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 11:30AM - edited Mar 22, 2018 09:57AM by djmammo

Posted on: Aug 25, 2017 11:30AM - edited Mar 22, 2018 09:57AM 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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Jun 27, 2020 07:02AM djmammo wrote:

Djabi53

The report is a basic normal report. The followup lay letter, the one you called a second report, contains the information now required in most states to tell patients that more than just a mammogram could be done if the breasts are dense.

Please send me links to the articles your found indicating the degree of false positives on breast ultrasound that your referenced in your post.

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

Jun 27, 2020 07:04AM djmammo wrote:

Bea89

This is the path report that goes to your doctor, the one that ordered the biopsy. That doc is responsible for explaining this report to you, in detail.

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

Jul 3, 2020 09:08PM everythingwillbefine wrote:

Hi,

Glad I found this place. I am 47 and 2 young kids and I am so scared now.

2018 I went for my screening mamo and called back for diag mamo and was recommended biopsy but was clearly told that >95% is benign and it was ALH.

I then consulted two breast surgeons both said just watching which I did.

2019 screening mamo was fine.

This year 2020 June mamo they found new calcifications then I was called back for diag mamo right after. The report says as follows

FINDINGS:
The right breast is extremely dense, which lowers the sensitivity of
mammography. There is a 7 mm new group of coarse heterogeneous
calcifications in the right upper likely outer posterior breast. The X
biopsy clip marking the previous biopsy site which showed ALH is anterior
and inferior to these calcifications. There are no suspicious masses or
areas of architectural distortion.

I took the report and films to another breast center and came back slightly different report but seems even worse.

There are linearly distributed pleomorphic calcifications in the central posterior right
breast posterosuperiorly adjacent to the X-shaped clip, measuring approximately 1.4 cm in
maximum AP extension.

IMPRESSION: Suspicious calcifications in the central upper posterior right breast adjacent
to the X-shaped clip. Stereotactically guided biopsy of the right breast is recommended.

BIRADS: 4 - Suspicious Abnormality.

I am now waiting for my biopsy which is on 7/10

I am so worried. I am prepared for the worst IDC. I just want to know how big chance is that it invades to the lymph nodes already. Since my breasts are very densed that I am concerned that the cancer might be there for some time already.

Dx 7/7/2020, LCIS, Right Dx 7/14/2020, DCIS, Left, Stage 0, Grade 2, ER+/PR+ Surgery 7/31/2020 Lumpectomy; Lumpectomy (Right) Surgery 7/31/2020 Mastectomy; Mastectomy (Left) Dx 8/6/2020, LCIS, Right Dx 8/6/2020, DCIS, Left, 6cm+, Stage 0, Grade 2, 0/1 nodes, ER+/PR+ Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

Jul 5, 2020 09:02PM 12jessie04 wrote:

I hope I’m putting this in the right spot (new here). DJ MAMMO, if you could provide some feedback on my ultrasound report, I’d really appreciate it. Biopsies are scheduled 7/21/20. Appointment with breast specialist 7/31/20. Thank you so much in advance.

BILATERAL BREAST ULTRASOUND LIMITED

INDICATION: 49-year-old woman presents for second look ultrasound post MRI for evaluation of new densities seen on mammography. Breast MRI demonstrated lobulated regions of predominantly persistent enhancement associated with mildly increased signal on T2 in the right inferior breast 6-7 o'clock and left lateral breast 3-5 o'clock.

COMPARISON: Breast MRI 6/19/2020, mammography and breast ultrasound 6/9/2020, 5/26/2020, 3/19/2019

TECHNIQUE: Grayscale interrogation of the RIGHT and LEFT breasts was performed. The region scanned included right inferior and subareolar breast and left lateral breast. Doppler interrogation was performed as necessary.

FINDINGS:

RIGHT BREAST: In the right inferior breast adjacent to the chest wall and corresponding in location to lobulated enhancing region, there are hypoechoic irregularly marginated and lobular foci which demonstrate bleeding vessels and appear to represent different vibration characteristics on power Doppler vocal fremitus evaluation. In the right breast in region of involvement measures approximately 1.4 x 1.1 x 0.7 cm.

LEFT BREAST: Sonographic evaluation of left lateral and lower outer breast demonstrates shadowing region which is ill-defined, taller than wide with irregular margins measuring approximately 1.6 x 2 x 1.9 cm. Power Doppler vocal fremitus evaluation confirms this to represent a real finding.

IMPRESSION: Bilateral regions of sonographic shadowing, ill-defined, centered in the right posterior breast at 6:00 and left lateral breast 3-4 o'clock, corresponding to regions of increased lobular enhancement on MRI and more nodular asymmetry on mammography. Differential considerations include: stromal sclerosis/fibrosis, Pseudoangiomatous Stromal Hyperplasia (PASH), lobular and other neoplasia. While benign etiology is favored, definitive diagnosis would require tissue sampling.

