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Topic: Interpreting Your Report

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 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 helping members understand their health care provider's reports and recommendations.
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Jan 10, 2019 11:11AM NJgirl2018 wrote:

Thank you so much djmammo for all that you do for this group! I wanted to add my findings here and see what you think--this is my first mammogram and it just seems to keep going, and going, with nothing definitive other than just a "feeling" that something is wrong.

Screening mammo:

No prior exams were available for comparison.

The breasts are heterogenously dense, which may obscure small masses.

There is a subtle distortion within the RIGHT breast upper outer quadrant, posterior depth. Recommend ML, spot CC view with 3D and spot MLO view with 3D as well as targeted ultrasound.

There is partial visualization of possible distortion within the lateral aspect of the LEFT breast, posterior depth. Recommend ML, XCCL, spot CC view with 3D and targeted ultrasound.

IMPRESSION: INCOMPLETE:NEED ADDITIONAL IMAGING EVALUATION
There is a subtle distortion within the RIGHT breast upper outer quadrant, posterior depth. Recommend ML, spot CC view with 3D and spot MLO view with 3D as well as targeted ultrasound.

There is partial visualization of possible distortion within the lateral aspect of the LEFT breast, posterior depth. Recommend ML, XCCL, spot CC view with 3D and targeted ultrasound.

The patient was notified of the results

Diagnostic mammo:

Comparison is made to exam dated: 12/10/2018 Morristown Medical Center.

The breasts are heterogenously dense, which may obscure small masses.
Bilateral ML and CC spot compression 2D/3D views were obtained in this patient for further evaluation of bilateral distortions in the lateral regions seen on recent screening mammogram.

The distortions predominantly dissipate on today's views. No sonographic correlate is seen on the left. 6 month follow up left mammogram is recommended.

There is a questionable finding on the right for which ultrasound guided biopsy is recommended.


IMPRESSION: PROBABLY BENIGN
Please see separate ultrasound report detailing recommendation for right ultrasound guided biopsy with post procedure tomogram.

6 month follow up left mammogram is recommended.
These findings were discussed with the patient at the time of examination.

Breast ultrasound:

Real-time ultrasound of both breasts was performed.

Targeted ultrasound of the left 2-4:00 area and right 9-10:00 area was performed. No definite sonographic correlate for distortion on the left is seen. 6 month follow up left mammogram is recommended.

There is an ill defined hypoechoic area at right 9:30 8 cm from nipple. Biopsy of this area is recommended.

There are scattered cysts/benign appearing nodules measuring up to 6 mm at right 9:00.

IMPRESSION: SUSPICIOUS OF MALIGNANCY - FOLLOW-UP RECOMMENDED
Ultrasound guided biopsy of the right 9:30 8 cm from nipple area with post procedure tomosynthesis is recommended. It is uncertain whether this corresponds to the area of right mammographic concern. The above findings were discussed with the patient by myself at the time of examination. The referring physician's office will be contacted by the breast center staff today. The patient was facilitated.

Please see separate mammogram report detailing recommendation for 6 month follow up on the left.

Biopsy, including radiologist impression of pathology:

PROCEDURE DESCRIPTION: The patient was prepared and draped in the usual aseptic fashion and 10cc 1% lidocaine solution was utilized to achieve local anesthesia.

An ultrasound guided biopsy using real-time ultrasound was performed for the mass located in the right breast at 9:30. This was described on the previous ultrasound report. The skin was prepped in the usual manner. Local anesthetic was administered to the access site. A biopsy needle was placed adjacent to the abnormality under ultrasound guidance. Once the needle was documented to be in the correct location, multiple specimens were obtained using a BARD biopsy device. A coil clip was inserted into the biopsy cavity. A skin closure strip and a sterile dressing were applied to the access site. The specimens were sent to the laboratory for pathological analysis.


IMPRESSION: ULTRASOUND GUIDED BIOPSY
Ultrasound guided biopsy of the mass in the right breast at 9 :30

Dr. Paul Friedman
pf/:1/3/2019 13:19:34

AMENDMENT: 1/7/2019 Paul Friedman
Final pathology from the ultrasound guided biopsy reveals benign fibrocystic changes, there is persistent subtle distortion on the mammogram at 9:30 and there is a question of concordinance- i spoke with the patient and a consult with a breast surgeon is recommended. a breast mri may provide additional information. if the mri is negative then a follow up mammogram in 6 months can be performed. if there is enhancement then excision of the area is recommended.

