Topic: Interpreting Your Report

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 25, 2017 08:30AM - edited Mar 22, 2018 06:57AM by djmammo

Posted on: Aug 25, 2017 08:30AM - edited Mar 22, 2018 06:57AM by djmammo

djmammo wrote:

Mammogram and ultrasound reports contain (should contain) a fairly specific vocabulary as recommended by the Birads Lexicon. They have very specific meanings so if used correctly other docs can picture in their mind what the abnormality looks like without seeing the actual images.

I have divided the more common terms into 2 groups Favorable and Less Favorable, favorable meaning it leans toward the benign side, and less favorable if leaning toward the malignant side (as no finding is 100%). This in combination with the Birads score should give you a good idea about what the rad is considering if in fact they did not speak directly to you about your results. Below that is a link for a downloadable guide which is more complete.

Favorable: Oval; parallel; circumscribed; anechoic; hyperechoic; isoechoic; posterior enhancement or good through-transmission; avascular; macrocalcifications include pop corn, large rod like, rim, milk-of-calcium.

Less Favorable: Irregular; non-parallel (can also be written as "taller-than-wide"); not-circumscribed margins includes indistinct, angular, microlobulated, and spiculated; hypoechoic; posterior shadowing; architectural distortion; internal vascularity; microcalcifications including amorphous, coarse heterogeneous, branching, fine pleomorphic.

Downloadable Quick Reference Guide PDF which also includes MRI terminology

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com

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Apr 10, 2020 07:42PM djmammo wrote:

Nelsonfam05

When comparing measurements taken with two different digital modalities know that they will never match exactly. The physics of US, mammo, MRI are all different so they look at different aspects of a mass.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com

Apr 11, 2020 04:24PM Tdiiulio wrote:

I amlooking for help interpreting my ultrasound report. I did have biopsy and am waiting on those results. Some places say moderate concern and other places say high suspicion for malignancy. I feel confused

Study Result

Impression

BREAST DENSITY AND RISK STATEMENT:

The patient has heterogeneouly or extremely dense breast tissue and and elevated lifetime risk of

breast cancer secondary to the Tyrer-Cuzick risk assessement model. Consider genetic screening

if applicable and adjunct screening whole breast ultrasound and/or screening breast MRI as

clinically indciated.

LIMITED ULTRASOUND OF LEFT BREAST AND AXILLA: 4/2/2020

COMPARISON:

Comparison is made to exams dated: 5/9/2014 mammogram and 6/17/2011 mammogram.

FINDINGS:

Color flow and real-time ultrasound of the left breast 2-4 o'clock, 11 o'clock, and axilla regions were performed. All representative images including gray scale of the real time examination were reviewed.

Accession #

MA-20-0040063

MA-20-0040066

There is a 1.4 cm x 1.4 cm x 0.7 cm oval mass with a lobulated and circumscribed margin in the left breast at 11 o'clock 6 cm from the nipple with the long axis parallel to the skin. This correlates as palpated and with mammography findings. Color flow imaging demonstrates that there is vascularity present and an adjacent vascularity.

There also is a 0.4 cm x 0.4 cm x 0.2 cm oval mass with a circumscribed margin in the left breast at 3 o'clock middle depth 7 cm from the nipple. This oval mass is hypoechoic. This correlates with mammography findings. Color flow imaging demonstrates that there is no vascularity present.

There is no sonographic correlate for the palpable concern in the left breast 11 o'clock 8 cm from the nipple.

A left axillary lymph node is visualized, normal in size and appearance, fatty hila maintained.

ULTRASOUND IMPRESSION: SUSPICIOUS ABNORMALITY - MODERATE CONCERN BUT NOT CLASSIC FOR MALIGNANCY

No sonographic or mammographic correlate a reported prior palpable concern in the left breast 11o'clock 8 cm from the nipple. Negative imaging results should not deter further evaluation or biopsy of a clinically suspicious finding.

The 1.4 cm x 1.4 cm x 0.7 cm oval mass in the left breast at 11 o'clock is consistent with a solid mass and is at a high suspicion for malignancy. An ultrasound guided biopsy is recommended.

The 0.4 cm x 0.4 cm x 0.2 cm oval mass in the left breast at 3 o'clock middle depth is probably benign. Follow-up left mammogram and ultrasound in 6 months are recommended to demonstrate stability.

Results were given to the patient at the completion

OVERALL STUDY BIRADS: 4c High suspicion of malignancy

Apr 12, 2020 08:48AM djmammo wrote:

Tdiiulio

Any new solid mass needs a biopsy.

