Topic: Breast MRI Explained

Forum: Not Diagnosed But Worried — For those who are experiencing symptoms or received concerning test results, but haven't been diagnosed with breast cancer.

Posted on: Aug 24, 2017 07:34AM

Posted on: Aug 24, 2017 07:34AM

djmammo wrote:

From RadiologyInfo.Org : Click Here

Excerpt:

"Magnetic resonance imaging (MRI) of the breast uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the structures within the breast. It is primarily used as a supplemental tool to breast screening with mammography or ultrasound. It may be used to screen women at high risk for breast cancer, evaluate the extent of cancer following diagnosis, or further evaluate abnormalities seen on mammography. Breast MRI does not use ionizing radiation, and it is the best method for determining whether silicone breast implants have ruptured."

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Aug 24, 2017 10:11AM luckynumber47 wrote:

Thanks for this info. Every piece of the puzzle makes this whole diagnosis easier to understand. My MRI found DCIS that the mammogram had completely missed. Although the terrible noise from the test really freaked me out I feel like it saved my life.

My avatar is a Blue Footed Boobie. Cracked me up. Dx 2/15/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Dx 3/16/2016, DCIS, Right, <1cm, Stage 0, Grade 3, 0/1 nodes, ER-/PR- Surgery 4/5/2016 Mastectomy; Mastectomy (Left); Mastectomy (Right) Hormonal Therapy 5/16/2016 Femara (letrozole)
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Aug 24, 2017 12:29PM djmammo wrote:

DCIS will not show up on a mammogram unless it has developed calcifications therefore MRI can find it earlier.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Aug 24, 2017 09:07PM luckynumber47 wrote:

Wait, did I understand you correctly? Women could be going for their yearly mammogram, thinking they could catch BC early but DCIS could be growing and never be seen unless there are calcifications. Seems like that puts a whole lot of women at risk. Mammograms don't work for dense breasts and they also don't works for DCIS?Yikes!

My avatar is a Blue Footed Boobie. Cracked me up. Dx 2/15/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Dx 3/16/2016, DCIS, Right, <1cm, Stage 0, Grade 3, 0/1 nodes, ER-/PR- Surgery 4/5/2016 Mastectomy; Mastectomy (Left); Mastectomy (Right) Hormonal Therapy 5/16/2016 Femara (letrozole)
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Aug 25, 2017 04:59AM djmammo wrote:

Luckynumber47

The short answer is yes. see this page

Excerpt: "It should be noted that not all cases of ductal carcinoma in situ will show microcalcifications. In these situations, high resolution ultrasound can be useful for detecting non-calcified DCIS. However, there would typically have to be some compelling reason to use ultrasound, such as a high risk patient or unusual clinical features. Approximately 10-20% of DCIS cases will not show calcifications at all and about 16% of all breast DCIS is hidden from mammography altogether."

The long answer is DCIS is not cancer yet. It is the last step in the spectrum of breast disease just before invasive carcinoma. It does not metastasize, it is not found in lymph nodes, but it is usually treated with lumpectomy +/- Tamoxifen +/- radiation. This may change in the future.

There are three grades, I,II, and III, the first two are considered "low grade" and the third "high grade". DCIS can progress to invasive cancer in some patients or remain quiescent in others. Of all patients with DCIS no one knows or can tell who will go on to invasive disease so today everyone gets treated. You may have heard the terms "over diagnosis" or "over treatment"? These terms refer to DCIS, especially low grade.

Here is an excerpt from an article at Cancer.Org explaining why it might not be a life threatening situation if DCIS cannot be seen on mammography:

Managing DCIS

"In ductal carcinoma in situ (DCIS), the abnormal cells are just in the top layers of cells in the ducts within the breast and haven't invaded any deeper. In some women, DCIS turns into invasive breast cancer, or sometimes an area of DCIS contains invasive cancer. In some women, though, the cells just stay within the ducts and never invade deeper or spread to lymph nodes or other organs. The uncertainty about how DCIS will behave can make it hard to choose the best treatments. Researchers are looking for ways to help with these challenges.

Researchers are studying the use of computers and statistical methods to estimate the odds that a woman's DCIS will become invasive. Decision aids are another approach. They ask a woman with DCIS questions that help her decide which factors (such as survival, preventing recurrence, and side effects) she considers most important in choosing a treatment.

