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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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Oct 2, 2019 11:38AM TechieGirl wrote:

DJMAMMO- my results are benign!!! I want to thank you for the time you take to review report language for us. You have no idea how many times I reread your comments to ease my mind.

I will do 6 month checkups now which actually will bring me comfort to know the area is being watched.

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Oct 2, 2019 06:05PM djmammo wrote:

TechieGirl

Great news!

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 3, 2019 09:34PM Ljp wrote:

Got my radiology report today and it doesn't sound good. I was aware of a spiculated mass and a birads 5, but it shows 3 masses in left and multiple cysts in both breast. I few terms have me concerned, any thought?

Heterogeneously dense

Spiculated mass

Hypoechoic mass

Irregular heterogeneous mass

Neoplastic process

Neoplasm

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Oct 3, 2019 09:48PM djmammo wrote:

Ljp

It would make more sense in context in order to comment on all the findings.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 4, 2019 07:37AM - edited Oct 4, 2019 07:56AM by Ljp

This Post was deleted by Ljp.
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Oct 4, 2019 11:43AM Joreo wrote:

I want to follow up... it’s benign! I came here to get intel and really appreciate the support. I felt it was important to follow up and let everyone know since it seemed like many just posted and never followed up. I took it as they weren’t diagnosed with breast cancer which is wonderful but I wanted to share so those with similar reports would have a final report to give some hope. Sending good thoughts with healthy wishes for all

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Oct 4, 2019 11:56AM Moderators wrote:

Dear Joreo,

Thanks for sharing your good news. We appreciate it. Best wishes to you.

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Oct 8, 2019 08:57PM MamaAvery wrote:

hello. I had an ultrasound and mammogram yesterday. After years of being told I had a Fibroadenoma I insisted on having it removed because it is bothering me. The doctor changed his tune and sent me for testing.

The radiologist said she thinks it’s a Fibroadenoma. She said she was going to send me for a biopsy though due to my thinking it may have grown (I’m not sure since my boobs have gotten smaller since I found it due to nursing/weight loss) and because it is painful with periods/pressure.

Then I saw the nurse to schedule the biopsy who said not to worry, they send everyone over 20 with a Fibroadenoma for a biopsy because it’s their policy. (Which she lamented about for a bit and said it’s needless worry)


I was emailed a copy of the report today and am unclear about it all. The vascularity and BIRADs score did not match what I was told yesterday.

Thanks for any insight


Study Result EXAMINATION: Bilateral Diagnostic Digital Mammography and Limited Right Breast Ultrasound

EXAM DATE: 10/7/2019 2:47 PM

TECHNIQUE: Bilateral diagnostic mammography, producing direct digital images and bilateral diagnostic digital tomosynthesis, all views, with computer-aided detection (CAD). Limited right breast ultrasound.

COMPARISON: None

INDICATION: 35-year-old female presenting with right breast lump with perceived increased size and tenderness

_____________________

MAMMOGRAPHIC FINDINGS:

Breast Density: The breasts are extremely dense, which lowers the sensitivity of mammography.

There is an obscured probable oval mass underlying the triangular palpable marker in the upper outer quadrant of the right breast posteriorly, measuring at least 15 mm in length. No additional suspicious findings in either breast.

Tomosynthesis images confirm.

RIGHT ULTRASOUND FINDINGS:

Sonographic evaluation of the right breast at 11 o'clock and 6 cm from the nipple, in the area of palpable concern, shows an oval circumscribed hypoechoic mass, measuring 18 mm x 8 19 mm x 7 mm. Internal vascularity is present.

____________________

IMPRESSION:

1. Right breast palpable mass which likely represents a benign fibroadenoma. However, given the patient's perceived increased size and associated tenderness, ultrasound dated biopsy is recommended for histopathological diagnosis.

2. No mammographic evidence of malignancy in the left breast.

Recommendation: Biopsy Right with Post-Procedure Mammogram

Follow-Up Interval: NOW.