BI-RADS: 4 Suspicious

RECOMMENDATION: Biopsy Bilateral Bilateral ultrasound guided biopsy of right inferior breast region of shadowing at 6:00 and the left lateral breast 3-4 o'clock.


Jul 6, 2020 12:14PM jothegreek wrote:

Subject: birads 3 needing biopsy exactly 2 years after (benign) excisional biopsy 58 yo

Hi guys, hi djmammo! Heart Haven't posted in a while as last year's breast routine tests were ok and I pushed the whole issue to the back of my mind not that the rest of my health problems allow me to be very carefree anyway (diagnosed with borderline MGUS/smouldering myeloma last year, just watch-and-wait still, no chemo or other therapies)...

Fast forward to present summer's breast imaging where a new finding is observed in both the digital mammogram and the 3D/4D ultrasound. As I'm translating the terminology from Greek please bear with me! The mammogram states that in the posterior tertile of my right breast an asymmetry is observed which constitutes a new finding compared to last year's mammogram. The 3D/4D U/S confirms that at the posterior breast region @ 6.00 h of my right breast there's a solid spindle-sized nodule 0.9 cm which is well defined, has poor vascularity and medium stiffness in elastography (BIRADS 3) and a biopsy is recommended as it is a new finding and I'm 58 yo (which, I guess, means that no finding is considered benign anymore and everything has to be checked out through biopsy...).

Mind you that this is the exact spot in my right breast where a wide excisional biopsy took place back in July 2018 with the histology findings being listed below in the description of my lesions.

I'm consulting with my doctor/breast surgeon this Thursday and, of course, getting prepared for yet another summer surgery which doesn't make me very happy but what can I do, not much other than adhering to my doctors' guidelines...

I would love to have the input of both djmammo as well as anyone else's who has had a similar experience with a new lesion in the exact spot of a previously biopsied area so as to know what I should expect this time...

Thank you so much for listening and I'll be grateful for any responses.

Happy summer wishes to all of you,

As ever,

Jo

Diagnosis 07/2018 @ 56 - Adenosis, apocrine metaplasia, usual ductal epithelial hyperplasia Surgery 7/9/2018 Lumpectomy; Lumpectomy (Right)

Jul 21, 2020 12:31PM - edited Aug 18, 2020 04:05PM by GracieLulu

This Post was deleted by GracieLulu.

Jul 26, 2020 12:08PM - edited Jul 27, 2020 07:43AM by mangosan99

Djmammo; thank you in advance for any info/insight you can shed on this results of my MRI. I have been on this journey since early June (had screening mammo, diagnostic mammo, and biopsy which led to genetic testing and this MRI before any more surgery. Still pending results of genetic testing and followups with first and second opinion breast surgeons so wanted to get any info I can while waiting. Just FYI, reason for collapsed implants is I was preparing for cosmetic revision when COVID hit--left had ruptured, right was drained to determine volume; delay led to annual mammogram, and now here!

My main questions are whether these findings are definitive for upstaging and, if so, are the indicative of DCIS? or are we looking at invasive BC?

CLINICAL INDICATIONS: D48.62 (Neoplasm of uncertain behavior of left breast)
R92.0 (Mammographic microcalcification found on diagnostic imaging of breast)
Z80.3 (Family history of malignant neoplasm of breast) . 52-year-old with history of left atypical ductal hyperplasia from stereotactic biopsy. She is premenopausal and is not on hormones. Maternal and maternal grandmother history of breast cancer.
History of breast augmentation

TECHNIQUE: Axial T1 nonfat saturated, T2 fat saturated, and precontrast fat saturated sequences were obtained. After the uneventful intravenous administration of 15 mL MultiHance, 5 total dynamic post-contrast sequences were obtained with subtraction
axial and sagittal subtracted and axial MIP reconstructions. A post contrast oblique series was acquired. Imaging was evaluated with DYNACAD software on an independent workstation for kinetics assessment.

COMPARISON: Prior mammograms back to 2016

FINDINGS: The breasts are composed of heterogeneous fibroglandular tissue. There is moderate symmetric background parenchymal enhancement.

LEFT BREAST: There is a T2 hyperintense chamber containing a clip on T2-weighted image 25 corresponding to T1 weighted nonfat saturated image 25. This is immediately deep to the skin in the lateral slightly lower left breast. On this examination, the
nipple is folded to the left. There is a deflated implant shell in the subpectoral left chest wall. There is a small amount of T2 hyperintense fluid within the capsule without associated enhancement.