Another recent area of research and debate among breast cancer specialists is whether changing the name of DCIS to one that emphasizes that this is not an invasive cancer could help some women avoid overly aggressive treatment."

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Aug 25, 2017 11:44AM luckynumber47 wrote:

I found the ductal carcinoma in situ link very interesting, especially his New page link It gave a really good explanation of all the terms we see referenced here on the forum.

One part I found interesting ( but didn't apply to me) was where he stated: "Tamoxifen is a chemical agent which specifically attacks the estrogen receptors and may be of some benefit for women with DCIS, but it doesn't work well for all women and is not thought to be effective at all for women who have had radiotherapy." Is he saying that radiotherapy is so effective that no tamoxifen is needed or is he saying that radiotherapy changes something so that tamoxifen doesn't work

My avatar is a Blue Footed Boobie. Cracked me up. Dx 2/15/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Dx 3/16/2016, DCIS, Right, <1cm, Stage 0, Grade 3, 0/1 nodes, ER-/PR- Surgery 4/5/2016 Mastectomy; Mastectomy (Left); Mastectomy (Right) Hormonal Therapy 5/16/2016 Femara (letrozole)
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Aug 25, 2017 05:36PM - edited Aug 25, 2017 07:17PM by djmammo

Specifics like that about treatment are a bit outside of my field of expertise.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Aug 25, 2017 07:31PM luckynumber47 wrote:

I got to thinking about it and it seems like radiation is used for high grade, hormone receptor negative when having a lumpectomy for DCIS. Tamoxifen isn't used for hormone receptor negative so that may be the answer

My avatar is a Blue Footed Boobie. Cracked me up. Dx 2/15/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Dx 3/16/2016, DCIS, Right, <1cm, Stage 0, Grade 3, 0/1 nodes, ER-/PR- Surgery 4/5/2016 Mastectomy; Mastectomy (Left); Mastectomy (Right) Hormonal Therapy 5/16/2016 Femara (letrozole)
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Nov 14, 2017 11:31AM Sjcback wrote:

I am considered high risk, therefore I had an MRI in April 2017. This MRI showed an "area of enhancement". An ultrasound was performed and showed nothing. I had another MRI on 11/8/17. This MRI showed the "area of enhancement " is now larger. I am scheduled for another ultrasound on 11/22/17. Has anyone else experiences this? I keep thinking that it has to be something because it is "larger". What if the ultrasound shows muting again? Should I get a second opinion

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Nov 14, 2017 11:50AM djmammo wrote:

Sjcback

Can you post the entire report's description of that breast?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Nov 30, 2017 01:03PM - edited Nov 30, 2017 06:16PM by dw0531

Hi djmammo,

Appreciate your lending expertise on the site. Have learned much from your comments. Would welcome your opinion on my situation:

I'm 59, healthy and with no known risks. To date, have never had breast pain before. Over the summer i found a small dent after checking due to breast pain on left bottom inner breast. No lumps and nothing showed on multiple US and 3D Mammo. Went for a breast MRI and got a Birad 3 and reco to come back in 6 months for another (report is below). Was still concerned so went to new breast surgeon for second opinion and she reviewed MRI image of left breast with me and pointed out a line by dent and said it was Mondors disease however original radiologist report below did not note this at all. The long full story is on the site. Here is the Topic: Dent, Pain, No Lump - MRI reveals Mondor Disease

Should I be concerned that original MRI report is not accurate or was not interpreted right? Does Mondors typically show on MRI and would it usually be called out? Thanks very much in advance for any insight you can offer.

MRI Report: BIRAD 3 - return in 6 months.

Breast tissue is heterogeneously dense.

Technique: Magnetic resonance imaging of both breasts was performed with and without contract at 1.5 Tesla. Multiplanar, multisequence technique was used. Post Processing include multiple subtractions.

Finding 1: Several scattered small cysts in the left breast Impression: Cysts in the left breast are benign.

Finding 2: Focus of enhancement measuring 4 mm in the middle upper quadrant of the right breast. Impression: Probably Benign. Follow up recommended in 6 months.

thanks,

DW

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