BI-RADS Category: 4 Suspicious Abnormality - Biopsy Is Recommended.

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Oct 9, 2019 12:55AM djmammo wrote:

MamaAvery


"The vascularity and BIRADs score did not match what I was told yesterday."

Fibroadenomas are vascular, that's how they grow. They are far less vascular than cancers.

You cannot get a biopsy without a B4, no matter how benign it looks.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 9, 2019 01:52PM - edited Oct 9, 2019 01:52PM by Joreo

@djmammo

okay, I'm back because I specifically have a question for you. Do you think this makes sense? So did we get the right spot, it's oddly worded. I'm wondering is this normal for radiologist to report this way?

** ADDENDUM: #1 **

Postprocedure mammogram was again reviewed. He coil clip from the ultrasound biopsy does not correspond to the nodule seen mammographically which is more posteriorly located. I do agree that this may been present on previous exams. Short-term follow-up mammographic examination 6 months is recommended.

Electronically Signed by: JC DO, 10/7/2019 2:57 PM

Study Result

Impression

Biopsy clip seen to be in place.

ASSESSMENT:

Waiting for Pathology.

RECOMMENDATIONS:

Right Follow up with your physician for clinical correlation

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Oct 9, 2019 02:24PM futurejenboston wrote:

I had my first mammogram last Friday at age 42(Birthday was two days later). I have been sick, a slew of different things and my body feels off. I knew when I left they were going to be calling from what the tech said but followed it with try to enjoy your birthday weekend. My mom was DX with BC at 42 and passed away at 44. They called first thing Monday morning as said "we need you to come back in for a diagnostic mammogram and ultrasound due to suspicious area in your left breast." They couldn't answer anymore questions and the first opening isn't until next week. I have attached my report below and wondered if anyone could explain better.


They said I do NOT have dense breast tissue.


This was a 2D and 3D mammogram.


BREAST PARENCHYMAL DENSITY: There are scattered areas of fibroglandular density.

FINDINGS:

Questioned masses in the upper outer anterior left breast.

No suspicious masses, areas of architectural distortion or micro calcifications are evident on synthetic 2D mammogram or tomosynthesis images of the right breast.

ASSESSMENT:

BIRADS Category 0: Incomplete - Needs additional imaging evaluation.

I am worried and a nervous wreck waiting

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Oct 9, 2019 03:01PM - edited Oct 10, 2019 08:04AM by djmammo

Joreo

That's not uncommon. The whole idea of the clip is to document what site in the breast was actually biopsied and in a vast majority of cases it matches up with the mammo finding. If it was calcs you can see the clip in the grouping and there are fewer calcs present. With a mass it can be in or adjacent to the mass.

If it does not match up withe the mammo finding there are 2 possibilities. One, the intended target was not what was biopsied or two the target was biopsied and the clip moved between the biopsy and the post bx mammo.

It is essential at this point to wait for the path report. If the path report shows a diagnosis like "fibroadenoma" then the target was hit but the clip moved. If it comes back "benign breast tissue" with no other diagnosis, one has to assume the target was not sampled. Either way the clip served its intended purpose.

Now if they said they saw this same finding on mammos from years past and its stable/ hasn't changed, then they would ask for a short term follow up. Let us know what the path shows.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 9, 2019 03:03PM futurejenboston wrote:

I had my first mammogram last Friday at age 42(Birthday was two days later). I have been sick, a slew of different things and my body feels off. I knew when I left they were going to be calling from what the tech said but followed it with "try to enjoy your birthday weekend". My mom was DX with BC at 42 and passed away at 44.

They called first thing Monday morning and said "we need you to come back in for a diagnostic mammogram and ultrasound due to suspicious area in your left breast." They couldn't answer anymore questions and the first opening isn't until next week. I have attached my report below and wondered if anyone could explain better.

They said I do NOT have dense breast tissue.

