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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May 27, 2020 03:11PM - edited May 27, 2020 03:12PM by djmammo

robinorbit

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

yes

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

7mm refers to the nodular assymetry

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

yes

--Is there any specific risk associated from one punctate calcification located in or near a nodule or mass?

depends in the size and shape of the calc. large and smooth is better than small and irregular. If there is only one it could just be in an early stage and only one calc has formed. There can be calcs in both benign and suspicious massses.


I would not jump to any conclusions until the US is done. That's where a more specific diagnosis is usually made.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 27, 2020 03:18PM djmammo wrote:

sushu

I don't see the words "irregular enhancing mass" anywhere in the report. The findings described can go either way along the continuum from benign enhancement to ADH to DCIS but usually not IDC without an actual mass. We did many biopsies for these kinds of findings. They just take a while and can be uncomfortable to lay there without moving through it all. Good luck.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 27, 2020 03:30PM djmammo wrote:

acnort

This happens now and then. If the two exams were close together in time, only a week or two, the variables are the machine, the tech, and the radiologist. Was it the same machine and are they of equal quality? Was it the same tech each time or different? In our facility the breast US tech was board certified in breast ultrasound and did it every day. Those who are not certified and only do it now and then are not as proficient. There are settings on the machine that can make good things look bad and bad things look good so one has to know breast. Was it the same radiologist? At our facility the two of us did nothing but breast imaging period. Every day for many years. We can tell what's what on a breast study more confidently than those who only read occasionally. So if there were two different rads reading them, which had more experience in breast imaging? Also was the facility listed as a Breast Imaging Center of Excellence (BICOE) by the ACR? Certain standards that affect the above have to be maintained in order to get that certificate. If the exams were months apart and you are still cycling it might have been an actual hormone related change in your breasts that simulated a problem on that one study. Look at the reports and see what their explanation was. There should also be a recommendation for follow up or for a tie breaker exam of one kind or another.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 28, 2020 10:04PM robinorbit wrote:

djmammo,


Thank you so much for helping me better understand the mammo report! I really appreciated your clarifications and honestly haven't jumped to any conclusions except that it's too early to do so.


I sincerely appreciate you.

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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May 29, 2020 02:39AM Munalula1 wrote:

I have a biopsy booked for Tuesday. The radiologist didn't not say much except that I'd need a biopsy to determine what this lump is and that my breasts are dense. I wish I had asked more questions. Please check out my report and help me understand what this means? Thank you.

Indication: Newly found approximately 2cm lump at the 10 o'clock position in the right breast.

Technique: Bilateral MLO and CC 2D mammograms. Bilateral MLO and right CC 3D mammogram. Bilateral breast ultrasound.

Breast Density: Volpara D, 18.2% volumetric density.

Findings: There are no previous images for comparison.

The palpable lump at the 10 o'clock position in the right breast correlates with a 15mm round mass with mostly smooth margins. No other mass or architectural distortion is seen in either breast.
There are no suspicious microcalcifications.

Ultrasound examination of the lump at the 10 o'clock in the right breast shows a 15 x 14 x 9mm oval mass, 10cm from nipple. This has slightly lobulated margins. It is solid and heterogeneous but with small cystic areas. There is prominent vascularity within it on colour Doppler examination.

No other sonographic abnormality is seen in either breast. There is no axillary lymphadenopathy.

IMPRESSION:
The palpable lump at the 10 o'clock position in the right breast is an indeterminate, mostly solid mass with cystic areas.
Ultrasound-guided core biopsy is recommended

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May 29, 2020 06:53AM djmammo wrote:

Munalula1

The biopsy is clearly indicated and should be an easy target at US.

There are two scenarios with mixed cystic/solid masses. One is a cystic mass with solid elements that have blood flow. The other is a solid mass with blood flow that incidentally has a few cystic spaces in it. The first is suspicious and the second leans more toward the benign side.

Fibroadenomas can present this way, and considering its size, its probably been there for a while. There are however no old studies for comparison to show if its stable or not so in this situation we always biopsy them.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 29, 2020 12:26PM jjjry wrote:

Mammogram Results and Very Alarmed

I had a mammogram today. I can see in my health portal it was reviewed with

Left Asym Per Dr. Name

Then I see Bi Diagnostic Mammogram Bilateral W Contract and US Breast Complete Bilateral.

What does these mean? To me it says they found an asymmetry and I will have to go back for more testing.

My doctors have left for the day and I am very worried.

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May 29, 2020 01:04PM djmammo wrote:

jjjry

Are you sure thats the report? It looks like the clinical history followed by billing information

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 29, 2020 01:40PM Munalula1 wrote:

Thank you djmammo for your reply. I can see why the need for the biopsy the way you’ve put it. I’ll update what the outcome is after my biopsy.

Munalula

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Jun 1, 2020 01:11PM jjjry wrote:

Thank you for your reply. Yes. I did get a call back today.

The nurse said there is a slight asym in the left breast from last years mammogram. I am scheduled for a contrast enhanced digital mammogram on Thursday. I am not familiar with this procedure. I feel worried. I was called back last year for additional mammogram and biopsy and all turned out fine.

But, I have never had CEDM. Does this indicate greater concern from the radiologist?

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