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Interpreting Your Report

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  • stuckinohio
    stuckinohio Member Posts: 11
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  • minustwo
    minustwo Member Posts: 13,153
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    Note : DCIS is not malignant. In many cases it is classified at stage "O" - zero. I had a mastectomy with DCIS because I could not continue to deal call backs every 6 months on mammograms. But it's is my understanding that many docs will not operate if it's "ONLY" DCIS. Hope your reports come back good.

  • amusingsoprano
    amusingsoprano Member Posts: 77
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    @minustwo DCIS is non-invasive but is still malignant. Because of that it has the potential to become invasive. Once researchers figure out which versions of DCIS are likely to turn invasive then the specialists can be more discerning about treatment.

  • stuckinohio
    stuckinohio Member Posts: 11
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    My doctor says mine will be removed. The mass is palpable and decent sized for DCIS and she is concerned it will potentially end up being upgraded after surgery because of the features of the lesion.

  • mspaws
    mspaws Member Posts: 5
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    hi. this thread is very insightful. thank u all. can anyone help with the following terminology. maybe you have seen them on your report. need to know if it increases risk. the pathology is from a duct excision where a single duct was removed after lesion seen on ultrasound with bloody nipple discharge. previous lumpectomy 2 yrs ago for fibroadenoma.

    dilated ducts contain macrophages and red blood cells. apocrine blebbing with cystic change. Focal Epitheliosis with no cytological atypia.

  • melrxse
    melrxse Member Posts: 1
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    Hi all, my mom (50 yo) recently had a mammography which requested additional imagining and I would really appreciate if you help us interpret these results:

    Mammography:

    Abnormal mammography. Asymmetry in the right breast has a differential diagnosis of fibroglandular tissue and appears indeterminate.

    Ultrasound of right breast:

    There is a 1 cm oval mass with a circumscribed margin in the right breast at 9 o'clock anterior depth. This oval mass is hypoechoic with a well-defined boundary. This correlates with mammography findings. Color flow imaging demonstrates that there is an adjacent vascularity.

    Impression:

    Probably benign. The 1 cm oval mass in the right breast is consistent with a fibroadenoma and appears probably benign. Follow-up mammogram and ultrasound in 6 months is recommended to determine stability.

    Thank you so much for any insights!

  • kaynotrealname
    kaynotrealname Member Posts: 410
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    Hi Mel! They don't think there is anything to worry about with your mother but to make sure they want to check her again in six months. Very routine.

  • jessicargrimes
    jessicargrimes Member Posts: 8
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    Hi! New here and scared. I went to HerScan for a screening ultrasound and got back this

    Hypoechoic area 8:00 right breast 3-4 cm from nipple measuring about 14 mm. Adjacent
    complicated cystic density measuring about 13 mm. Complicated cystic density 1:00 left breast 2-3
    cm from nipple measuring about 10 mm. Cystic density with septation 6:00 left breast 2-3 cm from
    nipple measuring about 17 mm. Recommend consult physician and consider additional diagnostic
    imaging. Moderately dense tissue

    My U/S and Mammo from 2021 was all clear -so this coming up is scary and Im not sure what to make of this. I am 43 with no 1st degree relatives with breast cancer. No signs or symptoms. I was just going to get screened.

    My PCP has put in for a follow up Mammo and U/S to get more clarity.

    How worried should I be?

    Im really very scared right now.

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,950
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    The words, unfamiliar and medical speak, certainly can be frightening, I think that you have little to worry about. First let me say that we are not doctors and, more importantly, not your doctor. The questions you have are best directed toward your own doctor.
    You are simply being asked to have some follow-up imaging that may help clarify whether those areas of density need to be explored further. Imaging is not perfect and it is very common for folks to be called back for different/additional imaging. The vast majority of them turn out to be nothing. I won’t tell you not to worry but keep it in perspective i.e. additional views are needed to clarify the situation. That is all you know right now and that in itself is predictive of nothing! No guarantees but there’s simply no reason to jump to worst case scenarios based on what you currently know. Take care

  • jessicargrimes
    jessicargrimes Member Posts: 8
    edited January 19
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    As far as my report- is an area the same as a mass or a cyst? The phrase Hypoechoic area has me confused. There was no information on borders, measurements ( tall vs wide) or anything. Same with Cystic density with septation - is that an area? A cyst? I thought ultrasounds would give much more info on these areas.

  • kaynotrealname
    kaynotrealname Member Posts: 410
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    Hypoechoic simply means an area that is denser than the surrounding tissue. It could be anything including benign tissue.

