Lump not showing up on ultrasound

AnnieB7777

My gyn noticed a lump on my left breast, and ordered a diagnostic screening. The lump is large, maybe an inch, at about 7oclock on the bottom of my breast, it seems to be fixed on the chest wall, rubbery and unmovable. It's completely different from the rt breast, which is totally flat in the same spot. Doc seemed very concerned when she felt it, going back and forth between both breasts. I haven't had a mammo in 4 years, I'm 46 but I'm not fond of them, plus last annual exams she didn't feel anything.

The lady who did my mammo flat out told me she saw nothing of concern, when I asked her if a lump on the chest wall would even show up, I'm not sure how it could even be viewed with the mammo.

An u/s was done, the young gal who did it said she was a student. She found the lump right away, and I watched her measure it on the screen, it was perfectly oval in shape. She said she would be right back, left and came back, then said it was my rib - and as such, she hadn't shown it to the radiologist and wanted to redo it. She asked me where the lump was, I showed her, she felt it, put the wand there and could find nothing but the "rib".

She left the room, the radiologist came in and asked me where the lump was. She put her finger on it and said "there, it's the size of a grape, right?" and I said yes! She puts the wand on it and again, nothing shows up, this time she didn't even see the rib. She says it must be dense breast tissue, she spent maybe 10 seconds looking. And that was it, I left so relieved!

But now that I've had a day or two to sit on it, I'm starting to rethink it all, wondering: 1) can a rib really show up as perfectly oval? The tech didn't even show it to the radiologist to evaluate it, which scares me...but I'd like to think she could tell by the consistency or something 2) can a rib be felt on one breast (feeling like a big lump) but not the other, like maybe one of my ribs is bigger and sticking into my breast?? and 3) can a cancerous lump just not show up on the us?

I'd love some of your thoughts on this. I've been feeling flu like and fatigued since November of last year. Even had a run up of tests long before doc found the lump, blood tests showed nothing amiss last November. I'd hate to sit on this if it's something to be concerned about. Please help me put my mind at ease.

ksusan

Fatty cyst? I suppose you could ask for a biopsy.

AnnieB7777

I would be ok with that if they had actually found it on the u/s and determined that's what it was...part of me just wants to trust the radiologist, the other part of me wants to get a biopsy. I haven't heard from my gyn yet, and am wondering what she'll say.

dtad

Hi Annie...May I suggest a MRI?

djmammo

AnnieB7777

With today's US machines it would be very difficult to miss a mass measuring an inch across. That's about 2.5 cm which shows up as very large on an US screen. Over the years I have had patients present with a mass they found at home and have it turn out to be a portion of a rib (usually a prominent costochondral junction) which has a recognizable appearance on US.

A student tech always has someone supervising them, they are not making decisions on their own. They likely showed the images to the supervising tech and they were too embarrassed to show the radiologist.

Also know that the images you see in the room can be seen in other parts of the department specifically the techs station and the radiologists office. The images can be studied for a period of time before the come to see you where it appears they did not look at the screen for very long.

If this still concerns you have it scanned at another breast center / radiology department. Ask your insurance company how many days to wait between exams so that it will get paid for.

AnnieB7777

Thank you, dtad, that was my thought too. Based on your information, djmammo, I'm going to trust they know what they're talking about and watch/wait on it. If it's something more serious, I'm sure something else will come up soon. Thank you!!

AnnieB7777

So. Here is an update: Finally saw a breast surgeon, as the lump seems still bigger now, and it doesn't change sizes with my cycle. He found it on the US he did there in his office, but only when I sat up! He confirmed it's on the chest wall, if I lift the breast, then it can be felt on top of the rib cage, at about 6 o'clock - I can grab it and it's even visible to the eye if I do that, but if I lay down it hides under everything.

Anyway, he said it appeared to him like a cyst with junk in it. But he wanted the radiologist to look at it to make sure, so he set me up for that. I sure felt vindicated when he finally saw it, after being told previously it was a rib or just normal fatty tissue.

Over the last year I've been to the rheumatologist for the flu/joint pain/fatigue feelings, but blood tested negative for any autoimmune other than Hashimoto's (and no cancer indications). I've had US on my clavicle area for what appeared to be lumps, and it only found normal muscle tissue. I've had my sternum, sacrum and neck x-rayed because they hurt constantly, and only found straightening of the spine (from whiplash, I guess this must be from a car accident years ago). The last two months, I've begun having pain under my right rib that has kept me awake at night, so I had an abdominal US, which was unremarkable, but the pain is still there, so what is it? These are things that concern me enough to not just ignore this lump, which I've been inclined to do off and on during this time because nothing has been found. Except at 47, I've suddenly become very fibrocystic.

So today is my appointment for the diagnostic mammo and US, the surgeon told me to have them do both while I'm sitting up. He also mentioned MRI to rule anything out (finally - thankfully!). I'm hoping and praying it's just a cyst, but also want a biopsy to confirm that...I've gone from completely healthy to unhealthy in the last year and a half, maybe I'm just a hypochondriac, but maybe not. I told my husband, if it's a cyst, I'm going to go to a therapist and get some meds for my apparent medical anxiety!

Also, just wondering if they can do a biopsy while I hold my breast up, so they can get to it more easily?? Or no. If they have to go through the whole breast to the chest wall, it might be a rough one...

Rah2464

AnnieB7777 so glad to hear you kept pursuing this. I too had a lump close to the chest wall that they kept missing with mammography and ultrasound technology. I went thru two testing cycles a few months apart (mammogram plus ultrasound) and thank goodness the breast surgeon requested a diagnostic MRI. The MRI spotted it. I think if you have dense tissue and the spot is closer to your chest wall imaging perhaps is trickier. Good luck with everything and hope it is all benign and just a fatty little lump.

