Breast lump felt but not seen on ultrasound

TinaT

Klo1166 -  I'll start by saying that most lumps turn out to be benign.  You are obviously concerned.  Personally, I would not wait for any lump to get bigger.  I would ask to see a breast surgeon.  An MRI is sometimes the best imaging modality for dense breasts.  You will read many, many stories on BCO from women who had "negative" mammograms.

A breast surgeon may want to do a biopsy or an MRI to investigate further.  Sounds better to me than just waiting.

Hang in there and keep asking questions!

MrsCich

I found a mass on my R breast, between my nipple and under arm, about 3 weeks ago.  It doesn't hurt, can only be felt if I lay down and perform a SBE.  It is approximately the size of a fifty cent piece.  I went to my gynocologist today and he recommended an u/s even though he thinks it's fibrocystic because he can move it some. After leaving his office, I went to have the u/s done and the radiologist could feel the mass but couldn't see anything on the u/s.  He said that's a good sign and it's probably just dense tissue.  He informed me that my regular dr (who ordered the u/s to begin with) would be calling me in the next 24 hours but to not be worried that we can monitor it for the next 3-6 months.  That's it?  Is it premature to request a biopsy be done on this mass that can't be seen but can be felt?  Hard to not worry, ya know?

alison0328

MrsCich, I'm going through something very similar.  My US was also clear but my dr. wasn't 100% confident in that so has ordered an MRI.  It's going through the insurance approval process right now so I'm not sure when I'll have the test but am glad he is doing further testing.  I also have lumps under my armpit on the same side so perhaps that is why he's pushing.  I'm not sure but if you are not totally at ease, I'd ask about the MRI as from my understanding, it picks up a lot that mammo and even US doesn't.  Take care and keep in touch.

TinaT

MrsCich - I agree with the suggestion to ask about an MRI, especially if you have dense tissue.  Chances are definitely in your favor that all will be fine, but MRI can pick up things that can't be seen on either mammo or ultrasound. 

MrsCich

Thank you Tina and Alison,

 Yesterday after the u/s was the first time I'd heard I had dense tissue.  Actually, the Radiologist said "it's probably just dense tissue."  My question is, if you have dense tissue does it really just appear out of nowhere and only in one spot? 

MrsCich

Requested my report from the radiologist.  See below.

Clinical History: Right Breast palpable lump x3 weeks.

Technique:  Multiple real-time 2D/B-Mode sonographic gray scale images were obtained through the area of concern in the upper-outer right breast.

Findings: the visualized breast parenchyma demonstrates normal fibroglandular echotexture with no solid or cystic masses identified. No abnormal converging lines or worrisome posterior acoustic shadowing is present. No dilated ducts are identified.  The patient's palpable abnormality appears to represent a ridge of breast tissue.

Impression: No sonographic abnormality.  Recommend clinical follow-up and screening per ACS guidelines.

ACR BI-RADS

Category: 2, (benign) 

Recommendation:  Normal screening interval according to ACS guidelines. 

My question is....if he didn't see anything how can I get a Cat 2 Bi-Rads score....shouldn't it be a 1?

MrsCich

Just talked to my insurance company and they won't cover a biopsy or a MRI because it's not medically necessary.  I'm guessing I will just pray for the best and take the radiologist's word as truth.   good luck ladies!

TinaT

MrsCich - Usually, if you have dense breasts it would be throughout the whole breast, not just in one spot.  Women with overall dense breasts can definitely benefit from MRI.  I don't exactly understand what a "ridge of breast tissue" is.  Is this along the very edge of your breast?  Has there been a change there or is it possible that it's just the way you're put together and you've just noticed it?  Here's a link to deciphering Bi-Rads scores:

http://breastcancer.about.com/od/diagnosis/a/birads.htm

This does sound pretty benign according to the ultrasound report.  I guess if I was in your spot I would be agreeable to watching it since they will check again in 3-6 months.  If they told me to wait until next year I would be more aggressive about it.  Always listen to your gut.  If something changes definitely go back.  Please keep us posted.  Best wishes!