  • minustwo
    minustwo Member Posts: 13,153
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    Jessica: There is a difference between a plain screening mammogram and a diagnostic mammogram. The diagnostic will show much more detail, as will the ULS. Impossible I know, but try not to worry yet.

  • jessicargrimes
    jessicargrimes Member Posts: 8
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    This was an ultrasound. I went for an ultrasound at a place called Herscan, which does ultrasound for breast screening . that’s why I’m kind of confused because people normally get mammograms and then if there’s questions they get sent for an ultrasound. Well, I didn’t get a mammogram. I just went and got an ultrasound but it seems like it’s lacking and some information.

  • goldleaf
    goldleaf Member Posts: 2
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    Hi all - hoping for some feedback/insight. I’ll be 32 next month, and have been doing regular MRIs and mammograms for the last couple of years. My mother was diagnosed at 32 and died at 34, and three or four great-aunts on her side of the family had breast cancer (two of whom died from it).

    They’ve regularly requested 6 month MRI follow ups for me due to findings on my left breast. My last MRI was October 2023. I recently changed providers and new provider requested a diagnostic ultrasound and mammogram due to findings from Oct 2023 MRI, as well as doctor feeling a lump in left breast. Completed mammo & US February 15, 2024 with no suspicious findings (just simple cysts).

    However, I was due for my 6 month follow up MRI as well, so I completed that Feb 24, 2024. Due to some sort of mix up, the results were automatically released to me Feb 25 without the radiologist and/or my dr reviewing them. My dr is out of town, and I met with a NP yesterday who seemed very concerned but wasn’t able to provide additional interpretation. I’ve scheduled my mri guided biopsy at the first available (a little over 2 weeks).

    I know that there’s nothing to be done until the biopsy is completed, that we need more data, and that many biopsies are benign. However, are you kindly able to provide additional insight into how concerned I should be about my results? Thank you in advance.

    IMPRESSION: Marked background enhancement limits the evaluation subtle underlying findings. Suspicious focal non mass enhancement in the right breast measuring up to 2 cm at the 1 o'clock position. Within the limitation of marked background enhancement, there are no suspicious findings in the left breast Normal bilateral axillary lymph nodes. Bilateral cysts with the largest in the left breast. Recommendations: MRI guided biopsy of focal non enhancement breast position. BI-RADS category 4, Suspicious right breast. BI-RADS category 2, Benign left breast.

    Narrative

    EXAM DESCRIPTION: Bilateral breast MRI without and with contrast dated 02/24/2024. CLINICAL HISTORY: High-risk screening. Family history includes: Mother with breast cancer at age 32, 3 maternal great aunts with breast cancer. Menarche at age 11. The patient is nulliparous. The patient is unsure if she has had testing for the breast cancer gene mutation. TECHNIQUE: PULSE SEQUENCES: Multiplanar, multisequence MR images of the breast were obtained on a 3.0 Tesla MRI imaging scanner. Coronal T2. Pre-contrast axial T2 fat-saturated, pre-contrast non-fat saturated T1, and one pre- and six post-contrast fat-saturated images were obtained of both breasts together with the breast coil. Post-processed subtraction and MIP reconstructions were then generated. Dynamic images were spatially registered using the Confirma Cadstream software package, and dynamic curves and parametric images were evaluated. As part of the dynamic portion of this examination, 5.5 mL of gadobutrol was administered intravenously at a rate of 2 mL/sec, without complication. Field of view for the dynamic portion of this study was 34 cm. COMPARISON: Mammogram 02/15/2024, MRI 10/18/2023 FINDINGS: The technical quality of this study is considered adequate to make a final assessment and recommendation. There is heterogeneous fibroglandular tissue bilaterally and marked background enhancement. Coronal T2 sequences demonstrates normal bilateral axillary nodes. Axial T2 sequence bilateral simple cysts with the largest in the left measuring up to 9 mm. Non fat saturated T1 sequence demonstrates no fat containing lesions. High resolution post contrast sequence demonstrates no internal mammary lymphadenopathy. Regarding the right breast: There is non-mass enhancement at the 1 o'clock position, 5cm from the nipple with focal distribution and heterogeneous internal enhancement and measures 2 x 2 x 0.5 cm. This is best seen on post contrast dynamic image 119/171. Kinetic assessment demonstrates fast initial enhancement followed by washout in the delayed portions of the curve. Regarding the left breast: There are no masses, architectural distortion or suspicious areas of enhancement.

  • moderators
    moderators Posts: 8,184
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    Hi @goldleaf and welcome here. We're so sorry for all you and your family have gone through.

    Indeed as you say, it's really not possible to say anything without a biopsy. We understand just how difficult the waiting is!

    Have you or other family members had genetic testing?