EXAMINATION:

Digital screening mammogram on 10/4/2019. Low-dose full-field digital

breast tomosynthesis examination was performed with synthetic 2D images

and 3D acquisitions. Computer assisted detection was utilized.

PRIOR: No prior mammograms, this is a baseline.

BREAST PARENCHYMAL DENSITY: There are scattered areas of fibroglandular

density.

FINDINGS:

Questioned masses in the upper outer anterior left breast.

No suspicious masses, areas of architectural distortion or

microcalcifications are evident on synthetic 2D mammogram or

tomosynthesis images of the right breast.

ASSESSMENT:

BIRADS Category 0: Incomplete - Needs additional imaging evaluation.

RECOMMENDATION:

Left diagnostic mammography and possible targeted ultrasound.

I am worried and a nervous wreck waiting

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Oct 9, 2019 03:10PM djmammo wrote:

futurejenboston

Kudos to your radiologist.

They did not see anything on the mammo in a patient who presents with a lump. I have seen many rads quit right there and not recommend any followup and the patient returns with a problem the next year.

In patients who feel a lump, to make certain there is really nothing there, they will US the area where you feel the lump. If there is something there they will biopsy it. If there is nothing there, then that is documented. At this point if you are still feeling the lump they may ask you to come back in 6 months (I would do this myself) so don't be rattled if they do recommend that.

This kind of follow up protects both you and the radiologist.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 9, 2019 03:16PM futurejenboston wrote:

what does it mean when they say Questioned masses in the upper outer anterior left breast?


I did not feel a lump but had been having gynecological issues and referred for a hysterectomy and was told based on my age and family history I was long overdue and to get a mammogram before my appointment with surgeon

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Oct 9, 2019 04:12PM djmammo wrote:

futurejenboston

Unclear at this point why they listed that history. Maybe your doc felt a lump and gave them that history, or perhaps the facility used that so that your insurance would pay for it? No way to know.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 9, 2019 04:15PM futurejenboston wrote:

I am so confused. That was listed as their findings not my history.

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Oct 9, 2019 04:19PM djmammo wrote:

futurejenboston

Call the facility and tell them you have no lump(s) and ask them to check the names on all the paperwork to make sure that report is actually yours.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 9, 2019 05:23PM Joreo wrote:

@djmammo

You are amazing! Thank you! I really appreciate your support for us here and taking the time to answer. I’m grateful!

My path reports as follows...

BREAST, RIGHT AT 8 O'CLOCK, 7 CM FROM NIPPLE, BIOPSY:

-- BENIGN BREAST TISSUE WITH FIBROADENOMATOID CHANGES, USUAL DUCTAL HYPERPLASIA, AND APOCRINE METAPLASIA.

-- NEGATIVE FOR ATYPIA AND MALIGNANCY.

NOTEMicroscopic slides were examined. E-cadherin immunostain shows membranous staining, consistent with ductal hyperplasia (usual type).

EP/ash

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Oct 16, 2019 09:16AM trace621 wrote:

Hi djmammo -

I got my MRI results back yesterday and I am being rushed in today for a biopsy. If possible, could you by chance help me understand what the results mean? Thank you for your time!

Nonmass enhancement measuring approximately 2.9 x 2.8 cm in the middle 3rd lateral right breast, with areas of clustered ring enhancement (series 102, image 65 and series 6 image 126). Focus ultrasound with intent to biopsy is recommended.

There are scattered foci of subareolar enhancement in the lateral right breast (series 102, image 60 and series 6, image 124) with question of continuity to the non mass enhancement in the upper-outer quadrant.

Probable flash filling hemangioma in the liver.

RECOMMENDATION:
Focused ultrasound with intent to biopsy is recommended. In the absence of sonographic correlate, MRI guided biopsy of the upper-outer quadrant is recommended.

MRI of the liver (MRI abdomen with and without contrast).

