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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Nov 5, 2017 05:07AM djmammo wrote:

na_na

Fibroadenomas have a characteristic appearance on MRI usually very different from that of a cancer on MRI, so thats probably what it is. If it is not growing thats another reason not to biopsy it. They will continue to monitor it. If it doesn't change in 2 years they may not even mention it again. Are you alternating MRI and mammogram every 6 months or just the MRI?

What was the path result on the lymph node biopsy?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Nov 5, 2017 10:40PM - edited Nov 5, 2017 10:42PM by na_na

Thank you very much for your response, Dj Mammo.

I undergo MRIs, as I have very dense breast tissue and mammogram is not informative - BIRADS 0. I'm 36 and tried mammogram once.

The path report of lymphnode was hyperplasia.

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Nov 9, 2017 06:34PM - edited Nov 9, 2017 06:35PM by Ozarkgirl

DJMAMMO

Thank you so much for your quick reply -- I slept much better after your words. The good news is my biopsy shows benign however the bad news is that it also showed radial scaring with Atypia Hyperlasia which they indicated there could possibly be something hidden within. I have an appt with a breast surgeon on Nov 20 to discuss options. I'm still releived though! 😀

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Nov 9, 2017 08:46PM shazelwo wrote:

DJMAMMO,

I was hoping you can tell me more about my report. I am wondering if they may possibly be seeing scar tissue from a biopsy done to me in May that was benign . The clip did not show any issues on mammogram, but the area she describes is my previous biopsy site. I do not know if scar tissue could present the way she describes my area of suspicion. My report is LONG, so I hope you can find it in your heart to chime in. I dont know much about medical terms , my focus is in law so very different field of study! I do have a thread going in "waiting for results" but, I really wanted your opinion. Ofcourse, I will follow through with the biopsies she reccomends and they are scheduled for Monday. My anxiety is kicking up really good because of this whole thing.

Here is my report:

Standard images of both breasts in the CC and MLO projections using 
tomosynthesis were performed. Magnification views of the
calcifications in the right breast were performed and compared to
previous magnification views as well.

The breasts are heterogeneously dense, which may obscure small
masses. The parenchymal pattern on the left is stable. Scattered
benign calcifications are noted throughout the left breast.

No suspicious masses, areas of architectural distortion or suspicious
microcalcifications are identified in the left breast.

A biopsy clip is noted in the lower outer right breast where the
patient underwent a previous benign biopsy performed by Dr. McCroskey.
No suspicious abnormalities detected in this area on the mammogram.

Nonspecific dense tissue is noted in the area of palpable concern in
the upper right breast at approximately 12:00 and a few lymph nodes
are noted in the general area of palpable concern in the right axilla
but they do not have a suspicious appearance.

Generalized density is noted in the central and inferior right breast
where calcifications are present. The calcifications have increased in
number when compared to the prior examination. This area of the right
breast was subsequently evaluated with ultrasonography and will be
described below.

A targeted right breast ultrasound was performed with attention to the areas of palpable concern, the area that was previously biopsied at
7:00 and the inferior right breast in the location of generalized
density include an increasing calcifications.

Currently in the right breast at 7:00, 6 cm from the nipple, multiple
cysts or possibly dilated ducts which appear to contain calcifications
are noted. This corresponds to the increased generalized density and
increasing calcifications on the mammogram. This spans up to 5 cm in
its greatest dimension. While its possible that this could represent
fibrocystic change with multiple calcifications, the possibility of
dilated ducts containing calcifications consistent with DCIS cannot
entirely be excluded and further evaluation with an ultrasound-guided
breast biopsy using vacuum assistance is recommended. It is also
recommended that the core samples be radiographed to ensure that
representative calcifications are present in the sample.

A round hypoechoic nodule measuring up to 4.2 cm is noted in the
posterior aspect of the right breast at 10:30, 4 cm from the nipple
which may represent a complex cyst or solid mass. Further evaluation
with an attempted aspiration followed by core biopsy, if it will not
aspirate is recommended in further assessment.

In the area of palpable concern in the upper right breast at 12:00,
benign-appearing tissue was noted at real-time. No suspicious
ultrasonographic abnormalities were identified in the area of palpable
concern in the right breast at 12:00 at real-time.