    Here is a page on BI-RADS that could be helpful: https://www.breastcancer.org/screening-testing/mammograms/bi-rads-results

    Please know you're not alone. We're all here for you!

    The Mods

  • salamandra
    salamandra Member Posts: 745
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    I know from experience how nerve wracking this is. MRIs are known for being extremely sensitive though, and producing false positives. The anxiety roller coaster is the trade off for the screening sensitivity - once they see something, they are duty bound to biopsy.

    I had MRI screenings for a couple of years and one MRI biopsy that was benign.

    I know it's easy to say and impossible to do, but do your best not to worry. From my completely amateur understanding, a birads 4 from an MRI screening might be the least alarming route to a biopsy. Hang in there - hoping for the best for you!

  • goldleaf
    goldleaf Member Posts: 2
    edited February 27
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    Thanks @moderators ❤️ I’ve read all the things, but just wish I had a better sense of what to expect! I have done genetic testing twice - most recently in 2022 when I tested for all known genes linked to cancer. Both times were negative, but they advised I retest every 3-5 years due to advances in technology / ability to test more genes.


    thank you @salamandra ❤️ it’s certainly the trade off with MRIs! I was just telling my fiancé that possibly the hardest realization is that even if the biopsy is benign, it’s unlikely this will be the last time I go through it - given that I (hopefully) have many many more years of MRIs and mammograms ahead of me hah.


    I’ll keep y’all updated with my results in a few weeks.

  • moderators
    moderators Posts: 8,184
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    Completely understandable, @goldleaf. It is encouraging that there are frequent advances in the technology and knowledge around genetics. It's good to hear that so far you've tested negative both times with regards to the genetic tests.

    Holding you in our thoughts while you await the results! Thanks so much for keeping us in the loop. 😄

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,950
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    mitchalisa,

    I am so sorry you find yourself in an stress provoking situation. Let me start by saying we are not doctors and not your doctor. It is generally not a great idea for non-medical personnel to interpret a report written by doctors for doctors. Unless you are a trained radiologist, I think it is also not a great idea to decide by yourself if the Birads score should be updated, regardless of how much Googling you’ve done.
    While it is very difficult to wait for your biopsy, that will be the only thing that gives you a definitive answer. Nothing in the imaging results will be able to tell you if you have cancer, only the biopsy. Please stay away from Dr. Google, as he is a dreadful diagnostician. I know the fact that you have nothing definitive to go on leaves you in a stressful place, but speculating and trying to guess what might be going on is simply adding to it. Right now, you know you are going to have a biopsy. Beyond that, there is simply not enough info to conclude anything. Take care

  • moderators
    moderators Posts: 8,184
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    Hi @mitchalisa,

    Seconding @exbrnxgrl. We know how anxiety-producing this waiting period is, but to interpret these results, one really needs to be a trained radiologist. They may need additional information to further determine how to proceed going forward as well. The best suggestions we can make to manage the anxiety during this time until you hear back from your medical team is to try to stay busy to distract yourself and use mindfulness techniques when those intrusive thoughts come in. For most, it's always in the back of their minds to some degree.

    A guided meditation that is free and fairly good is one from a social worker named Belleruth Naparstek.

    Please let us know as you get more information! We'll be keeping you in our thoughts. ❤️

  • starryeyedstarr
    starryeyedstarr Member Posts: 1
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    Hello! New here and hoping someone can help me digest my US report and let me know if I should ask for a biopsy or wait 6 months for my recommended follow-up?

    HISTORY:  Call back right breast asymmetry.

    COMPARISON:  Screening mammogram 2024

    FINDINGS:

    Mammogram:
    Tissue Density:  There are scattered areas of fibroglandular density.

    There is a persistent asymmetry in the upper inner right breast that was evaluated with ultrasound. No suspicious distortion or microcalcifications.

    Ultrasound:  Targeted ultrasound of the right 1-4 o'clock axis of the right breast was performed.

    Within the right breast 1 o'clock axis, 9 cm from the nipple is a 0.6 x 0.3 x 0.5 cm oval hypoechoic, complicated cyst versus mass which corresponds to the finding on mammogram. No suspicious findings on ultrasound also in the visualized regions.

    ASSESSMENT:  BI-RADS Category 3:  Probably benign.

    FOLLOW-UP:  Follow-up imaging evaluation in 6 months.

  • minustwo
    minustwo Member Posts: 13,153
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    StaryEyed:

    Sorry as the Mods posted, the BCO member who was a radiologist has stepped away from the boards. It's unlikely that the rest of us would be able to override the recommendation you have been given. We do understand how upsetting this is since we've all been there, but if you are unsure, probably the best thing is for you to ask for a 2nd opinion from one of your doctors. Personally I went to my OB/Gyn after the mammo for a 2nd opinion and she recommended that I make an appointment for the 6 month follow up - BUT we are all different and it's important you talk to your personal docs.