Mammogram following clip placement:

The breasts are heterogenously dense, which may obscure small masses.
Post biopsy mammograms were performed, including cc and true lateral images. There is a coil metallic clip at the site of the previously described abnormality in the right 9:30.

So based on my very, very limited knowledge in this, I don't see a lot of "buzzwords" here and it's hard to tell what they are so concerned about. I had my MRI yesterday and will meet with a breast surgeon next week to discuss next steps. I know that when the radiologist called me about the path results he said they were benign but he was still worried about the architectural distortion on the mammo. (The actual path results are not in my chart--just his comment on them).

Thoughts? I will hopefully find out more on Monday! Thanks again!!

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Jan 10, 2019 12:03PM Anxiousmom wrote:

Hi everyone. So I had my biopsy on Tuesday (ultrasound guided). The breast center called me yesterday afternoon and advised my results were benign. This is great news! However, everyone at the breast center had acted like it was very serious and I got the impression from multiple people there that they were pretty sure I had cancer when I had my ultrasound done and as well when I returned for the biopsy. So of course, I have been prepared for the worst and hoping for the best. I am obviously very relieved that my biopsy was benign but I would like to get more information and better understand what happened. The dr at the breast center said that with microcalcifications I was automatically at a minimum of Birads 4B. Please note that my OB specifically said he would give me the results. I haven't heard from him yet even tho I left a few messages to talk to him. The breast center is the one that called and said it was benign. Specifically, the breast center said the biopsy showed "benign breast tissue with dense stromal fibrosis, non-proliferative fibrocystic change with microcalficiations with benign acini." follow up ultrasound and mammo in 6 mos.

My prior MRI & Ultrasound Report stated:

Indication: grouped left lower outer breast microcalcifications on screening requiring further characterization

Breast composition: heterogeneously dense which may obscure small masses

Findings: the grouped microcalcifications are again identified and appear to be of varying sizes and shapes. One of them demonstrates teacup like appearance on the true lateral projection which is compatible with milk of calcium, a benign entity. The calcification are within heterogeneously dense tissue. No discrete lesion or architectural distortion apparent on mammography.

Targeted left breast sonogram was performed and at 4:00 about 5 cm from nipple there is a Hypoechoic multilobulated 1.4 x 0.6 x 1.2 cm lesion with multiple internal echogenicities reflecting calcification. Finding is fairly posterior. No associated vascularity. The abnormality corresponds to the mammogram. The left axilla was imaged and no suspicious adenopathy identified.

Impression: a 1.4 cm left breast 4:00 mass with microcalcifications accounts for the screening mammogram abnormality. Finding is suspicious and requires tissue diagnosis.

Recommend left breast ultrasound guided biopsy.

Bi rads 4

The breast center indicated that they agreed with the pathology results. Can anyone give me any additional info? Can this change at my 6 month followup and again have to go through the same thing? I don't understand how everyone when from so concerned to.....nope everything is fine. Is this normal? I want to just lay this to rest and stop worrying about it but my OB hasn't called to confirm there is nothing to worry about and I'd love another opinion.

Thanks in advance!

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Jan 10, 2019 12:42PM djmammo wrote:

NJgirl2018

If you have already had all of that done, plus an MRI there is really nothing for me to add unless you have a very specific question. Let us know the result of the MRI.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Jan 10, 2019 12:46PM djmammo wrote:

Anxiousmom

Check back with us after you speak to your OB and have discussed all of your concerns with them. If something they tell you isn't clear, let us know.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Jan 10, 2019 12:55PM NJgirl2018 wrote:

Thanks...I guess I just don't know what we're really doing all of this for? There hasn't been a defined mass identified, my biopsy was benign, and I just feel like I keep moving down this treatment path but don't even know why. So I just didn't know if you could pull anything out of all of that which would explain what the real concern is. I will communicate what the MRI says when I hear!

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Jan 10, 2019 01:34PM cityrat wrote:

Hi, the back story about how I got to be in this mess is posted in the Waiting for test results topic.

