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Topic: ultrasound followed by mammogram?

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: Nov 13, 2019 06:46PM

Elamom wrote:

I'm a 36 year old mom of 3. I've been getting mammograms/ultrasounds, and a couple MRI's over the past 9 years or so due to very dense, fibrocystic breasts, plus family history. My mom had breast cancer at the age of 34, had a mastectomy, then had a recurrence at the age of 36. Thankfully she is alive and well today almost 30 years later.

My dr felt a lump in my right breast at my yearly check up 3 weeks ago and wanted me to get an ultrasound, which I had today. Turns out that the right breast is fine, but there was an area of concern on the left. The radiologist came in to view additional images and told me she sees an area of shadowing and she isn't sure what it is. So now I'm going in for a diagnostic mammogram of the left breast next week. I was expecting to be cleared today and told I just had a cyst, so I was caught off guard and didn't think of any questions until afterward of course.

It just seems odd to me to have a mammogram when I'm very dense and it's so hard to see anything on them. I would think she would want to biopsy? Any thoughts?

I know we can't know anything for sure until I have more testing, but I've been hanging around these forums every time I have an issue over the past years, and thought I'd finally make a post!

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Nov 13, 2019 09:25PM MamaAvery wrote:

can you call your radiologist or referring doctor? Mine encourage me to if I have questions between appointments. I hope it all goes well for you.

For what it’s worth, my suspected Fibroadenoma did show up on mammogram, but was much more clear on US.

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Nov 13, 2019 10:00PM Elamom wrote:

thank you for responding! I think I will call my dr and see what the report says. I only saw the ultrasound screen briefly when the radiologist showed it to me, but what I saw did not look smooth or oval. Looked very irregular. Of course I know nothing lol. I’ll leave that to the professionals.

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Nov 14, 2019 05:59AM Rah2464 wrote:

Please speak with your doctor about perhaps getting another MRI (not sure when you had your last one) . With your family history and your dense breast tissue, mammography and ultrasound may not show enough. I know I relied on the 3D mammography technology faithfully but it did not show my tumor at all. It was not visible easily on ultrasound either. Only after MRI scanning pinpointed the area was an experienced US tech able to locate it, after about 10 minutes of trying during by biopsy procedure.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/27/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Nov 14, 2019 08:57AM Elamom wrote:

Thank you, Rah2464. I absolutely will. I would've thought MRI or biopsy would've been the next steps, that's why I'm so confused. I don't think mammogram will give them any more info that the ultrasound just did.

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Nov 14, 2019 10:33AM djmammo wrote:

Elamom

Can you post the report of that recent ultrasound? Thanks.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Nov 14, 2019 12:12PM - edited Nov 14, 2019 12:17PM by Elamom

Djmammo, thanks for taking a look. My last Mammo & MRI were January of 2018.


US BREAST BILATERAL: 11/13/2019. BI-RADS:0

CLINICAL: 36 year old Female for Bilateral Diagnostic Breast U/S. Tyrer-Cuzick lifetime risk of 21.8%. Current reported family history of breast cancer: mother. The patient reports a palpable abnormality in the right breast.

PRIOR EXAMS: Mammograms(s). Breast MRI exam(s).

ULTRASOUND TECHNIQUE: Doppler used. Ultrasound exam of whole breast performed.

ULTRASOUND FINDINGS

Right: Upper Outer at 10:00, 2 cm from nipple, measuring 11x6x11 mm: there is a simple anechoic cyst present.

Left: Lower Outer at 4:00, Retroareolar, measuring 3x3x4 mm: there is no area of shadowing measuring about 4mm in the 4:00/subareolar region of the left breast. On previous mammograms, there is no macrocalcification to correspond to this finding.

At this time, a diagnostic left mammogram should be performed.

Left: Upper Inner at 10:00, 1 cm from the nipple, measuring 7x3x8 mm there is a simple anechoic cyst.

Left: There appears to be a few additional sub centimeter benign cysts in the left breast.

In the left breast 4:00 position there is a heterogeneous mixed echogenicity tissue, which appears contiguous with the heterogeneous retroareolar tissue.

Bilateral

Needs additional imaging evaluation.