MrsCich

I'm not sure what a ridge of breast tissue is either.  The mass is not along the edge of my breast.  It is my right breast, between the nipple and under arm.  It has not always been there.  I do SBE's pretty regularly...at least every 6 months and this was not there last time.  I talked to my the mammography lady in my Dr's office and she said I can get a biopsy or MRI but it would be out of pocket but that she would refer me if needed.  I called to see how much it would cost and the surgeon's office that would perform it, scheduled me an appt.  The office visit will be covered under insurance and if he wants further testing, he can make that call.  Having a second opinion saying it's nothing to worry about is a little more reassuring than it "appearing to be a breast ridge." 

My worry about watching it to see if it gets larger is due to the fact that my Gynocologist didn't measure it or anything to see how big it was to begin with...the u/s didn't find it so there's nothing to go off of, ya know?  It's approximately the size of a half dollar but I could be mistaken.

TinaT

MrsCich - That sounds like a good plan. I sit here with bilateral mastectomies and implant reconstruction, but I'm actually doing great because I listened to that little voice inside and fought for a "baseline" MRI for my dense breasts that found my cancers. If something just doesn't feel or sound right a second opinion is a reasonable approach. As you said, it is worth it if only to put your mind at ease.

MrsCich

So Tina, yours didn't show up on an u/s..only on MRI?

TinaT

MrsCich  - OK, here goes.....  I had a long history of very dense breasts and pretty useless mammograms.  After a small cluster of calcifications amazingly showed up in my right breast in 2009 and an excisional biopsy showed ADH I started wondering what else could be lurking.  I decided I wanted an MRI, which took almost 8 months to get approved.  I had actually decided to pay out of pocket in Dec 2010 when the auth finally went through.  Because I had no lumps, no family history, no symptoms it was apparently unusual for a "screening" MRI to be done.

The MRI showed 5 suspicious areas, all on the left.  3 areas could be seen on ultrasound for biopsy and the other 2 had to be biopsied with MRI guidance.  Between all the biopsies I had 3 benign fibroadenomas, 1 small ILC, and 1 small DCIS.  The mastectomy pathology also showed several more early lobular masses and multiple areas of ADH sprinkled throughout the mid-breast that hadn't even shown on the MRI.  The MRI report had stated that the study was slightly sub-optimal due to dense breast tissue.  Oddly, this was all in the left breast, the right that had the ADH in 2009 was totally clear.

So, I had multiple masses - 5 were seen on MRI, 3 seen on ultrasound, 0 seen on mammogram, and numerous small lesions not seen on any imaging modality.

My breast surgeon admits she was initially reluctant for the MRI because she knew I would end up having a bunch of biopsies because MRI picks up so much and almost always the biopsies are benign.  However, after the fact she was thrilled that I kept insisting and that my cancers were found years (probably 5) earlier than if we had waited to feel a lump.  Likely it would have been very advanced before it would have shown on mammogram. 

This might sound like a sad story to you, but I believe it has a very good and happy ending.  It sucks that it had to happen, but every time I've listened to that little voice throughout this journey it has led me in the right direction.  And you obviously can tell that I'm a great proponent of MRI, especially for dense breasts!

MrsCich

How do you know if you have dense breasts? 

MrsCich

Well, I go meet with the surgeon today to see about getting a biopsy or MRI done on my mysterious mass that the u/s didn't pick up.  Thanks for the reassurance Tina...I will let you know more when I return.

TinaT

MrsCich - The body of a mammogram report should contain a comment if the breast tissue is dense.  It likely will not be mentioned in the summary at the end of the report.  Also, the tech doing your mammo or ultrasound can usually tell you - it's not a "result" so they should be OK to give you that info.

If the breast surgeon has access to your mammo images he/she can tell you today if you ask.

Remember that the majority of "things" turn out to be benign so I hope you can take one day and one step at a time until you have more info.  I also hope that the second opinion will put your mind at ease a bit. 

wallycat

Glad to hear you will be getting an MRI.

I had no lump, nothing on mammogram, nothing on ultrasound and MRI picked up my cancer.

My breast surgeon is still amazed I kept after it.

Best to you.  Most lumps are b-9 and hope yours will be too!

MrsCich

Thanks Wally and Tina!