In the left lateral slightly lower breast, adjacent to the biopsy clip, there is mass enhancement which measures 1 x 1 cm on image 27. There is segmental nonmass enhancement which extends about 2.3 cm as seen on image 28. These areas show plateau
kinetics. In the left central breast, on image 33, there is more confluent nonmass enhancement which spans 1 x 0.7 cm and appears more unique in the background enhancement. In addition, in the upper outer posterior left breast, there is confluent mass
enhancement on sagittal oblique image 36, corresponding to axial image 42 on the sagittal oblique sequence, this has angular margins. No left axillary or internal mammary chain adenopathy. Skin and chest wall structures appear unremarkable.

RIGHT BREAST: In the background of moderate enhancement, there is an area of clumped nonmass enhancement in the right breast at 12:00 measuring 0.9 x 0.8 cm on image 46 with a correlate measuring 1.1 cm on sagittal reconstructed image 40. No right
axillary or internal mammary chain adenopathy. Skin and chest wall structures appear unremarkable. Deflated subpectoral saline implant shell.

EXTRAMAMMARY SOFT TISSUE AND OSSEOUS STRUCTURES: No abnormality identified.

ASSESSMENT: BI-RADS 4: Suspicious

Adjacent to the clip in the left lower outer breast, there is confluent mass enhancement which measures 1 x 1 cm. There is clumped segmental nonmass enhancement which extends posteriorly over an additional 2.3 cm.

In the background of moderate enhancement, there is unique enhancement in the right upper central breast at 12:00 (image 46), in the left central breast (image 33), and in the left upper outer breast (image 42) as described above. Patient was imaged in
the luteal phase. This could be hormonally mediated. Consider MRI directed biopsy.

Collapsed saline implant shells. Small amount of fluid surrounds the left shell within the capsule. No abnormal enhancement.

MANAGEMENT: Biopsy is recommended.

Bilateral breast MRI directed biopsy should be considered for the findings described above.

Dx 7/7/2020, DCIS, Left, 1cm, Stage 0, Grade 2, 0/6 nodes, ER+/PR- Surgery Mastectomy (Left): Skin Sparing; Prophylactic mastectomy (Right); Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander

Jul 26, 2020 08:46PM irina7k wrote:

Djmammo, could you please interpret my US results.. I am freaking out as I am currently pregnant (first trimester). I have "irregular shape mass, non parallel orientation" which fall under "less favorable". I am preparing myself for the worse but just wanted to hear your opinion.. THANK YOU SO MUCH!!!

-------------------------------------

FINDINGS:
BREAST ECHOTEXTURE: There is a homogeneous background echotexture - fibroglandular.

Right 10 o'clock 4 cm from nipple area of palpable lump as per the patient, 1.1 x 0.6 x 0.7 cm septated cyst, benign-appearing. Benign right axilla. Left 7 o'clock 2 cm from nipple nonparallel orientation irregular shape mass, indistinct margins, 0.5 x 0.5 x 0.5 cm, suspicious. Benign left axilla.

IMPRESSION:

1. Suspicious left breast 7 o'clock 2 cm from nipple ultrasound lesion. Monitoring stability over time will not be able to confirm a benign etiology in this case. Ultrasound-guided core biopsy left breast x1 recommended. Bilateral mammography would usually be recommended in this situation prior to biopsy. However, given the current pregnancy, mammography should only be performed after the first trimester with abdominal shielding, if left breast ultrasound core biopsy shows an indication for surgical intervention.

2. Right breast 10 o'clock 4 cm from nipple shows a benign-appearing cyst corresponding to the clinically palpable lump.

FOLLOW-UP: Ultrasound guided biopsy.


ASSESSMENT: BI-RADS Category 4: Suspicious.

Jul 30, 2020 11:06PM - edited Aug 2, 2020 11:39AM by RosaMystica

This Post was deleted by RosaMystica.

Jul 31, 2020 10:16AM moderators wrote:

Hi all --

Our wonderful, helpful, and much-needed djmammo has reached out to let us know that he's having some back issues and is in bed recovering for some time and will not be able to weigh in with assistance on reports for a little while. So, we are going to lock the thread for now.

We know this thread helps so many, and we are sorry to shut it down for a little while.

If you've posted here and are waiting a response from djmammo, we encourage you to copy and paste your post into a new thread here in the Not Diagnosed but Worried forum, where others can hopefully weigh in with their thoughts. We do have many other very helpful members who are always happy to help!

So sorry for the inconvenience, and we, along with you, are sending djmammo lots of healing vibes for a quick and full recovery!

--The Mods

To send a PM to the Mods: community.breastcancer.org/my/...

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