The radiologist was much more positive today for some reason; he actually said, when I expressed my concerns, "there is very little chance that what you have is cancer." Which felt like an enormous relief, though he sort of backpedaled on it a little by saying later something like "whatever it is we can take care of it." which is pretty vague. I think he just has an air of "we just can't be too sure." about him. and still terrified as it seems the world of bc is filled with unexpected bad surprises regardless of statistics and probabilities.

Anyway results on Monday. While he was drawing the fluid he said it was "a little cystic" though he'd said last time post-US it was definitely not a cyst, though that's what my dr. thought it was at first. He also said it looked like there was possibly an infection as the fluid was cloudy (or thick, i forgot which he said sorry)? It sort of seemed like it was that, and also something else which was a total mystery to everyone. And he did use the word suspicious again.

Anyway, this is my mammogram/ultrasound report from last friday. Going to try not to think about it too too much til then because ive been thinking of little else. thanks for any insight you can provide!

FINDINGS:
MAMMOGRAM:
The breast tissue is heterogeneously dense which may obscure small
masses. The in the area of palpable concern in the inner right breast
there is evidence of a 1.7 cm mass with indistinct margins. No
associated calcifications. No definitive architectural distortion. No
other abnormality identified in either breast.

RIGHT BREAST SONOGRAM :
At 3 o'clock 5 cm from the nipple there is a irregular mixed solid
and cystic appearing mass, overall measuring 2.4 x 1.8 x 1.8 cm. This
corresponds to the palpable lump. No significant internal vascularity.
No abnormality identified in the right axilla.

IMPRESSION:
There is an indeterminate mixed solid and cystic 2.4 cm complex mass
in the right breast at 3 o'clock. Ultrasound-guided core biopsy
recommended.

RECOMMENDATION: Ultrasound-guided core biopsy right breast. Results
were given to the patient.

BI-RADS 4: Suspicious (4B)

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Jan 10, 2019 02:56PM Airedale wrote:

Just got my biopsy report! I am relieved but not sure if I am out of the woods yet, because the report recommends a diagnostic mammogram in 6 months. I'm still not sure what this all means, but the radiologist told me she thought I had a 40% chance of having DCIS based on my mammogram. My doctor told me I don't have cancer.

Right breast core needle biopsy, calcifications at 11:00, 6 cm from
the nipple:
-Focal usual ductal hyperplasia.
-Nonproliferative breast disease (stromal fibrosis, atypical
metaplasia, columnar cell change, cystic changes).
-Microcalcifications within benign breast ducts.
-Negative for carcinoma.

RECOMMENDATION: Imaging and benign pathology are concordant. A
six-month follow-up unilateral right diagnostic mammogram is
recommended


The findings from my diagnostic mammogram last month were:

Bilateral diagnostic mammogram and targeted left breast ultrasound

COMPARISON: Mammogram December 5, 2018 and December 4, 2017 and
November 29, 2016 and December 30, 2014 and November 24, 2014 and
November 21, 2013.
TECHNIQUE: Examination was performed utilizing direct 2D and 3D
digital tomosynthesis, as well as CAD. 2-D spot magnification views
of the right breast were also performed.
FINDINGS:
Right breast: Magnification views confirm a small group of
pleomorphic calcifications in the upper outer quadrant, anterior
depth, 6 cm from the nipple. The calcifications span 4 x 4 x 4 mm.
These are changed compared to prior mammograms. They are suspicious
and stereotactic core needle biopsy is recommended


Thank you!

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Jan 10, 2019 04:50PM Nouj wrote:

Thanks djmammo

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Jan 10, 2019 06:12PM Ddub wrote:

Djmammo,

Thank you so much for taking the time to reply! I’m having a biopsy a week from today to “make sure it’s benign “.

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Jan 10, 2019 09:29PM Ar12 wrote:

Thank You for your response Djmammo! The hypoechoic, solid and irregular is what has me worried and being put at a Birads 4b. The Radiologist did say that it looked like a collection of cystst in one view but possibly solid in another view. There was no mention of internal blood flow, shadowing or lymp nodes in her report. Which is a good sign? Are there benign lesions that would put her in the 4b class? She has had a Fibroadenoma removed once before in her right breast. I just wish we could have got in to see the surgeon earlier than the 28th. Thanks again.

