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Topic: Breast MRI Explained

Forum: Not Diagnosed But Worried —

Meet others worried about developing breast cancer for the first time. PLEASE DO NOT POST PICTURES OF YOUR SYMPTOMS. Comparing notes, symptoms, or characteristics is not helpful here, as only medical professionals can accurately evaluate and assess your individual situation.

Posted on: Aug 24, 2017 10:34AM

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 01:11PM 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: Left, Right Hormonal Therapy 5/16/2016 Femara (letrozole)
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Aug 24, 2017 03:29PM 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 25, 2017 12:07AM 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: Left, Right Hormonal Therapy 5/16/2016 Femara (letrozole)
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Aug 25, 2017 07:59AM 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 02:44PM 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: Left, Right Hormonal Therapy 5/16/2016 Femara (letrozole)
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Aug 25, 2017 08:36PM - edited Aug 25, 2017 10:17PM 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 10:31PM 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: Left, Right Hormonal Therapy 5/16/2016 Femara (letrozole)
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Nov 14, 2017 02:31PM 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 02:50PM 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 04:03PM - edited Nov 30, 2017 09:16PM 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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Dec 1, 2017 06:31AM djmammo wrote:

dw0531

First of all, was it proven you have this particular condition or is it just the opinion of the breast surgeon? If it was not yet proven you don't know that the original interpretation was incorrect. The accuracy of reports is related to training and how many of these you read per day/month/year.

Also was the possibility of Mondor's included in the history when the MRI was performed? Sometimes specific imaging sequences are included with the routine ones when what you are looking for might not be seen on routine imaging. Most articles on the subject don't include MRI for diagnosis, but of those that do, some mention MRI angiography which is not a routine sequence. It is not the primary modality to diagnose this entity.

I have seen Mondor's (a thrombosed vein in the breast) once in 30 years and it demonstrated the classic physical finding of a hard tender "cord" in the breast and was easily diagnosed on ultrasound knowing where to look.

I would be curious to see a focused Ultrasound doppler exam of the symptomatic area of your breast performed by a certified breast sonographer (yes they should all be certified if scanning breasts) who knows that they are looking for a venous thrombosis.


Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Dec 1, 2017 11:30AM dw0531 wrote:

Thanks very much for the quick reply. I would agree that my Mondors was not and still isn't a diagnosed condition. I don't have a visible vein.

Mondors was not called out prior to MRI as the first BS I went to dismissed my dent as nothing. I went back to OBY/GYN and she agreed MRI & 2nd opinion was a reasonable next step. No one thought Mondors at this point, I have no visible vein, but the MRI nurse did put a little marker on the dent for reference before the MRI so they should have looked on the left breast in that area.

After MRI i went to new BS(with very accredited hospital) and she showed me the slightly bent line around where the dent was calling it Mondors. She seemed certain so I didn't really question it but probably should have - wasn't thinking clearly given anxiety of whole thing.

Just FYI, my diagnostic ultrasound on left breast pre-MRI said this. Technique: Real-time grayscale ultrasound imaging of the left breast targeted to the area indicated by the patient was performed. Findings: No suspicious cystic or solid masses on the left.

Now i am thinking i should call my new BS and ask her what i should be doing as a next step for Mondors to both confirm diagnosis and resolve condition. I can also suggest the focused Ultrasound doppler exam you mentioned. Wondering if i should also ask her to call radiology group to share her findings about Mondors - if she does that would they typically take another look at the existing MRI scans or do i have to wait for the next MRI (4 months from now) to mention it so they can do additional scans?

Thanks

DW

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Dec 1, 2017 01:39PM djmammo wrote:

dw0531

I think that's a good idea, to have the rad re-look at the scan asking about a thrombosed vein, to see if that's what that finding was that the surgeon picked up.

Do you or a family member have any known clotting problems?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Dec 1, 2017 02:32PM dw0531 wrote:

Grandfather had phlebitis I think, other relatives with varicose veins. But nothing significant i am aware of. I've been pretty lucky so far, all vitals good and not on any medicines. Have exercised all my life so perhaps that has helped in that respect.

I think i will do as you suggest and see if I can get radiologist to take second look based on BS observation. I also made an appt with a PCP to get a full checkup as I haven't really had a baseline in terms of heart, bone density etc. Maybe there is a more systemic thing i need to be aware of or they can help confirm if there is a Mondor thing happening.

Thanks so much for lending your expertise. Just sounding it out was really helpful. Will report back when i get more definitive answers.

