Interpreting Your Report

djmammo

bruinjamie21

I dont see a BIRADS #. Did they not put one in the report? It is required. Many places give a BIRAD for each breast on MRI.

What imaging was recommended after this? The most common scenario is to scan the breast with US to evaluate these findings to see if they are real and if real and suspicious, biopsy them under US. If they cannot be seen on US and your docs are still concerned, they can be biopsied in the MRI.

As a rule of thumb if there are multiple small similar scattered foci of enhancement, the more there are, the more likely they are benign. The T2 bright nodule is likely a FA.

There is no description in the report of anything that sounds like a classic cancer on MRI. Looks like they are being very careful not to miss anything.

bruinjamie21

djmammo thank you so so much for your reply. I am having an MRI guided biopsy next week. I copied/pasted the whole report that was on my health portal. No Birad. That said I don’t think the Birad was there for my original ultrasound report right away either. That was given a Birad 3 but my dr specifically said these were different then the original area of concernand not picked up on the original mammogram and ultrasound

Cunninghsm07

Djmammo, you are incredible for all of the work you are doing and for all of the insight you are providing. You indicated that you would need my mammogram and ultrasound results verbatim. They are below. Thank you so very much.

Narrative

MAMMO RIGHT DIAGNOSTIC, 3/20/2019 3:52 PM, Dean Clinic

INDICATION: Z98.890: S/P breast biopsy, right

ADDITIONAL CLINICAL INFORMATION: None

COMPARISON: 7/10/2018, 9/20/2017, 3/20/2017

TECHNIQUE:
Full-field digital mammography was performed with CAD. Five views of the
right breast were performed.

FINDINGS:
The breast tissue contains scattered fibroglandular tissue.

On the MLO projection and 90 degree lateral projection of the right breast,
seen in the posterior breast near the level of the nipple, there is a focal
asymmetry identified with slightly angulated margins. There is a potential
subtle correlate for this finding on the 3/20/2017 MLO view; however, the
finding on today's study is significantly more prominent and persists and
becomes somewhat more pronounced with spot compression imaging. There is no
clear correlate on the craniocaudal view.

No other significant focal finding is identified.

ASSESSMENT:
BIRADS ( 0 ) Incomplete. Need additional imaging evaluation.

RECOMMENDATION:
Sonographic evaluation of the right breast will be performed to assess the above-described finding.

US BREAST RIGHT LTD, 3/20/2019 3:51 PM, Dean Clinic

INDICATION:
R92.8: Abnormal mammogram

ADDITIONAL CLINICAL INFORMATION:
Ordering Provider Reason for Exam:
Technologist Note:
Additional: None

COMPARISON:
Mammographic imaging performed earlier today.

TECHNIQUE:
Ultrasound of the inner and outer aspects of the right breast was performed
utilizing standard protocol. Dr. Shadman was present for the procedure.

FINDINGS:
No focal sonographic correlate is identified corresponding to the mammographic
finding of concern.

ASSESSMENT:
BIRADS ( 0 ) Incomplete. Need additional imaging evaluation.

RECOMMENDATION:
Given the persistent focal asymmetry on mammographic imaging and lack of clear
sonographic correlate, MRI of the breasts is recommended for further
assessment.

djmammo

Cunninghsm07

It would have been a better report if they had mentioned the size of the mammographic finding.

There is a line that hints the finding may have been partially seen 2 years ago

It is only seen in one mammo view

There is nothing on US

In general things only seen in one view are less likely to be real and as a rule of thumb a cancer present in a breast for two years is usually rather obvious on US. Again giving us the size would have helped.

I think its terrific that they will get you an MRI to make sure that everything is as it ought to be. Let us know what it shows.

Cunninghsm07

Djmammo- Thank you so much.  You have no idea how helpful you have been.  I will post an update after the MRI.  

---faithhopelove---

djmammo can you tell me what a 2.5 cm linear enhancement on MRI might be? I was diagnosed with LCIS 9 years ago. I did 5 years of tamoxifen and have been on high surveillance mamo every 6 months and occasionally an MRI. They said I need a MRI biopsy. I’m very nervous. Thank you

djmammo

---faithhopelove---

Need a little more to go on.

Can you post the whole report?

---faithhopelove---

I just got a phone call. No report. Over 2.5cm regions with linear 4oclock. Linear enhancement was what she kept saying.

djmammo

---faithhopelove---

Here is a good article on types of enhancement MRI breast

---faithhopelove---

thank you. What is Linear A?

djmammo

---faithhopelove---

There are several paragraphs in a row describing patterns that are missing colons ' : '

Linear: A 'linear' enhancement pattern......

