BIRADS 3 or 4?

ColoradoJT

I had a mammogram and ultrasound that resulted in a BIRADS 4. The radiologist recommended a breast MRI before the biopsy to make sure the biopsy didn't miss or obscure one of the areas of concerns. The breast MRI came back as a BIRADS 3. I am scheduled for a breast specialist consult and she might do a biopsy depending on her opinion. My Gyn seemed a bit stumped regarding my need for a biopsy or not.

My question is, does the radiologist that did the breast MRI take into account the concerns that were on the mammogram (they wouldn't have been visible in the breast MRI)? Have the chance that the concerns are malignant reduced with the finding of the MRI? In other words, does the BIRADS 3 override the BIRADS 4? Or am I still at a BIRADS 4 based on the mammogram and US?

MelissaDallas

Readings can be subjective from radiologist to radiologist. Also, a Bi-Rads 3 is about a lessthan 3% chance of cancer, so a Bi-Rads 4 could logically be a less than 4%. Not a lot of difference. The MRI is the more sensitive test and often clarifies something that maybe just looked a little"iffy" on the other imaging modalities

ColoradoJT

Thanks for your optimism Melissa. The flip side of a BIRADS 4 is up to a 95% chance of malignancy. Also, the management for a 3 is short-interval follow-up and a 4 is a tissue biopsy.

MelissaDallas

I understand, but a Bi-Rads 4A is still only considered between a 3-10% chance of being cancer. Overall about 80% of Bi-Rads 4 biopsies are benign.

djmammo

ColoradoJT

Can you post the entire MRI report? There are many other factors to consider. Birads? Recommendation?

It is routine for the MRI to be read in light of all prior breast imaging so that a correlation can be made, and the report should include that.

The MRI being more sensitive than Mammo or US may indeed have overridden the B4 to a B3.

ColoradoJT

PRESCRIPTION HISTORY: Left breast lump. Follow up from mammography and ultrasound. Pre-biopsy MRI.SUPPLEMENTAL HISTORY: Follow up from recent mammogram and ultrasound. Group of small cysts with potential associated hypoechoic solid focus. Palpable lump left breast 5 O'clock. History of paternal aunt with breast cancer.

COMPARISON: Mammogram and ultrasound studies.

FINDINGS: Moderate fibroglandular tissue is evident in the breasts. Mild background parenchymal enhancement is noted. A 29 x 18 mm zone of tissue within the lower-outer quadrant of the left breast demonstrates the presence of numerous small cysts. There is no suspicious enhancement of the tissue in this region. A 17 x 9 mm ovoid focus of mild-to-moderate progressive enhancement is evident in the lower-outer quadrant of the left breast. The enhancement pattern suggests a benign finding, but a short-term followup study in 6 months should be considered for evaluation of stability. Alternatively, directed right breast ultrasound with attention to the finding in the 7 o'clock position of the breast could be considered.

(Side note: I notice he switches from left to right breast, and I have asked for this to be reviewed and corrected. All concerns have been on my left)

The axillary regions demonstrate no evidence of mass or lymphadenopathy.

IMPRESSION: 1. Numerous small cysts within an area of tissue in the lower-outer quadrant of the left breast, compatible with fibrocystic changes. No suspicious enhancement of this region is identified. 2. 17 x 9 mm ovoid focus of mild-to-moderate progressive enhancement in the 7 o'clock position of the right breast. This could be further evaluated with directed right breast ultrasound or with a 6-month followup breast MRI examination.

BI-RADS CATEGORY: 3 - Probably Benign Findings. Short Interval Followup Suggested.

From Mammo and US:

FINDINGS: On the left there is a loosely grouped cluster of pleomorphic microcalcifications, lower-outer quadrant left breast near the area of palpable abnormality. In the area of palpable abnormality on the MLO view there is an equivocal 5-mm spiculated density, less conspicuous on the CC view but partially persistent on the spot compression MLO view.

Multiple longitudinal and transverse sonograms of the left breast in the area of palpable abnormality which approximates the mammographic abnormality were performed. At the 5:30 position 3 cm from the nipple there is a cluster of slightly complex cysts or dilated ducts peripherally and a hypoechoic nonvascular central component without shadowing.

IMPRESSION: 1. Equivocal subtle spiculated density seen only on the MLO view in the area of palpable abnormality. There is a sonographic correlate in the area of palpable abnormality. While this may represent a cluster of complex cysts or dilated ducts, a subtle central hypoechoic neoplasm may be present. 2. Small indeterminate cluster of microcalcifications, lower-outer quadrant left breast. 3. While stereotactic biopsy of the microcalcifications is warranted, prebiopsy MRI may be helpful for further evaluation to evaluate the area of complex cystic change or focally dilated ducts and exclude a subtle neoplasm resulting in ductal obstruction prior to the biopsy, as biopsy may obscure this lesion. This would also help determine if an attempt should be made to biopsy the equivocal hypoechoic focus in the central portion of the dilated ducts or complex cysts. The findings and recommendations were discussed with the patient 1/10/2018 at 3:00 PM.

BI-RADS CATEGORY: 4 - Suspicious Abnormality. Biopsy Should Be Considered.

MelissaDallas

Sounds like to me the MRI solved the problem and definitively imaged what was poorly seen and "iffy" on the mammo/ultrasound and did not see it as concerning