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Jan 11, 2019 07:50AM Larlaw wrote:

Thought I'd post in this thread although I don't have my actual report (no way to get it in my province unless I ask my dr). Background: Last year I had my first mammogram that turned up a spot of asymmetry in my left breast. Followed up with spot compressions, ultrasound and mri. Was determined to be scar tissue from an injury I had roughly 6 months prior. The radiologist who did the ultrasound had said it looked like scar tissue - it was solid, around 2cm and looked like a capsule on the ultrasound. Had a follow up mammogram 6 months later with no call backs. Had another mammogram last week (roughly a year from the mri last year) and have a call back for another ultrasound. My dr said that its the same spot as last year. She did an exam yesterday and found the lump and said she could move it around and that it didn't seem concerning to her. I found it this morning and it was smooth and I could move it around as well. It was solid but not rock hard. My question is this what would be considered a normal follow up for what was found to be a benign without biopsy? I think I'm questioning it because I didn't get a call back after 6 months. Between the time of my mammogram and mri results last year I was a complete basket case and I'm trying to stay calm this time. Tks!

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Jan 11, 2019 08:44AM - edited Jan 11, 2019 08:55AM by djmammo

Ar12

There was no mention of internal blood flow, shadowing or lymph nodes in her report.

To me, this indicates incomplete reporting of the features of the mass, and these are features I personally consider important for giving an opinion of benign vs malignant.

In all my practices no one saw the breast surgeon until the radiologist performed a biopsy and the pathology was known, this being at the request of the breast surgeon.

As far as Birads goes, B4 means "biopsy this it might be cancer" whereas B5 means "this is definitely a cancer appropriate actions should be taken". 4B is somewhere in between. Yes many 4B biopsies come back benign.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Jan 11, 2019 08:49AM djmammo wrote:

Airedale

A 6 month follow up has become routine after a biopsy with concordant results, don't read too much into it. ;-)

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Jan 11, 2019 08:54AM - edited Jan 11, 2019 09:12AM by djmammo

cityrat

All cystic masses that are considered "complex" are biopsied. We worry less when there is no blood flow in the solid portions.

"...it seems the world of bc is filled with unexpected bad surprises regardless of statistics and probabilities"

Actually it is. In my experience, nowhere in radiology is there such an overlap of features and signs of benign vs. malignant disease. The gray area in the middle is quite large. The breast is also the only organ we image that is completely unique to each patient, like fingerprints. You can make a random pile of mammograms on the floor and I could match all the views of each study up together and identify which patient they go with. I doubt I could do that with a pile of chest x-rays or abdominal CT's unless there was some glaring abnormality present.

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Jan 11, 2019 08:58AM - edited Jan 11, 2019 09:14AM by djmammo

Larlaw

Help me out with the timeline. Was this finding present on physical exam, mammo and US prior to having that MRI? Was it reported on the MRI? If it was on the MRI they should have a good handle on the nature of the mass.

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Jan 11, 2019 09:41AM Larlaw wrote:

Yes it could be seen on my mammogram and ultrasound prior to the MRI last year. That was my first mammogram (my dr sent me because I turned 40) so there wasn't anything prior to compare to. Two radiologists looked at my MRI an agreed that it was benign (scar tissue or fat necrosis - are they the same thing?) but should be kept an eye on for the next little while. My dr didn't feel it on a physical exam prior to my first mammogram as my last physical exam at that point had been just before the injury happened. She can feel it now. She said yesterday (I was actually at the dr for something completely unrelated) that she may send me to get it removed regardless. Hope that made sense! Also thank you! I had horrible anxiety and panic attacks last year about this (doing better this year!)

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Jan 11, 2019 10:03AM - edited Jan 11, 2019 10:03AM by cityrat

Thank you for taking a look. I don't think it mentions blood flow.

I'm just terrifying myself thinking very bad things could be hiding in it (like a necrotizing high grade tumor or DCIS which i guess isn't "very bad" but still). And even freaking myself out with very unlikely things such as it being a secondary cancer from a thing on my scalp that my derm looked at and pronounced some kind of dermatitis a year ago but maybe it's melanoma and now spread to my breast. I even called her office. That's crazy, I know.

