Not diagnosed but worried….Input or Advice
Hi there, I'm posting this because I would appreciate some advice. I am very regular with my mammo/Ultrasounds as my sister was diagnosed with breast cancer at 49. I also have 2 aunts that have had breast cancer as well. Both my parents have passed from cancer(not breast). I have never been called back until now. I also had an MRI (routine because of my risk) in August and nothing was seen. I just had a call back due to seeing a distortion. I went in to get a biopsy but they could not see it well enough to warrant the risk of a biopsy. They are requesting an MRI. What I want to know is has something formed between now and last August? (clearly there is something) Do I try and push for a faster MRI because my doc called me and said if you don't hear back from us in 3 weeks, call us. I was thinking I would have an MRI this week?? Are distortions always there or do they just form? I have never had surgery on my breasts. I did have some breast tissue under my armpit removed after it swelled up after I delivered my first baby 28 years ago. Any input or advice would be very helpful. Thank you.
HISTORY: 52-year-old woman presenting for biopsy of a subtle area of distortion on mammogram which partially effaces on spot compression views as well as suspected corresponding small region of hypoechogenicity on concurrent ultrasound. DENSITY: C. This corresponds with ACR category heterogeneous, which may obscure small masses. FINDINGS: BREAST ULTRASOUND Targeted sonographic assessment of the right breast was performed. In the right breast, 10:00 axis, 2 cm from the nipple, is a subtle region of hypoechogenicity measuring 0.5 x 0.4 x 0.4 cm which is difficult to reproduce on real-time scanning and not associated with distortion. Based on adjacent landmarks, this does not definitely correspond to the area of hypoechogenicity measured on recent ultrasound and favored probably benign. Similarly, in the right breast, 9:00 axis, 1 cm from the nipple, is a subtle area of hypoechogenicity measuring 0.3 x 0.2 x 0.2 cm which appears similar location compared to prior although much smaller on today's examination and favored to be partially due to overlapping Cooper's ligament. As this appeared to be similar location compared to the recently described finding, a BB marker was placed over the area and mammographic images were obtained to assess the concordance with the subtle area of distortion. MAMMOGRAM Conventional views of the right breast were obtained after placement of a BB marker. In the right upper outer quadrant, mid depth, more superior and lateral than the BB marker, is a subtle area of possible distortion in the region described on recent mammogram, only visualized on CC view. Unfortunately, prior tomosynthetic were not available to review to confirm. No suspicious mass or suspicious microcalcifications identified. STEREOTACTIC BIOPSY PROCEDURE Given the presence of a subtle area of distortion on CC view, the patient was placed on the stereotactic table for attempt at a stereotactic guided biopsy. Informed consent was obtained in consultation with the patient. The patient was subsequently positioned in prone position on the biopsy table. On initial imaging, a subtle area of possible distortion was noted in the retroareolar region, more medial and inferior than the area of queried distortion on the diagnostic mammogram. Given the depth, this could not be safely targeted from a superior approach. As such, the patient was repositioned and images were acquired from an inferior approach. An other area of mild distortion is noted along the margin of the tissue but not definitely corresponding to the area of distortion on the superior approach images and diagnostic mammogram. IMPRESSION Given the lack of concordance between different views (as described above) and lack of a clear target, a biopsy was not performed. Findings described on diagnostic ultrasound and mammogram of February 5, 2025 are possibly related to overlap of dense fibroglandular or subtle distortion which most entirely efface in the context of a radial scar. Since the findings are of low suspicion, follow-up mammogram and ultrasound are recommended in 6 months and further characterization with MRI is recommended. FINAL ASSESSMENT: BI-RADS 3: Probably BenignRECOMMENDATION(S):
- RIGHT - Breast MRI Other. See interpretation for follow-up timeline
- RIGHT - Diagnotic mammogram and ultrasound in 6 months.
ADDITIONAL COMMENTS: Our department will organize the follow-up mammogram and ultrasound for your patient. However, we asked that you put a requisition for a bilateral contrast-enhanced MRI at your earliest convenience. This can be requested on an urgent basis to ensure prompt imaging.
Comments
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Hi @calmal, I'm sorry that you are dealing with the stress of indeterminate imaging. I would make sure that your doctor orders the MRI so that the radiologists can get another look at the tissue. Mammograms, ultrasound and MRIs all show things differently. It's not an emergency but is definitely something that should be done.
Architectural distortion (AD) is often caused by a radial scar, a benign lesion (not really a scar) that occurs in tissue that is favorable for breast cancer. AD can disappear but sometimes only temporarily. That is probably why they have scheduled you for another mammogram and ultrasound in six months. Radial scars are sneaky since they can hide a tumor from imaging. Most of the time it is nothing to worry about but a 6 month follow up to check is a good idea.
It sounds like your radiologists are following the appropriate protocol. I had AD that didn't show up on a recall mammogram but was given a BIRADS 2 score which does not warrant close follow up. Two and a half years and two mammograms later they finally found a tumor which had probably been there all along. It was stage 2 so even though it had grown it was still considered early stage with a good prognosis.
I sympathize with the frustration of not getting an answer but breast imaging is not perfect. The doctors can't biopsy something they can't find. If you get similar non-answers on your mammogram/ultrasound in six months you could send copies of all the imaging to a radiologist who specializes in breast imaging for a second opinion. My local radiologists are generalists so in retrospect they didn't have the expertise to find what a specialist saw looking back at my previous mammograms.
Hopefully you will get a more definite response from radiology within the next six months. All the best.
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Thank you so much for taking the time to respond. I really appreciate it. I think we all just have to be advocates for our own bodies. Especially when you hear stories like yours where something is there but nothing is really coming up. I'm happy to hear that you still had a good prognosis with yours. I do at least feel good about the fact that when I went for my biopsy appointment where they did 3 more ultrasounds and 3 more mammograms that it was at a world class cancer centre. So hopefully with all the experience they have I am in good hands. I guess we all just want some reassurance when things are not as concrete.
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