Focal Non Mass Enhancement with Washout Kinetic Enhancement
Hello- I'm back again…I have dense breast tissue (48y/o) and finally advocated my way to an MRI approval. In January I had my annual mammogram which was clear (I've had 4 biopsies over the last 8 years, so it's rare that it's completely clear). However, I'm in peri-menopause and have had left side arm-pit pain (right where my arm-pit meets my breast) on and off for the last year (the pain surges with my cycle, decreases during different phases, etc.). The way that I can accurately explain it, is that it feels like a clogged milk duct that I would get when nursing my daughters many years ago.
After the clear mammogram, my doctor called and recommended that I get an ultrasound on the area that was bothering me to check it out. During the ultrasound, that area looked fine, but the doctor noticed a mass (she felt it was another cyst based on presentation and said she felt comfortable waiting 6 months for a follow-up; I did as well because it presented just like the other cysts that I had biopsied over the years). After that appt, I was referred to a breast specialist; she conducted a risk assessment score and I was approved for the MRI. I had my MRI on 5/1, today I received the following report. I actually was proud of myself and waited to open the report in my chart until the doctor called (I had a feeling it wouldn't be straight forward, as this is my baseline MRI). This is the report and I have a biopsy scheduled for 5/15. I work in the medical field (on the research side) and of course I googled a few things. Overall, it sounds like IF this is something, it's small (caught it early) and may likely be easily treated. Something ductal may also explain my armpit pain/that clogged duct feeling? I'm also thinking (despite the washout enhancement), that this could be hormonal. I have very fibroid filled breasts.
Any advice would be greatly appreciated for others who had a nonmass enhancement with washout. I am preparing myself for whatever the biopsy news brings, but I have had BIRADS-4 in the past which turned out to be a cyst. I think the washout enhancement is what is making me nervous. The other mass is the one mentioned above that she found via u/s that we weren't concerned about.
BI MRI BREAST WITH AND WITHOUT CONTRAST (BILATERAL)Additional patient information: Elevated lifetime risk of developing breast cancer with strong family history. High risk screening.
TECHNIQUE: MR imaging of the breasts was performed using T1, T2 and fat-saturated
techniques. Dynamic multiphase imaging was also performed after
administration of intravenous gadolinium contrast agent. Computer
generated 3D reconstruction and enhancement kinetic analysis was
utilized by the radiologist in the interpretation of this examination.
COMPARISON: Comparison is made with relevant prior imaging. Breast composition: Heterogeneous fibroglandular tissue.Background parenchymal enhancement: Marked.
FINDINGS:
Right: There are no suspicious masses or areas of abnormal non-mass enhancement in the right breast.There is no axillary or internal mammary lymphadenopathy on the right.
Left: There is a 5 mm focal nonmass enhancement in the upper central breast at
middle depth demonstrating washout kinetic enhancement (axial image 113
sagittal image 153). In the upper outer posterior breast there is a 9 x 8
9 9 mm circumscribed enhancing mass (axial image 119, sagittal image
161). The delayed postcontrast images demonstrate dark internal
septations. This likely corresponds to the probably benign mass seen on
ultrasound from March 7, 2024 at 1:00 8 cm from the nipple and likely
represents a fibroadenoma.There is no axillary or internal mammary lymphadenopathy on the left.
Other: There are subcentimeter T2 hyperintense nonenhancing lesions in the liver likely cysts or biliary hamartomas.
IMPRESSION:
1. Focal nonmass enhancement in the left upper central breast for which MRI guided biopsy is recommended.
2. Probably benign mass in the left upper outer quadrant likely a
fibroadenoma corresponding to the mass seen on ultrasound from March
2024. If the biopsy results are benign, follow-up imaging with
ultrasound is recommended as per the ultrasound report. This will be due
in September 2024.
3. No MRI evidence of malignancy in the right breast.
BI-RADS 4 SUSPICIOUS
Please note that mammography offers complementary information to MRI and
certain findings may be visible primarily on mammography. The patient
should keep all scheduled mammography appointments and continue annual
screening mammography. The breast imaging department will contact the patient to schedule the recommended biopsy.Results and recommendations were communicated to the referring provider via the EPIC secure messaging system.
Comments
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Sorry that you find yourself concerned and I hope that like your other biopsies, this turns out to be benign. I am not an oncologist nor radiologist nor are our members (well, if some are, they’re not giving medical advice/interpretation) and do not know what washout enhancement is. The waiting stinks but the biopsy is going to give you the pertinent information. Until then, it would be darn near impossible for us to hazard a guess. So my advice is to wait until you know the findings of your biopsy rather than speculate based on the experiences of others. I hope your biopsy can be scheduled without much delay. Take care
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