It's the fact that no one seems to know that's scaring me. Monday seems a long way off.

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Jan 11, 2019 11:23AM djmammo wrote:

cityrat

This link may be helpful.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Jan 11, 2019 12:49PM - edited Jan 11, 2019 12:49PM by Salamandra

Actually it is. In my experience, nowhere in radiology is there such an overlap of features and signs of benign vs. malignant disease. The gray area in the middle is quite large. The breast is also the only organ we image that is completely unique to each patient, like fingerprints. You can make a random pile of mammograms on the floor and I could match all the views of each study up together and identify which patient they go with. I doubt I could do that with a pile of chest x-rays or abdominal CT's unless there was some glaring abnormality present.

DJMammo, I just wanted to say thanks. I love when you share information/perspective like this. It is fascinating and feels like a behind-the-scenes glance at what all of this is like from the other side.

Also striking to learn how much there is about breasts I had no idea about! It's funny to think that they're like fingerprints.

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 10/17/2018 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 12/2/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 13, 2019 06:56PM Chrissy24 wrote:

Hi all-so I had my annual mammo and sono before Christmas and got a call that I needed to have a biopsy. Apparently there was something on my sono from 2017 that changed causing this years sono to be a Birads 4. I went for the Biopsy Friday and they couldn't find the spot. How can something be there for 2 years and it can't be found to biospy? Has anyone ever experienced something like this before?

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Jan 14, 2019 06:19AM Ppixie93 wrote:

not sure if this is where to put this,

You all seem to understand these reports. Here is a cut and paste of mine. Any thoughts helpful.

Mammogram said both breasts are heterogeneously dense.

Right breast has mass in upper inner aspect middle depth. There is also asymmetry in the right breast posterior depth outer region seen on craniocaudal view only.

There is an asymmetry in left breast central to nipple middle depth..

There is also an asymmetry in the left breast middle depth outer region seen on craniocaudal view only.

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

I feel the more they said, the less benign it sounds.

I go to the breast center Wednesday morning.

My question is does this sound familiar to anyone? I don't understand it.

Lanna

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Jan 14, 2019 06:34AM djmammo wrote:

Ppixie93

I assume this was a screening mammogram, perhaps your baseline and you have no current lumps that you can feel?

If this is the exact wording, and it is the entire report, it is entirely too vague to draw any conclusions. Whether it looks different from your prior or it was your baseline study there are no descriptors present for you to infer malignant findings on your study. Yes you need the follow up but its way too early to be concerned.

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Jan 14, 2019 06:39AM - edited Jan 14, 2019 07:00AM by Ppixie93

This Post was deleted by Ppixie93.
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Jan 14, 2019 06:41AM djmammo wrote:

Chrissy24

I would be curious to see the reports, particularly the one that suggested the biopsy and the one after the biopsy attempt.

Yes this happens. It sometimes comes down to the sonography tech's level of experience. Depending how one positions/angles the transducer in conjunction with how they set up the 385 or so knobs and switches on the machine, you can almost manufacture images that look like there is a mass present. Then when a different tech scans the same breast, its not there.

I am not saying this is what happened in your case but I have seen this over the years when training new techs. Scanning the breast is very different from scanning other parts of the body, it is very operator dependent. Our techs were required to be certified in breast US.

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Jan 14, 2019 07:05AM Ppixie93 wrote:

Thank you so much for your response djmammo

Its wonderful to have someone like you for us scared women!

Here is my response to your question.

First mammogram. At the top part of report everything said indetermanite. I gave you the summary they provided.

Also, I knew something was wrong on right side. Nipple always acts cold, and hurts when I lay on my stomach. Lymph nodes on that side feel swollen to me and hurt occasionally.

Just wondering if Its silly of me to be worried.

Thanks again, Lanna

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Jan 14, 2019 07:05AM djmammo wrote:

Salamandra

A little more on the subject of mammographic patterns being unique to each patient:

They look different when comparing patient to patient but they should look fairly similar when comparing left to right and that is where the concept of the "asymmetric density" comes from. It has been compared to the Rorschach Ink Blot test, and this is particularly apparent on the cranio-caudal views (the one from the top where the machine is upright and the compression plates are parallel to the floor). Once you get an idea of the basic distribution of tissue in a particular patient the areas that look "out of place" usually become apparent.




