Have to wait a little over 3 weeks for breast MRI!!!!!

Brookelyn

So last Tuesday breast ultrasound screening found 2 masses, did a diagnostic ultrasound today, classified as Birads 4a, radiologist says she thinks it's fibroadenomas and wants me to do a breast MRI, likely a 3rd breast ultrasound and then decide what to biopsy so it can be done all at once. I don't understand how the one mass is being classified as 4a, it's anti parallel, has shadowing, calcifications so large they were seen on the ultrasound and is not round/oval and from what I've read this is not the typical characteristic of fibroadenomas but is typical of malignancy.

So my MRI is not till August 10th!! This feels like an eternity. Oh and they said the MRI should be done on days 7-21 and the first day of my cycle, day 1 was July 16th and if I count each day, then August 10th is day 26. The scheduler wasn't counting right because by her calculations she has me a "couple days" past the third week, day 21.which she said "should be okay" Do you think I should call back in the morning and perhaps speak to someone else?

ChiSandy

4a (actually, anything in BIRADS 4) is “suspicious for malignancy.” a,b,c are matters of degree of suspicion. It’s probably 4a rather than b because of the chance it could be fibroadenoma (more common in women still menstruating). Mine was 4b--10 yrs post-menopausal, no palpable lump, focal asymmetry discovered by routine annual screening, but ill-defined, hypoechoic and would not compress under the ultrasound probe.

As more and more women are being proactive and getting diagnosed, the demand increases yet the personnel and equipment remains finite. Hence longer waits. (Hard to believe that a generation ago, doctors thought breast cancers grew so fast that biopsies were done surgically under general anesthesia--they felt it was unwise to get biopsy results and then spend several days letting the patient decide her treatment plan--and the only way to know benign vs. malignant is if you went to sleep for a biopsy and woke up having had a mastectomy--and a pretty draconian one at that). The fact that you still menstruate and have to factor in the timing also affects your wait. I had my diagnostic imaging done a week after the routine mammo, had to wait 2 weeks for biopsy, and then another 2 weeks for surgery......and that timetable was considered fast by today’s standards.

BarredOwl

Hi Brookelyn:

I did a bit of looking around, and there seems to be some variation in what different sources report as the preferred time-frame for MRI relative to the menstrual cycle:

NCCN Guidelines for Breast Cancer Screening and Diagnosis (Professional Version 1.2015):

"Breast MRI is performed preferably days 7–15 of menstrual cycle for premenopausal women."

Mayo Clinic:

http://www.mayoclinic.org/tests-procedures/breast-mri/basics/how-you-prepare/prc-20020473

" If you're premenopausal, the MRI facility may prefer to schedule your MRI at a certain point during your menstrual cycle, around days seven to 14."

ASCO Patient Information:

http://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/breast-mri

"For best results, you may want to schedule your exam at certain times of your menstrual cycle. For example, if you are premenopausal, the MRI facility may ask you to schedule the procedure during days 7 through 10 of your cycle. Be sure to discuss this with your doctor."

Looking back in my files from 2013, Day 1 of my cycle was July 14, and the MRI was done on July 20 (they were open on Saturday), and then an MRI-guided biopsy was done on July 30.

If your Day 1 was July 16, it seems like the end of this week or next week might be preferred, if feasible. You may wish to call the facility back. If no appointment is available, then ask if there is a waiting list for openings in your desired time-frame (assuming you have flexibility in your schedule and could appear on short notice). Another option would be to inform the doctor involved about the assigned scheduling, noting the timing relative to your cycle, and inquire if they have any concern with the current scheduling. If so, ask them to assist you, as possible.

I had a situation with an ultrasound recently, where due to a changeover in scheduling systems, my ultrasound appointment was dropped, yet I was scheduled to meet with a doctor to discuss my non-ultrasound. I called in and they scheduled me for the very next day at the crack of dawn. They may have early openings for more urgent cases and may have some flexibility.

A good quality MRI might better inform understanding of the extent of disease (in areas that may be more subtle than the current areas of concern), with increased value to surgical planning. Anyway, it can't hurt to call and ask.

BarredOwl

Brookelyn

Thank you Barred Owl!! I did call back and was able to get an appt next Tuesday so it puts me at cycle day 11 and I feel so much better about that.

And I will put this out there in hopes of helping others making appts, I am finding that it's much better to schedule appt in the morning and also to directly call the place and talk to people in the office you are having your appt at. The health provider I have has "schedulers" that don't work in the offices and just make appts for all departments. I didn't know this until I was making my appt for my second breast ultrasound and the gal told me she could make me an appt but if I called and spoke to them directly when they opened next day, I'd likely get in much sooner.

SandyChi, I looked up the 4a, b,c definitions and my report says low suspicion for malignancy and after looking at my report online I think I understand better on some things and others have left me totally confused.

The online report for second ultrasound had more details than the radiologist told me when I was there. I think I understand why she is saying 4a and suspecting fibroadeonomas. Now instead of one of my masses being anti parallel with posterior acoustic shadowing, they are both listed as parallel with no shadowing and now also say well defined margin on one and relatively well defined margins on the other. I really don't understand how the mass went anti parallel to parallel and shadowing to no shadowing. oh and they are both measuring slightly smaller on the diagnostic.

How can there be so many abrupt changes from the original u/s screening to the diagnostic u/s screening? Do fibroadeonomas change with your menstrual cycle? I am so confused. I would have asked had the radiologist brought that up. No matter what I am not going to feel better until the last tests are done and I have final results. I am a little more hopeful for good results now that my odds are better but with my family history 10, 20, 30 percent chances of maligancy still scare me very badly.

BarredOwl

Hi Brookelyn:

on rescheduling success!! Meets the guideline preference for timing AND reduces the number of days of waiting,wondering and worrying.

BarredOwl