Long axis parallel to the chest wall in general is a good sign. Benign lumps can have a blood supply. Personally I like to know if a mass has posterior shadowing or through transmission on US as this helps me make a decision, but that feature is not mentioned here. Let us know what the biopsy shows.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com

Apr 12, 2020 04:06PM Nelsonfam05 wrote:

thanks! The biopsy did come back as IDC. I haven’t gotten to read the report and in all honesty didn’t understand anything after the word cancer.

Apr 12, 2020 05:17PM - edited Apr 12, 2020 06:23PM by Tdiiulio

@djmammo thank you for your feedback. I was expecting a biopsy was just surprised at a 4C, maybe they didn't mention everything in the report? Or it does look like they attached a couple images. Trying not to put too much stock into the BiRad rating.

Apr 13, 2020 09:46PM Jettie wrote:

its been a while since i was on this thread and djmammo did an awesome job of translating my reports, when i had no idea what they said. As you can see from my signature, treatment is underway. So i just wanted to take a moment and say thank you again.



Dx 2/14/2020, IDC, Right, 5cm, Stage IIIB, Grade 2, ER+/PR+, HER2+, Chemotherapy 3/10/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 3/10/2020 Herceptin (trastuzumab) Targeted Therapy 3/10/2020 Perjeta (pertuzumab) Surgery 8/11/2020 Lymph node removal: Right; Mastectomy: Right Radiation Therapy Whole breast: Breast

Apr 14, 2020 07:45AM djmammo wrote:

Jettie

You are very welcome. Good luck on your journey.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com

Apr 20, 2020 03:47PM sushu wrote:

Hi - I had a lumpectomy about 6 years ago that ended up being atypia hyperplasia. Because of that, I've had both an anual mammagram and a breast MRI - every 6 months I'm tested. My last mammo was clear, but the MRI I just had showed some concern (details below). I am having a guided MRI biopsy on Monday, but am having a bit of anxiety this time around, having been through the testing, lumpectomy, etc.

Any guidance is appreciated.

Thank you!


IMPRESSION:

1. Right Breast - BI-RADS 1 - Negative. No evidence of malignancy.
2. Left Breast - BI-RADS 4 - Suspicious. Grouping of small foci of enhancement at the central retroareolar tissues of the left breast. Of these, a focus of enhancement at the anterior third, retroareolar tissues (L1) measuring 8 mm in size, has
increased in size since the prior MRI. Recommendation is for tissue sampling.
3. Left breast-BI-RADS 3-probably benign. 2 other foci of enhancement in the central retroareolar tissues (L2 and L3) are very small, and could represent background enhancement, even if they are new since the previous examination. There is one other
small focus of enhancement in this general region that is stable since the prior exam (L4).

RECOMMENDATION:
1. MRI guided biopsy of the left breast, for lesion L1. If biopsy results are benign without atypia, then follow-up MRI can be obtained in one year. If results are malignant then consideration should be made for tissue sampling or image guided clip
placement for L2 and L3.

Electronically signed by: Ruby Chang, MD (3/5/2020 11:27 AM)
WKSTN: INTELERADRCG

Narrative MRI OF THE BREAST WITH AND WITHOUT CONTRAST: 3/4/2020 4:09 PM



PREVIOUS STUDY: Breast MRI 1/16/2019



HISTORY: 57-year-old female, history of left breast atypical ductal hyperplasia status post excision in 2013. Elevated lifetime risk of breast cancer, 34%.




TECHNIQUE:
1. Dedicated breast coil; 1.5 Tesla magnet.
2. Axial VIBE T1 non fat saturation images.
3. Axial T2 images with fat saturation.
4. Axial VIBE T1 images with fat saturation
5. Dynamic multiphase T1-weighted axial images with fat saturation and intravenous Gadavist contrast (8.5 mL). 1.5 mL of Gadavist discarded.
6. Sagittal VIBE T1 post-contrast images with fat saturation.
7. Axial diffusion weighted images.
8. Data analysis and post processing utilizing Cadstream.



FINDINGS:



RIGHT breast findings:



The breast parenchyma demonstrates scattered fibroglandular tissue tissue, and there is mild background parenchymal enhancement.



No suspicious masses or areas of abnormal enhancement.



There is no significant lymphadenopathy noted.



LEFT breast findings:



The breast parenchyma demonstrates scattered fibroglandular tissue tissue, and there is mild background parenchymal enhancement. Post surgical changes of the left breast are again identified without associated enhancement of the surgical scar, stable.



