Seeking Advice for MRI report - I wasn't expecting this curveball
Hello
Yesterday I received a MRI w/wo contrast for both breast. I am high risk and haven't had an MRI since 2021 but had a mammo this past Feb '25, mammo/US Jan '24.
I was surprised to get my report so quickly yesterday and then was like WHAT THE?! I have had many call backs on mammo/US over the years and have had ALH diagnosed on the L in 2018. In 2018 I received an excision biopsy. THIS is the first time a MRI has ever had a report than …… nothing suspicious.
Can anyone make heads or tails from the below excerpt?? I am really concerned about IMPRESSION 1 & 2. I got a call from the breast center and they only said that I would be called to schedule more views in about a week, If I hear nothing then reach out……
THANKS FOR ANY Information/Understanding.
Left breast: Enhancing complex cystic and solid mass within the central slightly inferior left breast at the middle depth measuring 1.3 x 1.0 x 1.1 cm (AP x TR x CC) (series 8, image 69) with washout kinetics.
Non-mass enhancement within the central superior left breast at the middle depth measuring 1.2 x 0.4 x 0.7 cm (AP x TR x CC) (series 8, image image 92) with mixed kinetics including plateau.
There are 2 areas of ring enhancement within the lower outer left breast at the middle depth at the 4 o'clock position measuring 0.6 x 0.6 x 0.9 cm (AP x TR x CC) (series 8, image 63) and in the central inferior breast at the 6 o'clock position measuring 0.5 x 0.4 x 0.8 cm (AP x TR x CC) (series 8, image 62) with persistent kinetics, which may represent evolving fat necrosis.
Enhancing mass within the lower inner left breast at the middle depth measuring 0.7 x 0.4 x 0.5 (AP x TR x CC) cm (series 8, image 56) with associated T2 hyperintensity and primarily persistent kinetics.
Prominent focus within the central inferior left breast at the middle depth measuring 0.4 x 0.3 x 0.5 cm (AP x TR x CC) (series 8, image 51) with associated T2 hyperintensity and mixed kinetics including washout.
Otherwise, multiple similar enhancing foci, likely representing background parenchymal enhancement.
A few benign cysts are visualized.
There is no suspicious left axillary or internal mammary adenopathy.
Calcifications within the bilateral axillary lymph nodes produces magnetic susceptibility. These lymph nodes appear similar dating back to 2023's mammogram.
Incidental findings: No significant extramammary findings.
IMPRESSION:
1. Suspicious complex cystic and solid left breast mass at the 6 o'clock position at the middle depth measuring 1.3 x 1.0 x 1.1 cm. Recommend MRI guided ultrasound for further characterization with possible biopsy. If no sonographic correlate is identified, recommend MRI guided biopsy.
2. Indeterminate enhancing left breast mass at the 8 o'clock position 4 to 5 cm from the nipple (series 8, image 56) and prominent focus within the left breast at the 6 o'clock position 4 to 5 cm from the nipple (series 8, image 51). Recommend MRI guided ultrasound for further characterization.
3. There are 2 probably benign areas of ring enhancement within the left breast at the 4 o'clock position 5 cm from the nipple and 6 o'clock position 4 cm from the nipple, which may represent evolving fat necrosis. Recommend further evaluation with diagnostic ultrasound. If no sonographic correlate is visualized, recommend short interval follow-up with MRI in 6 months to ensure stability.
4. Non-mass enhancement in the central superior left breast, which may represent background parenchymal enhancement. Recommend short interval follow-up with MRI in 6 months to ensure stability.
5. No evidence of malignancy in the right breast.
6. No suspicious axillary or internal mammary lymphadenopathy.
BI-RADS 0 - Incomplete: Needs additional imaging evaluation
Comments
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Hi @casm, We are fellow patients, not radiologists, so can't give you a professional medical opinion. Imaging cannot diagnose cancer; only a biopsy examined by a pathologist can.
Different types of imaging show tissue abnormalities in different ways. MRI is the best type of imaging for finding abnormalities especially in dense breasts but gives a higher percentage of false positives. Ultrasound seems to be the best modality for deciding whether the breast tissue looks abnormal enough to need a biopsy.
Basically impression 1 & 2 are identifying specific areas of the breast which need a closer look, The coordinates will help zone in on the right area using MRI so that it can be examined by ultrasound. If the area looks suspicious on ultrasound a biopsy will be done. Per #1 if that suspicious area on the MRI can't be seen on ultrasound a biopsy should be done anyway.
About 20 to 25% of breast biopsies are malignant so there is a good chance you will get a benign result. Since you had a biopsy previously you know that waiting for the appointment and/or biopsy results is difficult. Once you have an appointment you can always call and ask to be put on a cancellation list in the event there are openings sooner. Come back and let us know how things work out. Best wishes for no biopsy needed or a benign result.
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Hello Maggie15
Thanks for the advice. I have an US on Friday so we shall see what happens and what is found. I did understand that I will get a biopsy either way. Hopefully it will happen sooner than later. Good tip to request to be put on the cancellation list.
Thanks
CasM
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