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Topic: Biopsy Set for 3/26, BIRADS 4, brief report a good sign?

Forum: Waiting for Test Results —

For members not diagnosed with breast cancer, but waiting for test results:  Biopsy, mammogram, ultrasound, or other screening tests. Waiting is VERY difficult but remember...

"Worry does not empty tomorrow of its sorrow. It empties today of its strength." -- Corrie Ten Boom

Posted on: Mar 5, 2021 08:17AM

Flowermom05 wrote:

Hi all. I'm hoping someone can give me some insight on my report while I wait for my biopsy to happen.

In 2018 I had been told that I needed MRIs every 6 months for some areas in my breast that were classified as BIRADS 3 and everyone seemed to agree were benign. However, when I got the bill for my first breast MRI at over $1500 out of pocket, I decided not to continue with the every 6 months thing. I was also dealing some heavy personal stuff at the time and kind of put my heath in general on the back burner.

Now I feel pretty dumb about that decision. I went for a screening mammogram on 2/24 (since it had been so long since my breast MRI, I was in essence "starting over.") I got called back 2/26 for a diagnostic mammogram and an ultrasound. Afterwards, the radiology nurse took me into her office and told me I had 9 calcifications, and changes compared to my last MRI, and three spots of concern. (The 2.4cm was 4mm on my MRI in 2018). She said the breast health specialist who is also a breast surgeon would call me for an appointment for a surgical consult and the biopsy.

When I got my report, it's very brief. I don't know if that's a good thing or a bad thing. But the "surgical consult" freaked me out.

***

"ULTRASOUND SUSPICIOUS OF MALIGNANCY
The 2.4 cm wider than tall oval mass in the left breast at 3 o'clock anterior depth is suspicious of malignancy. An ultrasound guided biopsy and a surgical consult are recommended.
The 6 mm wider than tall oval mass in the left breast at 6 o'clock in the retroareolar region is suspicious of malignancy. An ultrasound guided biopsy and a surgical consult are recommended.
The 9 mm wider than tall oval mass in the left breast at 6 o'clock anterior depth is suspicious of malignancy. An ultrasound guided biopsy and a surgical consult are recommended

ULTRASOUND BI-RADS: 4 SUSPICIOUS OF MALIGNANCY.

letter sent: Biopsy Required"

***

I've been browsing through other people's posts and I feel like there is so much more detail on other reports. Is this a good sign that it's not so detailed? And also what exactly does surgical consult mean? What I am afraid it means is that no matter what I am going to be having surgery to remove the masses, hence "surgical consult."

I have an appointment with the Breast Health /Specialist/Surgeon on March 26 at 8am, and she will do the biopsy then "if necessary" - as per the scheduler. Since it's three weeks away, that felt a bit reassuring, like maybe it's not so urgent.

I don't have an immediate family with history of BC, but my mom and grandfather died of brain cancer, and my other grandfather died of leukemia. I am guessing none of that is relevant, right? Thanks for any insight. I know I have zero control over any of this and should probably do my best to put it out of mind, but struggling today.

THANK YOU FOR READING!

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Mar 5, 2021 08:46AM MelissaDallas wrote:

That is because it is just the recommendations part of the report. Is that all they sent you or that you can access? There should be much more detail in the findings portion

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor. Dx 5/20/2012, LCIS, Stage 0, 0/0 nodes
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Mar 5, 2021 09:17AM Flowermom05 wrote:

The "results" are what I have access to in MyChart, and are also on the sheet they gave me when I left that day.

From screening mammogram:

"Impression

MAMMOGRAPHY INCOMPLETE NEED ADDITIONAL IMAGING EVALUATION
The density in the left breast is indeterminate. Spot compression view as well as a possible ultrasound are recommended.
MAMMOGRAPHY BI-RADS: 0 Incomplete Need Additional Imaging Evaluation"

From dx mammogram:

"MAMMOGRAPHY INCOMPLETE NEED ADDITIONAL IMAGING EVALUATION
The oval mass in the left breast at 2 o'clock anterior depth is indeterminate. An ultrasound is recommended.
The oval mass in the left breast at 6 o'clock anterior depth is indeterminate. An ultrasound is recommended.
The oval mass in the left breast anterior depth central to the nipple seen on the craniocaudal view only is indeterminate. An ultrasound is recommended."