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Jan 14, 2019 10:47AM - edited Jan 14, 2019 10:49AM by Chrissy24

This is the original report:

BREAST ULTRASOUND BILATERAL COMPLETE

HISTORY: Z12.39 Screening breast ultrasound

COMPARISON: Breast ultrasound 9/13/2017 and bilateral mammography including 12/22/2018

Sonographic evaluation of both breasts in their entirety, was performed, including each of
the four quadrants and the retroareolar region, in clockwise fashion.

RIGHT BREAST:

10:00, 5 cm from the nipple, 1.1 cm morphologically normal benign-appearing intramammary
lymph node
11:00, 3 cm from the nipple, 1.2 cm irregular hypoechoic area, not significantly changed
in size

LEFT BREAST:

No cystic or solid lesion is identified. No abnormal acoustical shadowing is apparent.

IMPRESSION:

Suspicious right breast hypoechoic area now with irregular margins, 11:00 axis. R92.8
Benign Nodule Right D24.1
Otherwise, negative bilateral breast ultrasound.

RECOMMENDATION: Biopsy recommended.

BI-RADS 4- Suspicious Finding(s)


Here is the new report;


US BIOPSY NOT PERFORMED - RIGHT BREAST ULTRASOUND OBTAINED

CLINICAL HISTORY: Z80.3 Family history of breast cancer R92.8 Abnormal findings on breast

imaging exam

COMPARISON: Breast ultrasound 12/22/2018

Targeted sonographic evaluation of right breast was performed, with attention to the 11:00

axis, 3 cm from the nipple.

The area of concern demonstrates no sonographically discrete solid or cystic lesion.

Specifically, the previously described "hypoechoic area with irregular margins" was not

identified.

Extensive discussion with the patient at the time of the exam was entered into. The

patient was given the option of a general biopsy of the region. It was recommended to the

patient that she return for short-term follow-up sonography to confirm the absence of

suspicious findings. MRI of the breasts without and with contrast may be useful for

confirmation of these findings.

IMPRESSION:

Normal targeted right breast ultrasound.

RECOMMENDATION: Six month follow up right breast ultrasound recommended. MRI of the

breasts without and with contrast may be useful for further evaluation at this time.


I should note that I do feel something at the 9:00 position and when the original sono was performed the technician was focused on that area as well

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Jan 14, 2019 11:32AM djmammo wrote:

Chrissy24

Looking at the dates on the exams, it sounds like this "area" was seen in Sept 2017 and did not change in size in over a year which is, in general, uncharacteristic for a cancer. The words "shadowing, vascular, and mass" were not used so thats a good sign. It would be of interest (to me at least) which techs did each US study whether it were techs or the same one for all or some of the exams.

Was anything out of the ordinary seen on the mammogram that corresponds to the area on the US? Maybe an area of calcifications that corresponds? If there is I would lean more toward believing it may be a real though very subtle finding.

MRI would be great if ins will pay for it. If you want to biopsy that area and the tech cannot find it again, and if there is no mammo finding associated with it to correlate with the biopsy marker, and it comes back "benign breast tissue" you may never know if the correct area was biopsied. Let us know what you and your doc decide to do.


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Jan 16, 2019 01:31AM cityrat wrote:

Well the report came back with no malignancy, to my immense relief. Spoke to both my dr. and the radiology doc: the fluid part (sent to a different kind of lab) was a staph infection (ew?) and the solid mass is apparently an abcess of some sort. Dr. put me on a course of antibiotics. She says it's not uncommon, really could have come from anywhere (i dont have any nipple piercings and not nursing). She recommended I see her colleague who is a breast surgeon at the same facility and show her my reports etc... just to get an idea of the ideal way to deal with it i guess. Rdoc said they had two pathologists comb through it and found no signs of cancer. Dr. says it should just slowly go away by itself and we'll deal with it if not. I'm relieved but wondering how something like that gets in there.