AnnieB7777

Rah2464, thank you! I do have heterogeneously dense breasts. How did they do your biopsy and how was it?? I'm scared of the biopsy, as I've heard they can be painful, mine seems to be actually attached to the wall. Glad they found yours, and hope you are doing well now!

MelissaDallas

Annie, virtually all of us have hetergeneously dense breasts unless we are very young or very elderly. It is essentially “normal” brest density.

AnnieB7777

MelissaDallas, I know you have a lot of knowledge in regards to breast cancer, so I say this respectfully, but most cancer websites have given the statistic that approximately 4 out of 10 women have heterogeneously dense. I'm under the impression that cancer detection in mammograms is at least somewhat compromised with hd breasts. Everything I've seen (including this very website, and also my mammogram results that were mailed to me which stated so) said cancer is harder to catch with hd and d breasts, to the point where people have fought for required disclosure of whether they have it or not after testing. No, I don't have extremely dense, but hd is enough to make me concerned when I definitely feel a lump!

djmammo

ACR Statement on Reporting Breast Density in Mammography Reports and Patient Summaries

It is my understanding that half the population has what are considered Dense breasts (#Heterogeneous + #Exrememly dense) and half do not (#Fatty + #Scattered). If you currently take HRT or have used HRT for a long time and have recently stopped, this will shift you into the Dense group if you previously were not.

djmammo

AnnieB7777

Since your surgeon feels your mass is "attached" to the chest wall, did they recommend you have the MRI prior to a biopsy?

AnnieB7777

Thanks for the clarification, djmammo. BS recommended MRI next after today's testing, that's all I remember! I was so scared/relieved that someone finally saw it and that he thought it was a cyst. And I've been wondering if they wanted to biopsy today after, what that would be like, how do you get under there? Should I say no, I'd like the MRI first? My main concern was how much trauma to the breast going all the way in, unless they'd go underneath with me or someone holding it up. What would you recommend?

Rah2464

AnnieB7777, I had an ultrasound guided needle biopsy. The mass was in an area they felt they couldn't do with an MRI guided biopsy. They had to really work to define the area, working from the image found on the prior MRI. They spent about 30 minutes trying to decide if they were in the right spot. The actual biopsy didn't hurt (you are numbed) but it felt rough because the doctor really had to punch through the dense breast tissue and he had to go in several times to make sure they were getting enough tissue from the right areas. And I think I was emotional so that made things feel more intense. I was pretty bruised after but any discomfort was managed well with tylenol. I think if I had been more knowledgeable or prepared for how hard it was to get into the breast, it would have impacted me much less. So I hope that your biopsy is very quick and easy but don't worry if they have to push hard to get in there. That just means they are working diligently to get to that area to get the best information possible. Sending you wishes that everything is clear.

MelissaDallas

Sorry about that, I was thinking about the wrong stats for the situation

djmammo

AnnieB7777

There is no problem putting a biopsy needle deep into the breast. There is no "trauma" to the breast aside from the needle tract which would be no different from any other biopsy just a little longer. The rad doing the biopsy will choose an imaging modality that will allow them to both see the target adequately and orient the needle parallel to the chest wall.

AnnieB7777

Rah2464 - thank you so much, it's good to have this information up ahead and know what to expect! Thank you for the good wishes!

MelissaDallas - no problem. It happens.

Djmammo - what a relief that they'll orient the needle parallel to the chest wall and not go all the way through from the top! Thanks!

So here's what happened yesterday: they found nothing. Couldn't see a single thing out of the ordinary, found a couple of cysts that were up higher but that was it, the one the breast surgeon saw was gone. Everyone could feel the lump, but could not see it on either mammo or US. The radiologist was very confident, she said breasts are not the same, which is why the other one is flat where this one has a lump. The only way I'm going to find out what this is, is to do an MRI. But this whole process is humiliating and I'm tired of it already. My heart goes out to those who have had to deal with actually being diagnosed.

AnnieB7777

My MRI is scheduled for the 12th. I'm nervous, but after more than a year of this, definitely ready for some answers.

Question: Will the MRI see into the entire armpit? The lumps there are growing quickly in the area just underneath, and going into, my armpit. To the point where that breast is suddenly quite a bit bigger than the other and I can feel the swelling when my arm is at my side. Could anyone please share your experience with this? Thank you so much!

djmammo

AnnieB7777

Will the MRI see into the entire armpit?

Yes.

AnnieB7777

Good to know, thank you!

AnnieB7777

MRI is done, phew. It was easy peasy, quick and simple, I fell asleep! It helps that we have a good friend who does MRI's and I ended up at his hospital! He put my IV in, went over everything with me, and reassured me, even checked on me through the headphones, which were playing my favorite music. Didn't notice the contrast except for a bit of cold feeling. Glad to have that behind and find out what's up. As of today, the one nipple is always erect, is now leaning to the right, I peeled a bunch of skin off the nipple and around it the other day, and the breast and armpit are very swollen with shooting sharp pains that feel like razor blades are cutting me, just in the spot with the lump, that doesn't let up. I realize this could all be fibrocystic, hopefully it is, and wonder what can be done for these things if/when the MRI comes back with nothing. Trying to be positive

They said 3-5 days for results.

AnnieB7777

Just to follow up for anyone who may wonder how this ever turned out. Received a call today and everything shown on the MRI is benign! It's all cysts, very painful ones at that! No more caffeine for me, but very thankful!

Motheroftwo36

That’s great! And what a traumatic experience! Thanks for sharing the end result