Topic: How To Read A Mammogram: Part 2

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: Jul 18, 2019 10:53AM - edited Jul 19, 2019 03:54AM by djmammo

Posted on: Jul 18, 2019 10:53AM - edited Jul 19, 2019 03:54AM by djmammo

djmammo wrote:

Since I issued Part 1 of this topic I have seen member's posts where they have drawn conclusions regarding their reports based on only one or two of an abnormality's features listed in the report.

There are a finite number of features we look for in mammography and US to evaluate a mass. These include but are not limited to overall shape, margin, echogenicity, posterior shadowing vs through transmission, vascularity, etc. It is the relative combination of all these findings that leads us to a conclusion.

I think I have come up with a reasonable (?) analogy regarding the interpretation of a mammogram and in particular the method used in trying to decide whether a mass is more likely benign or malignant. I call it the "Taco Bell Analogy".

Mexican fast food is made of the same half dozen or so ingredients: corn in the form of a wrapper or shell, flour, lettuce, cheese, beans of one kind or another, ground beef, chicken, seasonings etc. So in light of this fact what makes a taco different from a burrito? An enchilada different from a chalupa? Its the presence and the ratio of the above ingredients.

You can't classify a mass using just one or two features just as you can't identify a Taco Bell menu item just by saying "it has cheese".

Additions and modifications to this "analogy" are welcome.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at
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Jul 18, 2019 10:59AM edj3 wrote:

Using your analogy (which btw I love), are there any ingredients in our Mexican fast food that really truly should not be in there?

Tried the tamoxifen, no thanks. Dx 4/9/2019, IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-, Surgery 5/5/2019 Lumpectomy; Lymph node removal: Sentinel Dx 5/6/2019, LCIS, Left, <1cm, 0/1 nodes Radiation Therapy 6/2/2019 Whole breast: Breast Hormonal Therapy 9/22/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jul 18, 2019 11:41AM spoonie77 wrote:

I soooo love this analogy! Thanks DJmammo

Dx 7/20/2018, IDC, Left, 3cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2-, FISHISHCISH Surgery 8/29/2018 Lumpectomy; Lumpectomy (Left); Lymph node removal; Lymph node removal (Left): Sentinel Dx 8/30/2018, DCIS, Left, 1cm, Stage 0, Grade 2, HER2- Radiation Therapy 9/30/2018 Whole breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 3/29/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 7/1/2019 Zoladex (goserelin)
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Jul 18, 2019 04:50PM tb90 wrote:

Not a mammogram, but similar features that raise concern. I had a Tirads 5 for my thyroid. I studied this system extensively. Biopsy could not confirm cancer, but a very concerning combination of features highly suggestive of cancer led to a total thyroidectomy. Benign! Odds of benign were so slim. There is no way to rule in or out a dx completely by imaging such as mammograms and ultrasounds. The weight applied to one concerning feature is amplified by certain combinations of features. It is so complex. Radiologists follow these guidelines and have very high rates of successful dx. But science is not exact, as much as I so want it to be. But I so appreciate the research that has gone into decomposing a taco and the ongoing research that may definitely differentiate a taco from a burrito.

Dx 11/28/2013, DCIS, Grade 2 Surgery 12/17/2013 Mastectomy; Mastectomy (Left) Radiation Therapy 2/19/2014 Breast
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Jul 25, 2019 09:39AM pancakes_tx wrote:

Thanks for sharing djmammo, this really helps! Happy

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