"Enlarged IM lymphnode" ultrasound morphs into BIRAD 4? 27yrold

angela0606

I'm currently 27 years old. For several years I've had a palpable mass in my RT breast, 12 o'clockish, right above my nipple. Maybe 2-3 yrs I cant remember, I told my health provider and they referred me to a local woman's health for ultrasound. The lady there was very dismissive saying "ohh it's probably a cyst" and def not cancer because of my age. Well went to ultrasound, the rad report said it was a swollen intramammary lymphnode. It measured something around 0.5x1.4x1.5 i think? I cannot remember exactly and cannot find the report. My health care provider wanted me to get a second opinion, but the place wouldn't accept my insurance.

So here I am, getting a diagnostic mammogram for a elective breast augmentation, and they want an ultrasound of the lump I mentioned. I've been told for years I have very "fibrocystic" breasts. What worries me is the ultra sound report below. They were under the impression that this is a newly found lump, which it isn't. I feel like the dimensions have changed/evolved of what i was told was an "intramammary lymphnode" a few years ago. Even looking at it on the computer screen, it looks like 3 masses merged together. Its hard to explain. So do I have an enlarged intramammary lymphnode that has morphed into malignancy or was the previous ultrasound wrong and misguided by my age?

*Getting Biopsy in 3 days, Monday*

mammo reports:

FINDINGS:

Bilateral synthetically generated digital mammography with CAD and

digital breast tomosynthesis. The CAD display and tomosynthesis

images were reviewed. The breasts are heterogeneously dense, which

lowers the sensitivity of mammography.

The patient is a 27-year-old female with a history of a palpable

finding in the right periareolar region. The patient is also

preoperative for upcoming breast augmentation.

There is no focally suspicious mass or suspicious density seen in

either breast. There are no abnormally clustered microcalcifications

seen in either breast. Additional ultrasound evaluation of the region

of the palpable finding within the right breast will be performed.

No radiographic evidence of malignancy.

ASSESSMENT:

BI-RADS 0-Needs additional imaging.

RECOMMENDATION:

Right breast ultrasound

_______________________________________________________________________

What worries me is the ultrasound report:

FINDINGS:

Corresponding to a palpable finding 1 cm from the nipple at 12

o'clock position, there is a hypoechoic solid-appearing lesion. This

measures approximately 0.7 x 1.6 x 1.3 cm. The margins of this are

somewhat irregular to micro-lobular in appearance. While fibroadenoma

is still a possible consideration in this age, given the lack of

smooth margination and coupled with the fact that this is a newly

palpable finding, the appearance is considered suspicious enough in

nature to warrant ultrasound-guided biopsy. Also identified, 2 cm

from the nipple at the 10 o'clock position was an ovoid structure

consistent with a slightly complex cyst which measured 0.2 x 0.7 cm.

ASSESSMENT:

BI-RADS 4 - Suspicious abnormality.

RECOMMENDATION:

Ultrasound-guided biopsy of a right breast mass at 12 o'clock

position, 1 cm from the nipple.

_________________________________________________________I

MelissaDallas

I think what they are saying is that it is new and since it isn't "absolutely textbook" shape-wise for a fibroadenoma, they need to be sure. Doesn't mean that it isn't in fact a fibroadenoma. Lots of them forget to read the book. Birads 4 is still a low suspicion. 80% of them are benign.

angela0606

it just concerns me that a few years ago an ultrasound of the same lump was dx as an intramammary lymph node. So now I'm unsure if it was an IMLN to begin with, or a fibroadenoma. I remember the ultrasound report saying things about a halo and other terms that are consistent with a lymphnode.

It was also concerning me that the rad tech left me there to talk to the doc, then came back to tell me they wanted to do a biopsy. They called the VA and ordered it the same day. I would assume if they aren't so concerned the process would take longer? Or maybe this place is just really good?

MelissaDallas

I don't know as far as scheduling and the VA.

I had a biopsy a few years ago for "inframammary lymph node vs. complex cyst." It did turn out to be a cyst. It started collapsing as soon as they stuck it.

TwinkleCat

Even though they've described it as "newly palpable," the other descriptions sound like it still would have been classified as suspicious. If you haven't already, check out the "interpreting your report" thread under the "not diagnosed bu worried" forum. djmammo gives a good overview of keywords to look for, and if you have questions about what your report means, you can post your report on that thread and he will explain.

https://community.breastcancer.org/forum/83/topics/858196?page=1