Final Pathology Diagnosis -- What does it mean?

Daisey4522

Hello. My name is Ginger and I am 28 years old. I have an 8 cm mass with calcifications in my right breast. The radiologist said it looked breast tissue within breast tissue with a spot that has calcifications. I had a stereotactic biopsy so they could capture the caclifications and well as the mass for pathology. I was told that the mass is benign, but the final pathology report does not give me a clean indication of what exactly the mass is. Have you ever seen a Pathology report similar to this? Can you explain what any of this means?

FINAL PATHOLOGY DIAGNOSIS:

Right breast, stereotactic guided biopsy:

1. Benign fibroepithelial proliferation with fibroadenomatiod features (see comment)

2. Florid adenosis.

3. Apocrine metaplasia.

4. Microcysts.

Comment(s):

These findings may represent fibrocystic changes or a fibroadenoma with secondary adenosis. Some areas are suggestive of tubular adenoma.

**Note: When I was 22 years old I had a sonogram guided biposy of what I believe is the same mass. At that time the biopsy finding was "Tubular Adenoma".

I have seen a breast surgeon and they recommend immediate surgery to remove the mass because of the size, location (directly under the nipple), and the fact that it appears to be growing... but I'd love to hear from anyone who might be able to give me more information regarding what the mass might actually be or hear from someone who has had a similar pathology report and your experience with your mass.

Thank you!
Ginger

Lily55

It seems to me that your mass is a combination of all of the above, it is dense and nodular fibrous and cystic tissue but BENIGN......but these are not common things so I honestly think you should ask your breast surgeon for more detailed info

Daisey4522

Thanks Lily... my Breast Surgeon did not even touch on what the report said. I'm getting a second opinion in December from another Surgeon, so I will try to ask then. But I have so many questions about the surgery, etc. I hope I have enough time!

Daisey4522

I ended up having the mass removed last week. It turned out that it was actually 2 large masses not 1! The final pathology for both masses is benign. I have not seen the actual pathology report yet, but my Doctor told me it is Nodular Adenosis.

PistolMama

Good news Daisey4522!

alicki

I am having fat necrosis masses removed next month. Just dreading it, but it's the last stage to my breast problems, I hope.

Alicki

Daisey4522

Good luck Alicki! No surgery is pleasant, but I wish you the best and for a quick recovery!

alicki

Hello,

Head of pathology called me (i know him) to say that it was b9 and i Will have report next week.

I can now go back to screening once a year or every mine months.

Youpi

Alicki

Daisey4522

That's great! Happy to hear your B9 Results!

MIGGY07

hello everyone.

I just had an ultrasound for breast pain last Monday. The results came back B9, but the report does not indicate what they saw or even where they saw it .

All it says is "no abnormalities seen on location of focal pain"

Recommend an ultrasound in another year

And then BIRAID 2

Now if it's B9 shouldn't the report indicate what if fact they found. If they found nothing it would be BIRAID 1... Right???

Should I go to my surgeon for this or the hospital where my ultrasound was done?

Daisey4522

Hi Miggy,

If you had a biopsy (where they removed a piece of a mass) you should get a pathology report that indicates what was found. It sounds like they just visualized an area in which you were having pain and did not find anything. It sounds like they may not have even found a mass. I would ask your doctor if they found a mass or not. If they did find a mass, ask why they did not recommend biopsy.

Hope this helps.

MIGGY07

it was an ultrasound.

My logic is if they didn't find a mass why would they categorize it B9 and not BIRAIDS 1? In my mind if it's B9 what did they see to find it B9.

Not all breast lumps need to be biopsy if they are clearly B9 but they don't even report a lump.

Daisey4522

I see your point! I was wondering why you were referring to it as "B9" but I figured it was just an error in terminology. If they really did put "B9" that does seem odd to me. I worked closely with the doctor in the Radiology department (where I got my imaging done), so if it were me I would ask them about it. If you do not really have a good contact there then maybe discuss with your surgeon. But my guess is the doctor who reviewed your ultrasound and made the report would have the most information. Good luck!