Best regards

DW



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Jan 3, 2018 06:36PM M_shirley wrote:

I'm getting worried... And frustrated with the testing and lack of clarity in the results. Please bare with my long message here. I would really appreciate any thoughts, clarity and advice! In July I had a mammogram, and it was then recommended to have a diagnostic mammogram and ultrasound. After some reading I also requested a MRI be done as well due to my family history. The ultrasound found a couple of cysts but I was told there was nothing concerning found but that I needed to have another mammogram and MRI done in 6 months to be cautious...i think due to some changes from my previous mammogram? Well I had the MRI and mammogram done the end of December. The mammogram didn't find anything but the MRI results say: right breast shows scattered areas of moderate enhancement. Largest area is seen at the upper outer quardrent at the middle one third of the breast measuring 21x21mm diameter. The time signal curve shows medium uptake of contrast without significant washout.

Examination of the left breast shows some areas of relative increased signal at the medial and lateral sides of the breast with multiple areas of moderate enhancement. The largest area of enhancement of the upper outer quadrant involving the middle of the posterior one third of the breast measures 4x1.5cm diameter. This has medium enhancement without significant washout when rebooted with the time signal curve. Review of prior examination shows enhancement of the left breast, which is described previously and which is moderate in degree of enhancement. This area of enhancement was decreased inn previous exam compared to this exam in size. The overall area of enhancement of the left and right breasts on previous exam is decreased. Given the diffuse distribution of enhancement, this is probably reactive changes or background enhancement. A developing mass or lesion cannot be excluded. Accounting for the enhancement at the upper outer quadrant of the right and left breasts. A mammogram was fine the same day which was reviewed in correlation. There is relative increased density at the upper outer quadrant as well.

Multiple areas of moderate enhancement of the right and left breast which are greatest at the upper outer quadrant. This could represent background enhancement or fibrocystic changes; however, a malignancy cannot be entirely excluded. The degree of enhancement is significantly increased from previous study. Targeted ultrasound recommended.

I had the recommended ultrasound done today and was told it was good. And then they said come back in 6 months for another MRI due to the results and changes from the MRI I just had. I'm getting frustrated and confused. Are they actually looking at or watching something? If there is something there then by my next MRI.. it will have been a year that they've spent watching it... And if there isn't anything ...why another MRI in 6 months. Do i need a second opinion?

Thank you for listening and for any advice or clarification you might give!

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Jan 3, 2018 06:58PM Georgia1 wrote:

Hi MShirley. Sounds like they are watching the "areas of enhancement," which seems prudent. If you have dense breasts reading mammorgrams and MRIs are particularly tricky.

This article is pretty wonky, but perhaps will give you a list of questions to ask the doctor at your next appointment. Best wishes to you.

http://breast-cancer.ca/mridets/

Cancer touched my breast so I kicked its ass. Dx 9/3/2017, ILC/IDC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 10/9/2017 Lumpectomy; Lymph node removal: Right, Sentinel Dx 10/10/2017, LCIS, Right, 0/1 nodes Radiation Therapy 11/26/2017 Whole-breast: Breast Hormonal Therapy 1/2/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 3, 2018 08:31PM djmammo wrote:

M_shirley

I didn't see the word "mass" in the report you posted. I also didn't see a recommendation for a biopsy.

Two different breast MRI's on the same person can look fairly different from each other depending upon when in your cycle it was performed (if you are still cycling), if the exams were performed on 2 different machines, the dosage of contrast and the rate of its injection, and other technical factors. Radiologists who read nothing but breast imaging are well aware of all these pitfalls. Best to look for someone who is ACR certified in breast MRI to read and compare your studies.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 3, 2018 09:22PM - edited Jan 3, 2018 09:45PM by M_shirley

Georgia1 Thank you! I will check out the article!

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Jan 3, 2018 09:32PM - edited Jan 3, 2018 09:47PM by M_shirley

Djmammo ......No they haven't mentioned a mass or a biopsy. Both MRIs have been done on the same machine but by 2 different techs... If that makes a difference. I have not met any of the radiologists and the results are being sent to my family practitioner. I feel like I'm in an endless loop of testing with no answers...And I'm not sure why because like you said there is no mass or lesion mentioned. So I guess I need to have my tests sent to someone more specialized? Thank you, maybe it seems like I'm worrying more than necessary at this point but I have a strong family history. Thank you again for your guidance.

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Jan 11, 2018 02:33AM marijen wrote:

Djmammo, I have lymphedema in my radiated breast (also had delayed breast cellulitis after radiation). I’m supposed to have a one year 3-D mammo, both sides in April and I’m already worried it will aggravate the swelling. Do you think I could request an MRI instead? I also have those armpit lumps on my good side. Is the breast MRI the one where you lay face down? Or is it a torso scan? Thanks in advance for your help!




