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 13, 2017 05:40PM renee_rn wrote:

Birads was 0 - indeterminate. I have a diagnostic mammogram and ultrasound on Wednesday.

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Nov 21, 2017 12:08AM Scaredsilly1973 wrote:

I have a biopsy scheduled for this Thursday. I’m worried as I have had some women tell me it’s very painful and others tell me it’s not so bad.

I’m not sure what to expect in all this. The waiting in between tests is enough to drive anyone craxy

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Nov 21, 2017 07:39AM djmammo wrote:

Renee

Agree with above. Could go either way but statistically it is likely overlapping area of dense tissue.

You will need a few pictures with magnification an a little tighter compression followed by an ultrasound. Do they have “3D” Mammo where you go?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Nov 27, 2017 08:06PM - edited Nov 28, 2017 04:28AM by Eljay62

What do you make of this mammogram/ultrasound report.

*There is partial fatty changes in both breasts.

*There is a history of bilateral breast reduction surgery.

*A well circumscribed lobulated soft tissue density lesion in the right breast lower outer quadrant 11mm diameter.

*There is some asymmetrical density in the right breast laterally which is associated with microcalcifications, however on the magnification view there is one small group the microcalcifications that are showing some pleomorphic appearance within the asymmetrical density which are 2.8mm overall diameter. BIRAD 4/5.

CONCLUSION

*Asymmetrical density of fibro glandular tissue laterally in right breast which is associated with microcalcifications & there is a small group of pleomorphic microcalcifications within asymmetrical density. These are recomended for excision biopsy.

*A well circumscribed 11mm diameter lobulated soft tissue density lesion in right breast lower outer quadrant ? Fibroadenoma.

* Ultrasound showed the well circumscribed hypoechogenic lesion in right breast 8o'clock position 7cm from nipple with some vascular flow in the wall, seen on mammogram as a separate lesion. It has characteristics suggesting it may represent a fibroadenoma. Core biopsy of this lesion is recommended with ultrasound guidance.


I have had the core biospy & am awaiting pathology results. I see a breast surgeon on 4th December to discuss what to do next as far as excision biopsy of microcalcification cluster.


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Nov 28, 2017 09:32AM djmammo wrote:

Eljay62

The impression and recommendations match the description of findings in the body of the report with one exception. I would have recommended a stereotactic biopsy of the calcifications in light of the way they were described. It is far less invasive than an excisional biopsy, leaves no scar and yields a reliable tissue diagnosis in the right hands.

Let us know the path report on your suspected FA.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Nov 28, 2017 11:50AM Usher1127 wrote:

Hi,

I just received my ultrasound report and this is what it reads and i don't understand a word of it could you please help.

In the area of the mammographic abnormality there is a 9 x 8 x 7 mm lobular mass that is not a simple cyst. there is no shadowing. This is about 5cm from the nipple at the 1:30 position. Adjacent to this about 5 cm from the nipple at the 1 o'clock position, is a small area measuring 4 x 1 x 4 mm has its long axis parallel to the skin. it is to small to definitely qualify as a cyst, but it's long axis orientation is a non aggressive features and there isno shadowing.

it does look more Hypoechoic then the larger mass seen at the 1:30 position

in the Axilla. there is a lymph node that is slightly asymmetric nodularity.

BI-RADS 4b

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Nov 28, 2017 03:45PM djmammo wrote:

Usher1127

If this is exactly what the report says, it is oddly worded and does not seem to draw any real conclusions.

1) US was done in response to a mammo finding and not a lump you felt correct?

2) 9 x 8 x 7 mm mass: (so less than 1/2 inch in greatest dimension). It says "lobular" but I will assume they meant "lobulated" which is a better prognostic feature than "irregular" or "spiculated".

3) Not a simple cyst: so a complicated cyst or solid? Wording is not very clear/nonstandard descriptor

4) Shadowing: In the overall scheme of things shadowing is a bad feature, so no shadowing is a good thing.

5) Small area measuring 4 x 1 x 4 mm: An adjective is missing from this phrase after small and before area.

6) Its long axis parallel to the skin: This is a feature common to benign masses

7) It is too small to definitely qualify as a cyst: I think they mean its so small it is difficult for them to tell if its a cyst or a tiny solid nodule on their US machine.

8) it does look more hypoechoic then the larger mass: it looks darker/blacker on the screen than the other mass. Cysts are completely pure solid black on US like an 8 ball (without the number on it) but still too small it seems.

9) in the axilla there is a lymph node that is slightly asymmetric nodularity: This is very poorly worded. The description of a lymph node on US should include its size in three dimensions, shape, its surface contour, the thickness of the cortex, and the status of the fatty hilum (center) as well as presence and degree of internal blood flow. The phrase they used does not tell me whether they though it was normal or abnormal.

10) Birads 4b: It is considered abnormal but not as suspicious as Birads 5 but more suspicious than 4a. I personally never used the subscript letters B4

11) You did not list the recommendations but I will guess they want to biopsy what they saw. Is this from a breast center or from a community hospital xray department?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Nov 29, 2017 03:29PM - edited Nov 29, 2017 05:13PM by Eljay62

I will get the path report at 9.30am Sydney Aus time, once I do I will let you know what it says.

Not too concerned about the ? FA more worried about the pleomorphic calcification cluster.

My 3D mammogram has now been compared to the Breast Screen government program films I had in May & although they say the ? FA was present then, the pleomorphic microcalcification cluster was not. Do FA show on basic mammography?

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Nov 29, 2017 07:01PM Eljay62 wrote:

Pathology Report

*The core biopsy of breast tissue shows a fibro epithelial lesion in which there is columnar cell change, usual ductal hyperplasia, adenosis & calcified secretions. The features are consistent with a complex fibroadenoma. There is no evidence of atypia or malignancy.

*Diagnosis: Features consistent with Complex Fibroadenoma

My gp has suggested montoring yearly instead of every 2nd year.

Is it correct that a complex fibroadenoma increases my risk of breast cancer slightly?

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Nov 29, 2017 11:09PM djmammo wrote:

Eljay62

I personally have never heard it increases your risk. They can be seen on mammo unless they are very small and surrounded by very dense tissue. They cannot hide from ultrasound.

Sounds like those calcifications are next. Good luck.


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

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