The central left breast tissues demonstrate a few new foci of enhancement, when compared with the previous MRI of 2019. 4 discrete foci are most prominent on the MIP images, 3 of these being of interest since they are different than what was seen on the
previous MRI. These 3 foci measured together span 1.7 cm TR by 0.8 cm AP by 0.7 cm SI.



L1: 8 mm ill-defined nonmass-like focus of enhancement (axial series 5, image 66) showing increase in size since the previous examination. This is at the central retroareolar tissues, 3.4 cm posterior to the nipple. This lesion shows a mixture of type
II and type III enhancement kinetics.



L2: Tiny 3 mm focus of enhancement (axial series 5, image 60) that is 8 mm posterior and 7 mm inferior from L1. This is small enough that it may represent background enhancement.



L3: Tiny 2.5 mm focus of enhancement that is 1.7 cm medial and 0.8 cm posterior to L1. This could also represent background enhancement.



L4: 4 mm focus of enhancement (axial series 5, image 66 that is 1.6 cm posterior lateral to L1, and this focus of enhancement is stable since the previous exam.

May 22, 2020 04:29PM acnort wrote:

I’m hoping to get some help here. I found a “lump” a few weeks ago. My Doctor examines and ordered a mammogram and an ultrasound. I went for those Wednesday and was told that I had a couple suspicious spots, that could be shadows or could be small masses. I was scheduled for an ultrasound guided core needle biopsy for today. I went to my appointment and was told by a different radiologist that there was nothing he could see for a biopsy. I’m relieved, but very confused as how I can feel a spot and had a technician and radiologist say that there were two places on Wednesday and today there’s nothing. I don’t know what to do or who to believe.

May 26, 2020 03:47PM robinorbit wrote:

Hello djmammo:

I have a few questions about findings from my recent 3D mammo screening (below in italics). I'm 55, post-menopausal, do not take hormones, and this was a routine screening. I'm scheduled for diagnostic mammo and US on June 5. This abnormality is reportedly new since last mammo 2018. I've never had any mammo call backs and no family breast cancer history.

Radiologist states they saw on both CC and MLO a "nodular asymmetry with ill-defined margins and a punctate calcification measuring approximately 7 mm." My questions about this would be:

--Does it appear that "a punctate calcification" means just ONE calclification rather than an asymmetry that is in general showing punctate calcification?

--Does it appear that it's the asymmetry itself that is 7 mm, and not the calcification?

--Does this appear to mean that the calcification appears fto be INSIDE the nodular asymmetry?

--Is there any specific risk associated from one punctate calcification located in or near a nodule or mass? (And I have read your other posts, so I understand that it hasn't yet been established that this is an actual nodule or mass.)

Thank you so much for any assistance you can provide.

Sincerely,

robinorbit


IMPRESSION:


Left breast nodular asymmetry. Further evaluation with 3-D diagnostic mammogram and ultrasound
is recommended.

BI-RADS Category 0: Incomplete: need additional imaging evaluation. Sutter Women's Imaging will
contact the patient for follow-up.

RECOMMENDATION:

1. The American College of Radiology and the Society of Breast Imaging recommend annual
mammograms for most women beginning at age 40, and continuing as long as a woman is in good
health. However, breast imaging frequency may vary depending on individual risk factors. Please
consult your primary physician to discuss your level of risk and coordination of optimal
management of your breast care.
2. A negative mammogram examination does not preclude further evaluation or biopsy of any
clinically suspicious lesion(s).

Electronically Signed by: RADIOLOGIST 5/20/2020 2:59 PM

Narrative

PROCEDURE: MAMMO SELF REQUESTED DIGITAL SCREEN W TOMO BILAT, 5/15/2020 12:52 PM

HISTORY: Screening

COMPARISON: 4/11/2018

TECHNIQUE: BilateralCC, MLO images were obtained.3-D imaging was performed. The study was
reviewed with computer aided detection (CAD).

FINDINGS:

The breast tissue is heterogeneously dense, which may lower the sensitivity of mammography.
Bilateral asymmetries are noted. A nodular asymmetry with ill-defined margins and a punctate
calcification measuring approximately 7 mm is now seen in the posterior third lateral left
breast on CC view and at nipple level on MLO projection (3-D CC slice 20, MLO slice 19). No
other significant interval change.

Surgery 8/20/2020 Dx 9/3/2020, IDC, Left, 1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2-, Dx 9/3/2020, DCIS, Left, <1cm, Stage 0, Grade 2 Radiation Therapy Whole breast: Breast

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