
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@obsolete thank you! Yes, it seems like all the benign possibilities are visible on ultrasound. I had a bilateral ultrasound in February and it only showed cysts in both breasts that were determined benign, hence my understanding that this is likely malignant.
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