RESULT/FOLLOW-UP CODING:
ACR BI-RADS Category 4B: Moderate Suspicion for Malignancy

Result Code: 4B

Follow-up Code: B

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Oct 16, 2019 08:15PM - edited Oct 17, 2019 10:13AM by djmammo

trace621

Although non-mass enhancement can go either way, the presence of clustered ring enhancement described as being associated with it, adds an additional layer of suspicion on that finding. They will look to see if it can be located by US and if not they will do it in the MRI. If the biopsy comes back abnormal they may want to take out all the similar areas of non-mass enhancement at surgery.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 17, 2019 08:40AM trace621 wrote:

thank you djammo for the response! greatly appreciated! i did have the biopsy yesterday and it was incredibly painful (i screamed in pain and they gave me more numbing shots). she said this could be a sign of inflammation. does that sound normal?

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Oct 17, 2019 10:21AM djmammo wrote:

trace621

The degree of pain experienced during a biopsy varies from patient to patient even with the same amount of local anesthetic used. That being said I personally think those patients with greater amounts of fibrous tissue seem to have more discomfort than those with fatty breasts.

Patients with mastitis, and particularly those with an abscess, have the most pain, even during the administration of the anesthetic. Some of them cannot tolerate a breast exam due to the pain.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 17, 2019 10:24AM trace621 wrote:

thank you very much for taking the time to answer! wishing you well!

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Oct 17, 2019 04:01PM mable wrote:

Hello everyone,

I am new to this site. I am 35 and recieved my first mammogram. They told me that they found 2 adjacent focal asymmetries at posterior depth and distortion in the right breast. I do have further testing scheduled but I am concerned. I do know what each diagnosis means however my question is when both are found in one breast what does that mean? I can't seem to find any information on that. I have a hx of breast cancer in the family so I am definitely concerned. Any explanation or advice would be greatly appreciated.

Thank You

Mable

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Oct 17, 2019 09:06PM Jack-Bear wrote:

I knew 'we' were watching the right breast & the 2 areas that have been biopsied. I just recently signed into 'My Chart' and read that I have a hypoechoic probably benign mass at the 9:00 position. In my heterogeneously dense breast. The stable appearance of the hypoechoic oval mass (measuring 4x2x4mm). From prior US: Internal thin septation. Limited characterization. Cyst with debris, fibroadenoma are possibilities.

Stable biopsy clips within the right breast. Previously questioned 4mm asymmetry in the outer breast, posterior depth remains not as conspicuous as on prior exam.

I didn't talk to anyone about something at 9:00.

I'm not in panic mode. I would like to understand. 🤙 NancyB

HeartMusic
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Oct 18, 2019 09:13AM trace621 wrote:

Hi Djmammo - do you by chance know what this means - (should have added this before but I went to a google rabbit hole)

"There is non mass enhancement in the superior lateral right breast middle 3rd measuring approximately 2.9 x 2.8 cm. There is rapid wash-in and progressive delayed washout kinetics. There is suggestion of clustered drain enhancement within the area of non mass enhancement (series 102, image 65, series 6, image 126). There are no suspicious axillary lymph nodes."

I am researching rapid wash-in and not getting positive results.

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Oct 18, 2019 10:35AM djmammo wrote:

Jack-Bear

The thin "septation" can refer to one in a cyst and if its razor thin then that leans toward benign. If its a solid mass then that line can indicate a benign fibroadenoma.

If its stable they must have compared it to an earlier study and the date of that older study is the key. If its 2 or more years of stability then we leave it alone.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 18, 2019 10:44AM djmammo wrote:

trace621

I think I addressed some of this post on another thread no?

"I am researching rapid wash-in and not getting positive results."

You are referring to the kinetic curves related to enhancement on breast MRI. How fast or slow it goes in and how fast or slow it goes out helps us evaluate benign vs malignant. It is only one puzzle piece, not 100% reliable on its own!

see: https://radiopaedia.org/articles/breast-mri-enhancement-curves?lang=us

======

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Oct 18, 2019 10:45AM djmammo wrote:

mable

Pretty sure I answered this elsewhere. Let me know if I didn't.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.

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