I also got a letter that told me to call my dr:

"Your breast imaging exam(s) performed on 2/26/2021 shows an abnormality for which a breast biopsy is recommended. We have notified your physician. We strongly suggest (this part was bolded) you speak with your physician immediately to discuss this finding.

Please remember that early detection of cancer is very important. Although mammography is the most accurate method for detection, not all cancers are found by mammography. A thorough examination includes a combination of mammography, clinical breast exam and monthly breast self-examination. It is recommended that annual screening mammography begin at the age of 40 along with a clinical breast exam."

When I called my regular doctor, she asked if I could feel the largest lump, I said yes, and she told me it was very important for me to have the biopsy, and to go ahead and call the breast specialist/surgeon to schedule, even though the nurse had told me they would be calling me. So I called and they told me it hadn't been reviewed yet, but they would call me for an appointment, and they ended up calling me the next day and scheduled me for the 26th.

If I call with more questions, do I ask to see a copy of the actual report? I figured the letter was a form thing, but maybe not? Thanks for your help.

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Mar 5, 2021 09:19AM - edited Mar 5, 2021 09:22AM by zebra_co

hi flowermom, I'm, sorry that you are going through this and so glad that you found this forum. Sounds like you are understandably having some anxiety over these recommendations. I don't know the relevance of the other family history cancers, that is a good question for your doctor. It is very hard to wait for tests and the results. Three weeks is a long time out for additional testing in my experience. I would suggest that you not overthink that. Or perhaps see if you can get in sooner. Try to stay busy while you are waiting although that is not easy for most of us. I like to recommend that you give yourself some time in the day to think about it, do your reading, talk to people you are close with and then do your best to move on with your day. Do you have support from a significant other or close friends? Please keep us updated on how things are going for you and when you have the next visits and testing. My hope is that everything comes back in your favor. Hugs to you! - zebra

I posted the above just before seeing your follow up. I do hope it all goes well for you.

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Mar 5, 2021 09:31AM Flowermom05 wrote:

Update, I did go back and look at the sheet they gave me and it is slightly different than what's in the mychart. Sorry about that.


"Today's Procedure: Left Diagnostic Mammorgram, Left Ultrasound and Consult with Nurse

Results:

"There are scattered fibroglandular elements in left breast.

There is an oval mass in the left breast at 2 o'clock anterior depth. The also is an oval mass in the left breast at 6 o'clock anterior depth. Additionally, there is an oval mass in the left breast anterior depth central to the nipple seen on the cranicaudal view only. No other significant masses or calcifications are seen in the breast.

IMPRESSION:

The oval mass in the left breast at 2 o'clock anterior depth is indeterminate. An ultrasound is recommended.

The oval mass in the left breast at 6 o'clock anterior depth is indeterminate. An ultrasound is recommended

The oval mass in the left breast anterior depth central to the nipple seen on the cranicaudal view only is indeterminate. An ultrasound is recommended.

Ultrasound of the left breast was performed.

There is a 2.4 x0.7 x 1.3 cm oval mass which appears intraductal in the left breast at 3 o'clock anterior depth. This correlates with mammography findings. There also is a 6 x 5 x 6 mm oval mass in the left breast at 6 o'clock in the retroareolar region. This correlates with mammography findings. Additionally, there is a 9x6x8 mm oval mass in the left breast at 6 o'clock anterior depth. This correlates with mammography findings.

