Confused about ultrasound report "echogenic halo"

meteormaggie

Hello, I'm new here! For reference: 31 year-old woman

About six weeks ago I felt a pea-sized lump behind my right nipple. My doctor sent me for mammogram and I am now awaiting results. I was not initially concerned, as I had previous ultrasounds 18 months and 7 months ago, and both times I was told I just had very fibrocystic breasts. This mass feels different though (harder and not easily moved), so I looked over the previous reports and did some research, and now am very much panicking. I feel that the reports were not conclusive at all and that a biopsy should have been done months ago. Since I'm very new to this though I wanted to get the opinion of people with more experience. Here is a summary of what the previous reports said:

18 months ago: BI RADS 3 due to a 2cm well-defined, solid, oval lesion in the right breast. It was hypervascular with a thin capsule around it. It was determined likely to be a fibroepithelial lesion. There were also a number of small cysts found and the report concluded "fibrocystic changes bilaterally".

6 months ago: No BI RADS listed. There are numerous cysts and extensive cystic changes in the right breast. The largest cyst is located behind and slightly lateral to the right nipple (which I'm sure is what I am now feeling). 13.5mm wide and 11.6mm tall. Lesion is well-circumscribed with an *echogenic halo* surrounding it. No definite suggestion of neoplastic involvement. Report also suggests follow-up, though the radiologist did not tell me that at the time and instead said it was nothing to worry about.

While I know that "well-circumscribed" is a good thing, when I googled "echogenic halo" it came back as a sign of malignancy, and even as 70% likely to be malignant according to one source. None of my research brought up examples of BOTH a well-circumscribed lesion AND an echogenic halo. My understanding is that they usually mean opposite things. Can anyone enlighten me on this? If the echogenic halo is an indicator of cancer, would they not have biopsied right away? I live in Canada and unfortunately I have found that many doctors do not take their patients very seriously. As I wait for my mammogram results, I am becoming sick with worry thinking that the cyst/lesion gave signs of cancer as early as 18 months ago. Any advice on this would be very much appreciated. Thank you!!

Georgia1

Hi MeteorMaggie. I'm not a doctor of course, but if the latest report clearly says it is a cyst I think you're ok. Cysts (or at least the vast majority of them) are liquid and squishy. Breast cancer is almost always described on ultrasounds as a solid "mass." So please try not to worry too much as you wait for the mammogram results. And I'll keep my fingers and toes crossed for you.

Recap

Standardization of medical terminology is important. I know of someone whose cancer was diagnosed too late and part of the (year) delay was due to incorrect assumptions made based on the terminology that was used in their referral to describe what they had.

Mass, lesion, bump, lump, cyst, tumor, 'oma', swelling, bulge, knot, growth, neoplasm, etc.

Age and location also leads to assumptions. For example, it is possible to have cancer in your foot, but most people would never associate a bump or lump on the foot with cancer. IMO anything in the breast should be thoroughly imaged.

djmammo

meteormaggie

Here is a good article on US findings in the breast . Like the law, we go with the preponderance of the evidence with some outweigh the others with some that are mitigating and some that are incriminating. You have to go on faith that the one reading your study is using the correct terms for what they are seeing.

I am a little confused with the reports: did the thing with the halo get bigger or smaller between your exams or was it new on the most recent?

Recap

Rads reading and dictating breast imaging are required to use terms from the BIRADS Lexicon so that everyone is on the same page with the findings. It is considered poor form to use other terminology.

meteormaggie

Thank you to all those who replied. It's really nice to know someone's out there!

Georgia1 - In terms of whether the report clearly stated that it was a cyst, it starts off by saying there are many cysts in the region, and then refers to the particular "thing" as a lesion. I also was under the impression that it wasn't 100% clear on an ultrasound whether something was a cyst or not?

djmammo - thank you for that link. Unfortunately, the language the radiologist used doesn't seem to conform with what is listed there. The lesion with the halo was seen on the most recent ultrasound only (6 months ago) and I have not had results yet from the mammogram I just did, so I cannot compare it to anything. I can say with certainty that it has gotten bigger though, because it is now a palpable lump. (The reason I believe it is the same thing is that I feel it in exactly the same spot that is listed on the ultrasound report.) Have you ever heard of a lesion being both well-circumscribed and having an echogenic halo? They seem to imply opposite results, as far as my googling has shown.

Recap - I certainly agree that standardized language is important. I only wish I had had a doctor at the time to interpret the results. I believe that because the radiologist only sent the report to the "walk-in" doctor I had seen, it is likely it was never reviewed. Certainly, no one ever told me that I should get a follow up, even though that is clearly listed on the report.

Edit: Sorry if this is obvious, but how do I make people's names link to their bios when I respond to multiple people in one post?

djmammo

meteormaggie

"...as far as my Googling has shown"

What Google doesn't tell you is none of these findings are absolute, or mutually exclusive and they are weighted differently in making a decision. There are also a variety of exceptions. A colloid carcinoma is very round and smooth with sharp borders but its still a cancer. Google has no experience and confers no degrees. No one can fully understand everything there is to know by Googling. No web site gets readers by saying "dont worry its probably nothing, you don't have cancer"