Went to the BS yesterday and he really feels my mass (and the others he found upon physical examination) are fibrocystic in dense tissue.  He is scheduling a MRI for certainty and to go off of for future use.  Not sure when the MRI will be, should find that out today!  Thanks for being there!

MrsCich

Wally, why did you end up having a MRI if you had no lumps?

TinaT

MrsCich - Sounds like he told you that you do have dense tissue so the MRI sounds like a great next step.  Hang in there!!!

Infobabe

MrsCich

MRI shows all kinds of stuff mammos and US do not.  It is especially useful with inflammatory breast cancer. 

MrsCich

Yes Tina, he confirmed I have dense breasts.  I asked him how do we find out if I have dense breasts and he said, with certainty may I add, "Oh I can tell by feeling them that you have very dense breast tissue." 

I'm relieved, actually not worried at all now, because two doctors and the radiologist that performed the u/s, think my one large mass (size of a fifty cent peice) and the others that I didn't know I had until the BS felt around yesterday (and in both breasts now) feel it's nothing to be alarmed about.  I know from reading on this site, that it's still possible for something to show up, but I am at ease.  I will definitley keep you posted. This is an amazing site that has TONS of information.

TinaT

MrsCich - The odds are definitely in your favor that nothing ominous is going on in there....really and truly.  Part of the reason that insurance companies don't like to pay for breast MRIs is because they are so sensitive and often lead to "unnecessary" biopsies.  Biopsies and other invasive procedures of course aren't without risks, but personally I would rather have an "unnecessary" biopsy and find out what's going on than speculate and watch.  That's just my opinion.

Sounds like you're getting some reassurance.  However, if you are troubled about this while waiting for the MRI tell yourself that even if it turns out not so favorably you can handle anything that comes your way and congratulate yourself for jumping on things early.  I think you're going to do great no matter what the outcome! 

MrsCich

Got a call from the Radiology department. Breast MRI is scheduled for Monday, August 13 @ 8:30AM.  Even though I've been reassured I'm so glad I get to have the MRI to be absolutely positive!

TinaT

MrsCich - Yay - that was quick!  I'll be sending positive vibes your way...

MrsCich

Ok, so MRI is scheduled for Monday morning and my Dr's office just called to schedule my results appointment.  It is scheduled for Thursday.  I'm sure it's all going to come back just fine.  Even if it doesn't, I'm thinking I will handle it ok.  My husband hasn't said anything about attending the results appt with me and since I think I'll be fine, should I just let it go and not bring it up?  I don't want him to miss work for nothing, ya know?

TinaT

MrsCich - Chances are so good that all will be OK.  However, if they see something on the MRI they are likely to recommend a biopsy so they probably wouldn't be able to give you a definitive answer on Thursday anyway.  Remember, even if a biopsy is recommended odds are still in your favor that it will be something benign like a fibroadenoma (common in dense breasts).

If I missed something and they have also scheduled you for a possible biopsy on Monday I would ask my husband to go to the results appointment with me.  If it's just the MRI sounds like you'll be OK going by yourself.

Best wishes!

BLinthedesert

MrsCich -- I took a valium before my MRI (just in case they needed to do a biopsy) -- personally, I think that xanax or valium before biopsies should be available to everyone!  Anyway - if you decided to go that route than having someone to drive you home would be required.  That said, if they don't do a biopsy on the same day as the MRI it is not necessary to have anyone drive you.  My first ultrasound guided biopsy I drove myself -- the second one was tougher (larger bore needle and done by a surgeon) so I had someone drive me (so I could take drugs) ;-).

Good luck to you tomorrow!! 

MrsCich

Well, MRI is complete. The technician that performed it said the results should be ready this afternoon.  I called my Dr's office and asked if they received the report, if I was able to move my results appointment up, so I wouldn't have to wait.  Five minutes later, she called back and said she has the report and asked if I wanted to come in TODAY!  Of course I jumped on it.  Little nervous but I keep telling myself I'm fine and the MRI was easy to read because nothing showed up. 

Infobabe

MrsCich

I am so glad you are getting this level of treatment.  I have been reading your posts and am rooting for you. 

MrsCich

Aww, thanks Info!  The support in these forums is amazing! Whether my results are bad or good, I would most definitley recommend this site to anyone!  You ladies are awesome!