IMPRESSION: ULTRASOUND SUSPICIOUS OF MALIGNANCY
The 2.4 cm oval mass in the left breast at 3 o'clock anterior depth is suspicious. An ultrasound guided biopsy and a surgical consult are recommended.
The 6 mm oval mass in the left breast at 6 o'clock in the retroareolar region is suspicious. An ultrasound guided biopsy and a surgical consult are recommended.
The 9 mm oval mass in the left breast at 6 o'clock anterior depth is suspicious. An ultrasound guided biopsy and a surgical consult are recommended."

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Mar 5, 2021 09:44AM Flowermom05 wrote:

That's a great idea, zebra_co, to set aside some time to hash out my worries and then move along. I'm definitely going to try to do that, starting today! I do have my husband who is being very supportive, which is great, and I am glad to have him. We are pretty isolated the past year because I am homeschooling my kids due to my son having some health issues we didn't want to chance in with COVID. I do have a few close friends I can talk to as well, but really glad to have found this forum, and I so appreciate people taking the time to respond to me. : )

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Mar 5, 2021 09:46AM moth wrote:

The waiting sucks the harderst, just try to put it out of your mind (or call your surgeon's office and ask to be put on cancellation list? They often have tons of no-shows or cancellations due to other illness. In my area any covid symptoms also push you out of the queue...)

Short or long....doesn't really matter. Bottom line is the radiologist said words to effect of "I don't like that. Someone should look at slides under a microscope". Imaging can only go so far and when they hit spots that just don't look right, that's what they say and bump it up to biopsy & a pathologist.

Family history is usually not relevant - most of us don't have family history, or have tons but the genetic testing for cancer predisposition comes back negative. And don't let your mind worry to regrets about woulda/coulda/shoulda. You did the best you could, now you're doing this. Good for you. You went for your mammo when you could and you're following up.

hang in there


Initial dx at 50. Seriously???? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: nevertellmetheodds2017.tumblr.... Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/15/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone, Grade 3 Radiation Therapy 3/3/2021 External: Bone
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Mar 5, 2021 10:37AM AliceBastable wrote:

Yes, schedule time to spend on this but DO NOT go to random Google, just use reputable sites like this one or Mayo if you feel the need. It's just as important to schedule other things while you wait for the next step - fun things! I don't know where you live, but spring is trying its hardest to show up where I am, so outdoor activities would be a great way to spend time right now. Have safe, masked social distance reunions with family and friends, take hikes, have picnics, even just walk around your neighborhood and play Spot the Crocus. I did things like this, and was so happy to have those memories to look back on instead of just dreary medical stuff once it was all over.

Endometrial cancer 2010, basal cell multiples, breast cancer 2018, kidney cancer 2018. Boring. Dx 5/2018, ILC/IDC, Left, 2cm, Stage IA, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 7/11/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 8/8/2018 Radiation Therapy 10/29/2018 Whole-breast: Breast, Lymph nodes
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Mar 5, 2021 01:14PM LivinLife wrote:

Hi Flowermom! Sorry you are dealing with all of this. I hope you're not being too hard on yourself for not keeping up with MRI's.... I do not know too many people who could pay for one of those let alone more than one. You have a lot going on with the masses! I too hope you can get on a cancelation list and get in sooner. So glad your husband is supportive!

with expansive comedo necrosis & weak ER/PR Dx 7/2020, DCIS, Left, 1cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Surgery 8/31/2020 Mastectomy: Left; Prophylactic mastectomy: Right
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Mar 7, 2021 07:22AM Flowermom05 wrote:

Thank you ladies for your words of support! It means a lot. I'm definitely trying to stay busy and spend more time being present and not letting Dr. Google get into my head too much. I will call to see about getting onto a cancellation list this week and will keep you posted.

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Mar 7, 2021 08:19PM OnTarget wrote:

Good luck! I hate waiting!!

Birads 4 is good since the majority are not cancer.

Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative. Lost right implant to infection March 2020. Waiting to start reconstruction all over again. Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/13/2019 Zoladex (goserelin) Chemotherapy 8/5/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/6/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Mar 23, 2021 12:16PM Flowermom05 wrote:

So, my biopsy is on Friday, and today I decided to check out if any instructions had been posted in my mychart. Looks as though my medical group did an update and there is much more information all test results I've ever had, including my latest breast mammo/us. Here is what it says now, so much more detail!

I'm editing out the facility/nurses names, but the rest is copy/paste.

#105304681936 - US BREAST DIAGNOSTIC 1-3 QUADRANTS LEFT

ULTRASOUND OF LEFT BREAST: 2/26/2021

CLINICAL HISTORY:Patient presents for sonographic evaluation of left breast mass.

COMPARISON:

Comparison is made to exams dated: 2/26/2021 mammogram, 2/24/2021 mammogram and 3/28/2018 ultrasound

FINDINGS:

Real-time ultrasound of the left breast was performed.

There is a 2.4 x 0.7 x 1.3 cm wider than tall oval mass with a circumscribed margin hich appears intraductal in the left breast at 3 o'clock anterior depth. This oval mass is heterogeneously echogenic. This correlates with mammography findings. Color

flow imaging demonstrates that there is some vascularity present.

There also is a 6 x 5 x 6 mm wider than tall oval mass with a circumscribed margin in the left breast at 6 o'clock in the retroareolar region. This oval mass is hypoechoic. This correlates with mammography findings. Color flow imaging demonstrates

that there is minimal vascularity present.

Additionally, there is a 9 x 6 x 8 mm wider than tall oval mass with a circumscribed margin in the left breast at 6 o'clock anterior depth. This oval mass is hypoechoic. This correlates with mammography findings. Color flow imaging demonstrates that

there is minimal vascularity present.

IMPRESSION:

ULTRASOUND SUSPICIOUS OF MALIGNANCY

The 2.4 cm wider than tall oval mass in the left breast at 3 o'clock anterior depth is suspicious of malignancy. An ultrasound guided biopsy and a surgical consult are recommended.

The 6 mm wider than tall oval mass in the left breast at 6 o'clock in the retroareolar region is suspicious of malignancy. An ultrasound guided biopsy and a surgical consult are recommended.

The 9 mm wider than tall oval mass in the left breast at 6 o'clock anterior depth is suspicious of malignancy. An ultrasound guided biopsy and a surgical consult are recommended.

ULTRASOUND BI-RADS: 4 SUSPICIOUS OF MALIGNANCY


*******

So I'm thinking all this additional information is mostly good, right? Lots of words I see used are "favorable", correct? Would love any more input or thoughts. I know it's only a few days away and I should just chill, but seeing the updated information was just so surprising I had to share it here. Thank you!!!

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Mar 24, 2021 10:15AM 2019whatayear wrote:

Oval is a favorable shape for the most part. So my fingers and toes are crossed. A solid 3/4 of all biopsies are benign so that's a plus. Hoping the biopsy goes smoothly and you get fast boring results!

5/6/2019 IDC 2cm, micromet 1/9 nodes, BRCA2+, ER+, PR+, HER- BMX 6/2019, A/C & Taxol 2019, Radiation, BSO - preventative 2/2020, Letrozole 3/1/2020
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Mar 26, 2021 03:52PM Flowermom05 wrote:

Update: I met with the breast specialist/surgeon today, and didn't have the biopsy. All the spots are clustered around my nipple and she said it would be painful to do all three masses and we should just do surgery to remove them instead. So I am getting all three spots removed in two weeks.

She said she was pretty confident that they were benign. So that was reassuring. We looked at the scans together, and two of the spots were identified in my previous MRI in 2018. She thought the biggest one was likely a papilloma. She weighed out the positives and negatives with me. It was on the old scan, so that's a good. It has grown, and now is showing blood flow, that's not so good. It is right by the nipple, so that's usually a papilloma, which are benign. In 2018, they thought that is what it was. But a different radiologist assessed the new scans, and she said that this radiologist has less experience than the other one from 2018.