Ductal: A linear or 'linear branching'......

etc.

---faithhopelove---

Thank you djmammo! Very much appreciate you responding so quickly and I think I have a much better understanding.

DizzyMariposa

Hello! I was hoping someone could help me interpret my reports, mostly the MRI report. Thank you in advance

I am most confused with “FINDINGS: background parenchymal enhancement is moderate” From my MRI report.

Ultrasound report:

Finding 1: The nipple discharge of the right breast is not seen on ultrasound. On clinical exam, patient expressed bloody right nipple discharge.

Finding 2: There are multiple complicated cysts and cysts of varying size in both breasts.

Impression 1: Area in the right breast requires additional evaluation. A breast MRI is recommended.

Impression 2: Complicated cysts and cysts in both breasts are benign.

BI-RADS Category 0

Incomplete: need additional imaging evaluation

MRI Report

HISTORY:

Patient is 28 years old and is seen for right bloody nipple discharge. According to the BRCA PRO Genetic Risk Prediction Model the patients lifetime risk of developing breast cancer is 13.2% based on the information provided by the patient at the time of the exam . In patients with a lifetime risk of 20% or greater, annual breast MRI in addition to screening mammography is recommended by the American Cancer Society.

PRIOR EXAMS: Ultrasound bilateral breasts on 1/28/19

TECHNIQUE: Axial T1, T2 fat-saturated, and T1 fat-saturated dynamic pre- and post-contrast with sagittal T1 post-contrast imaging. Additional post processing was performed on a separate work station, including maximal intensity projection, 3-D reconstruction, image subtraction and signal intensity analysis with color parametric mapping and DynaCAD computer aided detection software.

INTRAVENOUS CONTRAST: 20mL of ProHance

FINDINGS: background parenchymal enhancement is moderate.

On the right: there is no abnormal enhancement in the right breast. There is no skin thickening or nipple retraction. There are no enlarged axillary lymph nodes. There are right cysts with the largest measuring 2.0 cm.

On the left: there is no abnormal enhancement in the left breast. There is no skin thickening or nipple retraction. There are no enlarged axillary lymph nodes. There are left breast cysts.

IMPRESSION: No abnormal enhancement in either breast.

ASSESSMENT: Benign findings. There is no MRI evidence of malignancy. (BI-RADS Category 2)

RECOMMENDATION: Surgical consultation for right bloody nipple discharge.

BI-RADS Category: 2

Benign

mmetch

Hi! I'm considered high risk and had my first screening MRI last week. They found a small mass that they wanted to check out on ultrasound, but couldn't find it, so I'm just following up in six months with another MRI. I was wondering if you could help explain this section of the MRI report to me, though---

After injection of contrast, there is a 5 mm oval enhancing mass in the lower outer quadrant of the left breast at anterior depth on image 55 series 13 for example. This demonstrates progressive enhancement on dynamic CAD imaging. This is not definitively T2 hyperintense; however, this could be due to slice selection in this region when viewing the T2 sequence. This finding could represent background parenchymal enhancement as there is mild background parenchymal enhancement noted. The majority of the background proximal enhancement is subthreshold on dynamic CAD imaging, however.

BIRADS Category 0, awaiting further evaluation (the ultrasound, in which they couldn't locate the mass)

cattledoglv

Thank you! I did have the ones that are gummy type so technically it’s not supposed to do that. She said it’s more common for them to infiltrate the ipsilateral side but not so much the contralateral. I guess I have a very efficient lymph system lol

Demi424

djmammo ~ All of the help that you provide on here is truly amazing! I was wondering if you could help me better understand my mammogram/ultrasound results? I need to make an informed decision as to whether or not I should continue or forego plans to travel out of the area next week to take care of my father.

A couple of weeks ago, I was having pain in my left breast and could also feel a hard lump. At the doctor's appointment yesterday, the doctor did a breast exam and ordered a diagnostic mammogram and ultrasound which was done that day. Based on the findings, they did an ultrasound core biopsy that da. The pathology report will not be available for approximately 3-5 business days, but by that time I'll be a couple of hundred miles away. I'm looking for any guidance you can give me on the results of the mammogram/ultrasound. I know that you can't tell me whether or not I should go — this is a personal decision that only I can make, but my hope is that with your guidance, I'll be able to make a better informed decision that I'm much more confident about — THANK YOU!