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Jan 16, 2019 04:54AM Nouj wrote:

Hi djmammo,

I made the MRI as advised and kindly check the report:

FINDINGS:

Breast parenchyma:

The breasts parenchyma is of diffusely dense pattern with heterogeneously fibroglandular

elements filling most of the breast volumes and asymmetrical distribution on the both sides.

Mass lesions/cysts:

Both breasts:

Bilaterally multiple well-defined nodules, subcentimetre in size, intensely enhancing post contrast

injection (about 55 in the right breast while about 79 in the left breast) and curve analysis showed

type I curve pattern, located and distribution overall both breasts. Otherwise no suspected masses

or areas of parenchymal distortion. No collections.

Other lesions/cysts:

Multiple variable size cysts, which are located between the fibroglandular elements of the both

breasts, the biggest cyst is well identified located at 12 o'clock position of the left breast measuring

2.7×2.2 cm.

Axillary regions/chest wall:

No axillary pathologic lymph nodes identified on both side.

Nipple and areolar complex are unremarkable. Retromammary fat without specific abnormality.

Chest wall muscles are intact.

CONCLUSION:

Compared to the previous breast MRI no significant changes, however asymmetrical

fibroglandular elements of the both breasts associated with interposed multiple cysts and a

multiple enhancing nodules, corresponding functional curves confirming to type I, most likely

benign aetiology(consider fibroadenomas).

BI-RADS Classification:

RIGHT BREAST BI-RADS III. LEFT BREAST BI-RADS III.


But the ultrasound report was:

Left breast Ultrasound:

Behind nipple, cyst measure 1 x 0.5 cm.

At 10 - 11 o'clock B position, galactocele measuring 0.8 x 0.7 cm (no change by comparison with the previous study).

At 12 o'clock B position, cyst with thick content measuring 0.5 x 0.5 cm.

At 12 - 1 o'clock B position, cyst with septum measuring 2.7 x 1.2 cm (increase in size by comparison with the previous study).

At 2 o'clock B position near muscle, three cystic lesions with thick content measuring 0.8 x 0.5 cm, 1.2 x 0.5 cm and 0.8 x 0.4 cm (increase in size by comparison with the previous study). Follow-up after short time is recommended.

At tail of breast and in UOQ multiple cysts are seen measure between 0.4 cm and 0.6 cm.

At 4 o'clock B position, longitudinal hypoechoic area measuring 1.8 x 0.5 cm due to scar (post-surgery) (no change by comparison with the previous study).

At 5 near nipple, cyst measuring 1 x 0.7 cm.

At 8 o'clock B position, cyst with thick measuring 1 x 0.4 cm.

Normal skin and subcutaneous region.

No evidence of axillary lymph node enlargement.

ACR3

Right breast Ultrasound:

At 9 o'clock laterally position, cyst with septum measuring 0.4 x 0.3 cm.

At 9 o'clock A position, cyst with septum measuring 0.7 x 0.4 cm.

At 10 o'clock A position, cyst with lobulated border measuring 1.3 x 0.8 cm (no change by comparison with the previous study).

At 10 o'clock B position, cyst with thick content measuring 0.7 x 0.6 cm.

At 10 o'clock C position, cyst with lobulated border and septums measuring 1.5 x 0.6 cm (no change by comparison with the previous study).

At 12 o'clock A position, cyst measuring 0.7 x 0.4 cm.

At 12 o'clock B position, lobulated cyst with thick content and septum measure 1.4 x 0.6 cm due to atypical cyst (increase in size by comparison with the previous study). MRI is recommended.

At 12-1 o'clock B position near muscle, hypoechoic mass lesion with lobulated border measure 1.5 x 0.6 cm could be due to atypical cyst (increase in size by comparison with the previous study). MRI is recommended.

At 8 o'clock laterally position, cyst with septum measure 0.7 x 0.3 cm.

At 8 o'clock A position, cyst measure 0.4 x 0.3 cm.

Normal skin and subcutaneous region.

No evidence of axillary lymph node enlargement.

ACR0

One more thing, I'm facing pain under my urm for more than a week now especially that area between my arm and breast, is that related to anything?

Sorry for the long message but I'm really worried and not satisfied with the MRI report because the mass/cyst on my right breast grew in size once in the last report in September and before in last January

Hope you could advise.

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