She also said that if I get this all out and it's clear, that I wouldn't have to keep getting it flagged on mammos and doing followups every year. So that sold me on the idea.

So pretty good news and a plan!

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Mar 26, 2021 03:55PM LivinLife wrote:

Flowermom it does indeed sound like a good idea! Sounds like you are comfortable with the plan too which is most important. Totally understandable about getting those out, seeing what they are and then hopefully not having the year after year or more frequent concerns about "what are those?" "are they worrisome, is there change, etc. "One and done" I call that though realize things are not necessarily always that simple - one can hope though : ) Thanks for the update and keep us posted....

with expansive comedo necrosis & weak ER/PR Dx 7/2020, DCIS, Left, 1cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Surgery 8/31/2020 Mastectomy: Left; Prophylactic mastectomy: Right
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Mar 26, 2021 07:27PM canadaliz wrote:

Hi FM,

As you can see from my signature I am 3 years out. A few weeks ago on my usual screening they found a 7mm anomaly that needed a biopsy which I had today. My initial report was similar to yours however it had a letter. I was a BIRADS 4A. That means it had a 2-20% chance of malignancy. Could you ask for a letter assignment? My biopsy was today and the radiologist that did it immediately said she was 99% certain it was not malignant but rather an old cyst closing in on itself. They took 4 core samples then it collapsed. Always remember about 80% of biopsies are benign. Good luck sister. We are all shoulder to shoulder with you. Cheers, Liz

Letrozole Dx 1/11/2018, IDC, Right, 2cm, Stage IIA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 3/13/2018 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy Whole-breast
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Mar 26, 2021 07:42PM 2019whatayear wrote:

Glad you have a plan Flowermom!

5/6/2019 IDC 2cm, micromet 1/9 nodes, BRCA2+, ER+, PR+, HER- BMX 6/2019, A/C & Taxol 2019, Radiation, BSO - preventative 2/2020, Letrozole 3/1/2020
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Mar 27, 2021 01:33PM LivinLife wrote:

Congrats on great results canadaliz!

with expansive comedo necrosis & weak ER/PR Dx 7/2020, DCIS, Left, 1cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Surgery 8/31/2020 Mastectomy: Left; Prophylactic mastectomy: Right
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Apr 7, 2021 12:59PM Flowermom05 wrote:

Thank you all so much for your kind words!!

Canadaliz, I had asked my dr about a letter assignment and she said that the radiologist probably chose not to assign a letter on purpose, to let the breast specialist weigh in. I let it drop at that point. So glad to hear you had a good outcome!

And now a question: today as I was getting dressed I noticed that I have a few veins popping out on my left breast, which is new. I have pale skin to start with, and have always been able to see blue veins through both my breasts, but the ones on the left side (where the masses are) are kind of bulging like you see on muscles. I asked my husband if he could see it too, or if this was in my head. He said no, they are definitely popping out a bit, and he's never noticed that before either. It starts at the top of the breast and goes down into almost a circle around the nipple. Of course, Dr. Google is telling me this can be a sign that a tumor is "creating vascular demand."

Has anyone heard of a papilloma or other benign breast condition doing this? Could it be coincidence? I also sweated a lot yesterday because it hit 80 degrees where I live and our a/c is broken (we all know how boob sweat is, right?), could that be causing it?

I was starting to feel like this whole thing next Friday is overkill, based on my surgeon/breast specialist's confidence that it was a benign papilloma. I was feeling pretty chill about it all. But now I am starting to get nervous again since seeing that in the mirror this morning. Ugh!

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Apr 7, 2021 04:00PM AliceBastable wrote:

Never listen to "Dr." Google. Biggest quack out there.

Endometrial cancer 2010, basal cell multiples, breast cancer 2018, kidney cancer 2018. Boring. Dx 5/2018, ILC/IDC, Left, 2cm, Stage IA, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 7/11/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 8/8/2018 Radiation Therapy 10/29/2018 Whole-breast: Breast, Lymph nodes

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