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,950
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    staryeyed,

    I second minustwo’s post. None of us are doctors and, more importantly, not your doctor. A second opinion is a good idea. Take care

  • bossmom24
    bossmom24 Member Posts: 49
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    Can anyone help? I am newly diagnosed and very confused about the size of my tumor. Diagnostic ultrasound says:

    ULTRASOUND
    Ultrasound of the area of palpable lump was performed. This was localized to the right breast 9:00, areolar margin. An irregular hypoechoic hypervascular mass is seen with a hypoechoic tail extending all the way to the nipple measuring 5.3 cm in maximal length. Measurements of the mass itself were 3.8 x 2.0 x 1.8 cm.


    Is it 3.8 or 5.3?? That makes a big difference in staging since I also have an affected lymph node. I really don’t understand. I’m just scared and grasping for straws hoping it’s not as big as they think.

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,950
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    bossmom,

    I am going to re-iterate that I’m a retired teacher so take what I have to say with a generous grain of salt ! It seems to me that the 5.3 cm length is a measurement of the hyperechoic tail that extends to your nipple. As noted, 3.9 x 2.0 x 1.8 is the mass itself. Again, I have no more expertise in these things than any other non-medically trained person.
    I know that you are very stressed and anxious and want definite information but the process is slower than most of us would like. Worrying about every little detail, especially the unknown ones, may add to your stress and inform you of nothing until they are known. Take care

  • moderators
    moderators Posts: 8,184
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    Hello @bossmom24,

    We understand your anxiety. The waiting period is so difficult. You are stuck without knowing what to expect or be able to take any proactive steps (whether it be learning more about the specifics of your cancer, or the treatment approach you'll be going through). Like @exbrnxgrl said though, without being medically trained, it would be difficult for others to probably provide much clarification for you. Have you considered joining a support group in the meantime while you await the results? It can be helpful to at least be among others who are going through a similar experience and will be able to understand you in a way that would feel unique. We do have free weekly meet-ups on Zoom that you could try out. We have the details available here, where you can also register:

    Please let us know as you get additional updates. We'll be here to support you the best that we can! ❤️

  • kaynotrealname
    kaynotrealname Member Posts: 410
    edited April 23
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    Hi Boss! This sounds similar to what I was described having so I'll tell you what it meant in my case. The mass I had was measured by an ultrasound to be 1.8 cm. However, the total area of concern around it which included some calcifications was 3.6 cm. So to me, it seems like what they're saying is your actual mass is 3.8 cm but there is a tail on the end of it and with that tail included it is 5.3 cm. Now in saying that, what you are given is simply estimations. Nothing is final until pathology although the last we heard from you, you just went for your biopsy today. Have you already gotten results?

    By the way for the record, my total mass upon pathology was 3.2 cm so my cancer was much larger than the mass seen on ultrasound but smaller than the total area of concern. However, nothing else changed really from the biopsy results. And also, there are two systems of staging breast cancer and you can be at different stages based on your tumor makeup. So after surgery, because of my size increase in one staging system, I went up from 1A to 2A but in the other I only went up to 1B. There is a lot that goes into it. Again thinking of you and wishing you so much luck!!!!

  • bossmom24
    bossmom24 Member Posts: 49
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    Thank you for the replies. I am hoping that only one node is involved at this time so the size of the mass would make a difference if I am in stage 2 or 3. I asked the radiologist but she seemed perplexed too. That the palpable mass was one size but she saw the “disease extending”.

    This is just hell. Praying I can beat this as I have 4 young kids ages 1-11. They need their mom

  • bossmom24
    bossmom24 Member Posts: 49
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    oh I did get the biopsy done today in the mass and the 1 node, but I won’t have results for 24-48 hours. It just happened to be the same radiologist that did the exam yesterday so I tried to clear up some questions about the report.

  • kaynotrealname
    kaynotrealname Member Posts: 410
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    Ah. Well just to let you know staging isn't exact due to the two staging systems. If your lump does come back cancerous, regardless of lymph node status and size, the makeup of the lump will be taken into consideration. For instance, Liz O'Riordan a UK breast cancer surgeon, was diagnosed in 2015 with a stage 3 breast cancer. When the new staging system came out (I think in 2019) she was actually classified as 1B and this was with three involved lymph nodes. So again, there is no way to predict anything now. Once you get your biopsy report, if needed, we can help you understand what it means though.