In the area of palpable concern in the right axilla, multiple
morphologically benign-appearing right axillary lymph nodes are noted
with echogenic hila and non-thickened cortices. A note is made that no
suspicious right axillary lymph nodes are identified.

IMPRESSION:

1. There is no mammographic evidence to suggest the presence of
malignancy in the left breast at this time.
2. There is increasing number of microcalcifications associated with
generalized density in the inferior right breast with corresponding
cystic change containing calcifications detected at ultrasonography at
7:00, 6 cm from the nipple. Further evaluation with an
ultrasound-guided breast biopsy using vacuum assistance and with a
specimen radiograph of the core samples for verification that
representative calcifications were retrieved is recommended.
3. Low suspicion nodule in the right breast at 10:30 for which further evaluation with a cyst aspiration and possible core biopsy is recommended. BIRADS CATEGORY 4: SUSPICIOUS - Biopsy should be performed in the absence of clinical contraindication - 4B (Moderate suspicion for malignancy) A right ultrasound-guided breast biopsy x 2 is recommended.


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Nov 11, 2017 12:45AM - edited Nov 11, 2017 01:01AM by Red_Softail

Hi Everyone! I went for an ultrasound today for Rt and LtB as well as a lump inferior to the RtB (which was just a lipoma).Got called into docs at dinner time (more so i think so i dont worry waiting).

No mention from my doc if a follow up would be recommended (a f/u ultrasound ). However, my gut tells me to. I know nothing to worry about but I'd like a second opinion if I should F/u.

7x4x5 mm intramammary lymph node RtB and small coarse calcification on LtB.


I'm 34. Thank you everyone😀

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Nov 11, 2017 07:53AM - edited Nov 11, 2017 10:19AM by moderators

Dear Red_Softail,

We are sorry that these breast changes are causing you alarm. We are glad that you reached out to our members. Have you discussed the report with your doctor? Are you looking for some advice here as to whether or not you need a follow up ultrasound? Perhaps a discussion with your doctor about what the path report means would be helpful . Let us know what you learn. The MOds


To send a PM to the Mods: community.breastcancer.org/my/...
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Nov 11, 2017 09:13AM djmammo wrote:

shazelwo

I reviewed the report. It appears rather well written and complete in its descriptions compared to many I have seen here recently.

They describe a mass in the upper outer quadrant on the right at 10-11 o'clock. You have it labeled as measuring 4.2 centimeters. Did you mean millimeters?

They describe calcifications in ducts in the lower out quadrant in the region of your prior biopsy. This appearance does not suggest scarring from a prior image guided procedure. What was the target of your prior biopsy?

Their conclusion and recommendations match with their findings.

1) The calcifications in dilated ducts raise the possibility of DCIS and will need a biopsy to confirm or exclude that diagnosis.

2) Any newly identified solid nodule or complex cyst also needs similar evaluation. This possibly solid nodule (at 10:30) is in a different quadrant from your prior biopsy (7:00).

3) They apparently saw nothing that concerned them at 12:00 .

Let us know the results of the biopsies.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Nov 12, 2017 04:54PM - edited Nov 12, 2017 04:57PM by shazelwo

Thank you so much, as for the size i just copied her report so she may very well have meant mm since it is a long report. I have the biopsies tomorrow at 12:30 I will update when I know something. I looked at my other report where i had the nodule in May biopsied and it says that it was at 7 o'clock 6 cm from nipple.

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Nov 13, 2017 05:12PM renee_rn wrote:

djmammo,

I had my first ever mammogram on 11/1 and it's abnormal. I am 42 years old & a little nervous. I'm a RN but not real familiar with mammography terms. My specialty is critical care. Can you please tell me your impression of the results?

Current study was also evaluated with a Computer Aided Detection system.

No prior exams were available for comparison.

The tissue of both breasts is heterogeneously dense. This may lower the sensitivity of mammography.

There is a 0.9cm irregular density with an obscured margin in the right breast central to the nipple middle depth.

No other significant masses, calcifications, or other findings are seen in either breast.

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Nov 13, 2017 05:38PM melissadallas wrote:

What was the Birads rating and what were the recommendations? Are you called back for more views to be taken and/or ultrasound?

It is really common to be called back on first mammogram, as there are no films to compare for your personal "normal." It very well may look benign on more views.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor. Dx 5/20/2012, LCIS, Stage 0, 0/0 nodes

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