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Jan 11, 2018 07:13AM djmammo wrote:

marijen

I don't think it would do any harm but a radiated breast is less compliant I would wonder if the entire breast could be pulled into the compression plates, not seeing enough tissue near the chest wall. An MRI would accomplish that and see both axillae.

You lay prone on the table with breasts in two wells that contain the receiver coils. See diagram.


Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 11, 2018 07:25AM Paco wrote:

djmammo

I posted this under the DCIS topic but since you're here....

"Diagnosed with DCIS to the left breast with CN biopsy on 1/02/2018. Just received the results of the MRI from 1/06/2018. This sounds like they didn't find anything else and the DCIS is not embedded into the skin or muscle? So I might still be a candidate for lumpectomy (the DCIS has a high nuclear grade, per the CNB)?

RIGHT BREAST: There is magnetic susceptibility artifact along the posteromedial aspect of a postbiopsy hematoma in the lateral aspect of the right breast, near the 9 to 10:00 position. The hematoma measures 23 x 18 x 22 mm in craniocaudal span. Lateral to the hematoma, extending to the lateral skin surface, there is an irregular area of hyperenhancement demonstrating progressive and plateauing enhancement characteristics. This measures 13 x 13 x 18 mm in AP dimension, and is consistent with ductal carcinoma in situ and/or post biopsy changes. No residual calcifications were identified in this area on the postbiopsy mammogram. The area of enhancement extends to within a few millimeters of the anterior aspect of the right pectoral muscle.

No suspicious mass-like enhancement or suspicious segmental enhancement is seen throughout the remainder of the right breast. The skin and nipple complex of the right breast is unremarkable.

LEFT BREAST: No suspicious mass-like enhancement or suspicious segmental enhancement is seen in the left breast. The skin and left nipple are unremarkable.

CHEST WALL: Unremarkable.

AXILLARY NODES: No adenopathy.

OTHER FINDINGS: The visible liver is unremarkable.


Dx @ 48 Dx 12/28/2017, DCIS, Right, 1cm, Stage 0, Grade 2, ER+/PR+ Surgery 2/13/2018 Lumpectomy: Right Radiation Therapy 3/27/2018 Whole-breast: Breast Hormonal Therapy 4/25/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 11, 2018 07:41AM djmammo wrote:

kellyoc519

From that report it sounds like they didn't find anything other than your original diagnosis. That's good.

If everyone agrees on lumpectomy, they will want to remove all the areas of enhancement surrounding the biopsy site plus a margin of normal appearing tissue. At this point I would compare all your mammograms to the MRI and map out the tissue that should be removed.

On the day of surgery I would insert a number of localization wires around the border of the area to be removed (called bracketing) while the patient is compressed in the mammogram unit. Multiple images would then be obtained and carefully labeled and saved on the PACS unit for display in the OR. Just prior to surgery I would review all the images with the breast surgeon so that we were on the same page.

The tissue that is removed in the OR is sent back to X-ray to be evaluated before closing the incision to insure the entire area was indeed removed. It is then sent to pathology, patient is closed and goes to recovery.

Let us know how it goes.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 11, 2018 09:52AM marijen wrote:

Thank you djmammo. I had a face down mammo the week of dx and remember it was an ordeal. But it would be worth it to get better readings too.


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Jan 19, 2018 09:47AM Paco wrote:

Thanks DJMammo. I appreciate your input and expertise. I see the surgeon on Monday.

Dx @ 48 Dx 12/28/2017, DCIS, Right, 1cm, Stage 0, Grade 2, ER+/PR+ Surgery 2/13/2018 Lumpectomy: Right Radiation Therapy 3/27/2018 Whole-breast: Breast Hormonal Therapy 4/25/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 24, 2018 01:15PM Ja9831 wrote:

what is a irregular non mass enhancement

Dx 4/8/2019, LCIS, Left
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Jan 24, 2018 02:44PM djmammo wrote:

Ja9831

Here is a pretty good explanation of that

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 24, 2018 03:07PM momto3sons wrote:

I had a breast MRI last week, and now it looks like I'll have an MRI-guided biopsy. Will that be pretty similar to my MRI experience?

Carolyn, mom to 3 sons - ADH, intraductal papillomas 3/1/18 Surgery 2/21/2018 Lumpectomy: Right
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Jan 24, 2018 05:22PM djmammo wrote:

momto3sons

Click here for information regarding MRI guided breast biopsy

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 6, 2018 09:37PM - edited May 6, 2018 09:39PM by Noratara

could you help me with my ultrasound report, I really do t understand. I had an Mri after and now need biopsy on both breasts. I called the radiologist and she said to me she had a very low suspicion that it is breast cancer she said 2% she mentioned something like fibroademiaor maybe cystic changes

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