Janet456

My last two have come back as a Birads 2. My understanding is that they are writing about things they see that they know are benign. I am assuming in my case it is scar tissue or something from my lumpectomy. I've got another follow up in a couple of weeks. Am hoping for a 2 again, if so I might ask what they are seeing.

lintrollerderby

Daisey: I see people sometimes write "B9" when they mean "benign" as it sounds almost identical--it's used as shorthand by a few people here (I never use it, but it comes up occasionally).

MIGGY07

im sorry if I'm using incorrect terminology.

My issue is I have breast pain so if I have a cyst (for example) I know those can be painful and I will have some piece of mind. But with this general BIRAID 2, I'm no better off about what is causing my pain except of course pretty sure it's not cancer.

MelissaDallas

It would seem that the 2 is to specifically remark on a benign finding, as opposed to no finding at all, so yes, it should be mentioned what the finding was

BI-RADS 2

Dr Matt A. Morgan◉ and Radswiki et al.

BI-RADS 2 is a benign category in the breast imaging reporting and data system. A finding placed in this category should have essentially a 100% chance of being benign.

Examples of such lesions include

• calcified fibroadenomas
• multiple secretory calcifications
• fat containing lesions such as:
  • oil cysts
  • breast lipomas
  • galactocoeles
  • mixed density hamartomas
• cutaneous neurofibromas 3: e.g. in neurofibromatosis type I (evidence of sarcomatous change is change is considered very low)
• intramammary lymph nodes
• breast sebaceous cysts
• simple breast cysts 4

Reporting recommendations

Although BI-RADS 1 and BI-RADS 2 have an essentially 0% chance of malignancy, BI-RADS 1 is used in situations where the breast is completely unremarkable, and BI-RADS 2 is used when the radiologist wants to remark on a benign finding.

Any BI-RADS 2 breast finding is not expected to change over the follow-up interval. The radiologist should mention that it is a definite benign lesion.

Usual screening follow up is recommended.

References

MIGGY07

thank you so much Melissa. I will be calling my suergon soon maybe he forget to give me the whole report.

lintrollerderby

MIGGY07: No worries about the "B9" thing. As I mentioned, a few people here use it from time to time as shorthand. I'm not much into most common shorthand typing such as B9, U, etc.; I was just clarifying your intentions for Daisey.

I hope you get to the bottom of what's causing your breast pain. Congratulations on the BI-RADS 2 designation, though that doesn't help with getting answers, other than to put you more at ease regarding a malignancy. If you Google more info on it, your results may not match up if you type BIRAIDS as you have above. Just leave out the second I. The acronym is for "Breast Imaging-Reporting and Data System (BI-RADS)". This is a common tool here and in breast health literature. Liver health has LI-RADS, head injuries have HI-RADS, prostate health has PI-RADS, etc.

It sounds like the radiologist felt that there were no abnormalities to note in that area, hence the "no abnormalities seen on location of focal pain" explanation. In regards to your question above:

"Now if it's B9 shouldn't the report indicate what if fact they found. If they found nothing it would be BIRAID 1... Right???"

My take on this would be that it seems that's what the radiologist was doing by stating he noticed no abnormalities in the location of focal pain. I also pulled up the same BI-RADS guide that Melissa posted above, and it outlines: "BI-RADS 1 is used in situations where the breast is completely unremarkable, and BI-RADS 2 is used when the radiologist wants to remark on a benign finding." I interpret this as to why a BI-RADS 2 was indicated rather than a 1.