I am 41 years old and have a history of PASH and a cyst in that same breast. I do not have any family history of breast cancer.

MAMMOGRAM DIAGNOSTIC LT W/CAD - Left breast upper inner quadrant on the initial views a 1 cm focal asymmetry is seen. Additional evaluation with spot compression with tomosynthesis demonstrates a persistent left breast 10:00 position 1 cm focal asymmetry with a solitary central macrocalcification. This case was also reviewed with the aid of the R2 Checker computer aided detection. Comparison is made to 6/18/2018, 1/16/2017.

ULTRASOUND - Real time ultrasound is performed to the left breast targeted to the area of concern indicated by the clinician and the patient in the left breast 10:00 position 6 cm from the nipple corresponding to the mammographic mass there is a 0.6 x 0.3 x 0.6 cm irregular hypoechoic mass with non circumscribed margins.

IMPRESSION: BI-RADS Category 4: Suspicious

Left breast 10:00 position 0.6 position cm hypoechoic mass is suspicious.

RECOMMENDATION: Ultrasound core biopsy left breast.

djmammo

DizzyMariposa

I am most confused with "FINDINGS: background parenchymal enhancement is moderate" From my MRI report.

That's the MRI equivalent of breast density on Mammo, its not an abnomality.

djmammo

mmetch

That paragraph basically means they see something thats probably of no clinical significance but lets make sure with an ultrasound. The T2 reference means they thought it might be an FA but they are not sure.

We usually ignore things 5mm and smaller on MRI especially when multiple, because normal glandular tissue can have this appearance. When there is only one though we investigate. A negative US with a 6 month MRI follow up is a very common scenario in my experience.

djmammo

Demi424

Check your PM's

Demi424

djmammo — Thank you very much! I will post my results when I receive them.

~Demi

Chrissy24

After biopsy’s and Ct Scans and Pet scans and double mastectomy I will “bottim line it” the MRI showed a “real” cancer IDC stage 3 6cm as well as IDC and DCIS in right breast. The technician back in 2017 tagged the wrong area which was tagged wringvin 2918. Then the radiologist told me with no known cancers they don’t read the films with the same level of scrutiny as someone with cancer.

djmammo

Chrissy24

What the radiologist was referring to was Pretest Probability. This governs most of medicine, not just radiology.

Not sure what this phrase refers to: "The technician back in 2017 tagged the wrong area which was tagged wringvin 2918".

Unlike ultrasound which is highly operator dependent, MRI techs do not label abnormalities on the images. The software used to view the images however does highlight certain area depending upon the particular CAD algorithms written into it.

Chrissy24

meaning the technician who original did the ultrasound said there was something f in the 11:00 position which she had it wrong it was at the 8:00 position which again In 2018 said 11:00. Hence why nothing was there to biopsy because of operator error. The MRI showed the abnormality at8:00 which you made reference to it being “real”

LIgma

Hi djmammo,

Architectural Distortion vaguely seen left breast on screening mammo. Distortion presses out on DBT. US shows subtle distortion. No masses found. No other changes to breast. No further descriptions. Bi rads for mammo and US were 0. Stereotactic biopsy done 22 years ago. Not tagged. I have noticed since menopause 5 years ago Left breast seems slightly smaller than right. Chance this is malignant? MRI scheduled.

Thank you.

djmammo

Chrissy24

I see. I read it as the MRI tech tagged the wrong area. Makes more sense now.

djmammo

LIgma

Can you post the entirety of the reports?

If you are asking if the arch dist could be from the stereo biopsy, I don't believe I have ever seen that with the standard 11 gauge needle commonly used on a stereo unit.

LIgma

No suspicious tumors or calcifications seen. 3 D spot compression view with 1 mm performed. Sagittal area of distortion seen on preliminary cc compresses out with no definite abnormality.

Bilateral screening US. Includes all quadrants. No suspicious findings. At 2:00 4 cm from nipple corresponding to area of Architectural Distortion subtle Architectural Distortion seen.

May represent area of prior stereotactic biopsy. No other significant change since prior study in either breast.

MRI recommended for further evaluation.

Bi Rad 0

P.S. Biopsy was a core biopsy. Fibroadenomatoid

djmammo

LIgma

Let us know what the MRI shows.

LIgma

Thank you. Will do. Seems from my reading the odds are fairly high for malignancy when there is corresponding evidence of the distortion.

mmetch

Thank you so much. That helps reassure me.