RECOMMENDATIONS

Left

Further evaluation with diagnostic mammography

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Nov 15, 2019 06:35AM - edited Nov 15, 2019 06:42AM by djmammo

Elamom

I am going to assume that the report should read there is "...a new area of shadowing..." not a no area of shadowing.

Basically there are two things that shadow on US with the above description, a small cancer or a big calcification and thats why there is a reference to the lack of a large calc on the prior study. So something developed since prior study in that area wither a small cancer or a big calcification. Regardless of your breast density big calcifications are readily seen on a mammogram. If they see a calc on the follow up mammo then the question of what is shadowing has been answered. If they don't see a calc then they have to proceed under the assumption that there may be a small cancer shadowing on US which will then require a biopsy.

"I don't think a mammogram will give them any more info that the ultrasound just did."

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Nov 15, 2019 08:33AM Elamom wrote:

Djmammo,

Thanks so much for taking the time to read the report and give me your thoughts. It’s so very appreciated

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Nov 15, 2019 08:34AM Elamom wrote:

and yes I think that part of the report is a typo. She specifically mentioned shadowing to me.

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Nov 16, 2019 02:50PM Elamom wrote:

djmammo,

Is one of these scenarios more likely than the other?

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Nov 16, 2019 05:22PM djmammo wrote:

Elamom

Not from the amount of information we have at hand.

Board Certified Diagnostic Radiologist specializing in Breast Imaging helping members understand their health care provider's reports and recommendations.
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Nov 19, 2019 04:55PM - edited Nov 20, 2019 08:58AM by Elamom

I had the diagnostic mammogram today. The radiologist said everything is fine and I'm good to go. She said it was just an area of dense tissue. Thankfully I'm good for another year. Thanks djmammo and those who responded.

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Nov 20, 2019 08:42AM - edited Nov 20, 2019 08:43AM by Jons_girl

djmammo so if a person has extremely dense tissue they can rule out cancer vs dense tissue on a mammo??? And be completely positive of that? I'm guessing maybe her density level was scattered? Or they may not have been completely confident to give her that result correct?

I looked at my mammo when they missed my cancer in 2017. I hadthe disk sent to me with the scans. I was shocked how everything was white! They missed my tumor on my mammo completely could see where the sticker was (my tumor was felt)

This gal didn't mention her density level. Hopefully they told her how dense her tissue is. I don't mean to question this result. Just curious how you said definitively that they can see microcalcifications in any density. That shocked me as they completely missed my cancer. But my tissue is extremely dense.

I'm very glad she was cleared. I don't mean any offense at all. Just wondering about what you said.

Breast cancer at age 49. Felt tumor. Wasn’t caught on mammo even after feeling tumor. Ultrasound caught my cancer. Dx 6/2017, IDC, Left, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 7/5/2017 Lumpectomy: Left; Lymph node removal: Sentinel
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Nov 20, 2019 10:46AM - edited Nov 20, 2019 10:46AM by Elamom

johns_girl,

Absolutely no offense taken. I appreciate the response as I also am still a bit concerned. The radiologist just came into the waiting room and said I was fine that it was dense tissue. It was crowded and I didn't want to ask questions there. I'm curious what djmammo's take on this is.

I've always been told I'm very dense but never given a rating. Very dense and fibrocystic with frequent callbacks for more images, more scans, etc.

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Nov 20, 2019 12:22PM djmammo wrote:

Jons_girl

Cancer vs. dense tissue can be a tough call. There are times that when extremely dense breasts are compared to prior studies you can see a difference in the distribution of tissue, that is an area that is white now but not last year, an area of black fat seen before is now filled in whit, It does not need to look like a cancer to warrant evaluation. Additional views and US would be required especially if it persisted on the compression views. If it is palpable, regardless of whether or not it is seen on US, if its on the mammo and palpable it should be evaluated by a surgeon and biopsied by clinical findings (by feel).

Other than actual metal and bone, calcification is one of the densest things on x-ray. It does not look like breast tissue, it stands out against the background. All digital reading software has a CAD program that will detect and circle calcifications that are difficult to see on first pass as a safety net. Also not all cancers have calcifications. If your cancer was palpable and was not seen on US or feel suspicious enough on physical exam, that's a different story.

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

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