Where was this imaging done? Was it at a radiology center that has a specialized "Women's Imaging" location? I ask because the BI-RADS designation, while in theory is supposed to follow specific guidelines for each of the 7 major designations (0-6 not including sub-classifications), it is still a subjective rating based on the skill of the radiologist, the experience of the technician, and the quality of the equipment. I really hesitate to mention this because I know that I'm a statistical outlier in all things breast cancer, but I feel I'd be remiss if I didn't pass on my experience to others. If your breast imaging was not done by a facility and read by a radiologist in which the majority of time is spent in reading and performing primarily or only breast imaging, then perhaps you should seek a second opinion at a more specialized location. After finding my lump, I had a mammogram and ultrasound performed and got a BI-RADS 3 designation. This means "probably benign" and indicates a >0% but <2% chance of malignancy with a 6 month follow-up. I pushed back and was then sent to "Women's Imaging" radiology practice where the radiologist only reads breast-related imaging and was given a BI-RADS 4a "low suspicion of malignancy" rating meaning >2% but <10%, but this was only after speaking with the radiologist. At first, he was inclined to concur with the first radiologist who practices in a competing business. Both of these radiologists were wrong. I had a malignancy. Let me be clear: I think that most radiologists get it right, but that was not my experience. So, my experience has taught me to persevere until I'm satisfied I've been given the accurate information and to make sure all of my questions are answered. If you feel the radiologist has not thoroughly explained why you're having a breast issue and is somehow blowing you off, then get an answer from another one until you feel that you've done what you need to do. Again, I don't think the BI-RADS system is inaccurately applied for the majority of women; however, it will cloud the advice I give because that happened to me twice. The main difference between my case and yours is that I was dealing with a rapidly-growing, palpable lump that was very tender--not just breast pain. So, while your situation is SO much more likely to be accurately reflected by the BI-RADS 2 rating because there is no questionable growth, I feel it would be disingenuous of me to suggest to women who are concerned that they should just be happy with the score given to them if they feel like there's still unanswered questions. I do not believe there is much of a chance at all that you're dealing with a malignancy, but you deserve to know why you're having breast pain. I hope my advice was not anxiety-inducing. I hesitate to mention it, but feel you need to advocate for yourself until they've answered any and all questions you have.

Best of luck.

Daisey4522

You are right, I have heard B9 plenty of times on this forum! You were not using the wrong terminology I just thought I might be misunderstanding at first.

I think it would be a good idea to talk to your surgeon about what was seen.

Good luck!

MIGGY07

thank you.

It was done in a breast clinic location at a major hospital in my city (Detroit)

I was told the day of the ultrasound that they didn't see anything to worry about and I will receive a more detailed report in two days via doctor.

I thought I would get a lot more info.

My pain in not general, it's just the right breast in a specific area. The ultrasound was the whole breast but focused on the area with pain.

What do you ladies think about waiting another month to see if it's really my hormones (what my doctor said he thinks it is) ? If pain still there get more test???

lintrollerderby

I think that's a good plan. What is your age, if you don't mind sharing? It's unlikely that there's a sinister cause for the breast pain considering the lack of a palpable mass or visible abnormality on the breast imaging, but as I said earlier, you deserve to know what's causing it. Hormonal pain is a possibility. Certainly, if it persists or gets worse, you should find out the cause. Unfortunately, breast pain can be common and there are a multitude of causes, most of which are not cause for concern.

MIGGY07

I'm 25, 26 in a week. No family history of breast cancer at all. Prior biopsy - results b9.

alicki

Hello,

Just received my results back (path report) and I have exactly the same results (+ tubelar adenosis) and scleosing adenosis. I had a breast reduction revision, so I'm not quite sure what is still lurking in my breasts, scary...I have an appointment with breast specialist in November to see what further monitoring needs to be done.

For now, I'm going to cut down on fat and sugar and let me breasts heal from the operation.
I think a mascetomy at this point would be an overkill so I guess it will be monitoring and more monitoring.

Glad you are getting the mass removed.

Melissa: can you tell me a bit more about scleorsing adenosis? Mine was not diffuse, only two foci. Thanks

Best
Alicki

Daisey4522

I just wanted to update that soon after all of this in 2014 I was referred to a breast surgeon and I did have the mass removed. It ended up being 2 very large masses that were pushed together, and they were benign. 3 years later there is barely a scar and only very mild dimpling. You care barely notice anything! With such large masses near my nipple I would expect that it would have looked worse. I guess I had my age on my side.