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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Jan 9, 2018 12:36PM djmammo wrote:

momto3sons

US is extremely good at showing spiculated masses that are often the cause of architectural distortion on a mammogram so thats in your favor provided they scanned the correct portion of the breast. Did they give a size to the area of interest?

If a mammo shows arch dist, and nothing is seen on US, this may be a radial scar which is always removed but is not a cancer. This, among other things is what they will be looking for on the MRI.

The insurance company goes by your history and the wording of the request. I usually recommend "suspicious mammographic finding without ultrasound correlate" for the reason for the MRI. If there is a cancer there, the MRI should see it.


Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 9, 2018 12:52PM momto3sons wrote:

They didn't give a size to the area of interest, unfortunately. I could definitely see the spot on the mammogram when the doctor reviewed them with me, but she didn't mention any size either.

The doctor and her nurse tried to word it the best way to get insurance to cover it, and with my family history of BC and other cancers (plus the density issue) will help push it through.

Thanks for the follow up!

Carolyn, mom to 3 sons - ADH, intraductal papillomas 3/1/18 Surgery 2/22/2018 Lumpectomy; Lumpectomy (Right)
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Jan 9, 2018 01:06PM jennaaz wrote:

DJmammo: I found out on 12/20 that I a mass was found in left side at 2:00 position thru diagnostic mammo & u/s, core biopsy ordered and is scheduled for tomorrow. I just read the report yesterday and am looking for some insight.

Birad 4c - Findings of moderate concern but not classic for malignancy

Findings: A hypoechoic, parallel, not circumscribed mass is noted measuring 2.2 cm. The margins are indistinct with angular margins also noted. No abnormal axillary nodes are identified.

Breast Composition: C heterogeneously dense

I'm 44 y/o, no immediate family history of bc

Thank you!

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Jan 9, 2018 04:01PM moderators wrote:

Dear jennazz,

Welcome to the community. We are sorry about these breast changes and hope that you find the information that you are looking for. The Mods

To send a PM to the Mods: community.breastcancer.org/my/...
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Jan 10, 2018 05:56AM djmammo wrote:

momto3sons

Good. Let us know the results of the MRI

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 10, 2018 06:04AM djmammo wrote:

jennaaz

Not all of those descriptors are worrisome but in general and for safety's sake, if a mass does not fit the strict definition of benign on imaging it will usually get biopsied. There are some fibroadenomas that can look odd, and that 'parallel' adjective leans toward that. Benign masses if not spherical, will have their long axis parallel to the chest wall, while suspicious masses usually perpendicular to the chest wall which is a fairly reliable rule of thumb based on the structure of the breast.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 10, 2018 10:57AM MayDayMelK wrote:

I have a random question about mammograms. Does the radiologist take into consideration the hormonal status of a woman when they view a report? Or just view the age? Because I wasn't asked any questions about my menstrual cycle/etc and I have been in surgical menopause for 7 years. I was given a BIRAD of 3 and read that due to scattered density and focal asymmetry that generally they'll request more of a workup if you're in menopause versus what a natural/normal hormonal 32 year old would be recommended. The ultrasound they did with the mammogram couldn't view anything solid or cystic. Right now I'm just waiting to go back to the doctor.

Hysterectomy, Stereotactic Biopsy, Columnar Cell Changes, Cysts, now waiting on MRI results.
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Jan 10, 2018 12:01PM djmammo wrote:

MayDayMelK

I never paid much attention to hormonal status unless I saw a difference in the appearance of the breast when compared to the prior mammogram.

Any mammographic changes re: hormones are usually related to onset of hormone therapy or pregnancy.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 10, 2018 02:05PM - edited Jan 10, 2018 02:27PM by Wathom

I have my biopsy tomorrow. In the last 10 days, I've had an MRI, ultrasound and a mammogram. I am a biards 4c - Suspicious Abnomality, High suspicion for malignancy. They found 3 areas in my left breast and 1 in my right. I am 48 but I had Hodgkin's Lymphoma 18.5 yrs ago and was treated with chemo and chest radiation. i know I am at a high risk for bc because of the prior chest radiation.

I am trying to be an optimistic realist. I am assuming it's cancer (yeah, not too optimistc, but hey!) but I just want to know one way or the other. My ultrasound report uses words like

"hypoechoic, indistincly marginated lesion"

"hypoechoic, irregular mass measuring 1.4 x 0.6 x 0.7 cm with internal vascularity. Calcifications are identified"

"spiculated mass measuring 1.5 x 1.3 x 1.2 cm with posterior acoustic shadowing"

I guess what I'd really like to know is what is the chance of this being benign? I'm making myself crazy thinking about it. Any insight would be greatly appreciated. Thank you!





Dx with Hodgkin's Lymphoma 4/16/99. Treated with ABVD chemo and chest radiation. Breast cancer Oncotype Score 17. Dx 1/18/2018, DCIS/IDC, Left, Stage IA, ER+/PR+, HER2- Surgery 2/26/2018 Mastectomy: Left, Right Hormonal Therapy 3/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 7/26/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Jan 10, 2018 03:08PM MayDayMelK wrote:

Thanks for the reply! I have not had any prior imaging. I did read an article about trying to steer clear of using Birads 3 in menopausal women due to the lack of hormonal shifts and fibrocystic changes. I won't pretend to understand it! I guess I just don't want my age to lead to being dismissed. Thanks again!

Hysterectomy, Stereotactic Biopsy, Columnar Cell Changes, Cysts, now waiting on MRI results.

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