Frightened after reading U/S results

Oedgar

I am 47, mom of 2 teens. I formerly had a career in the medical field. I went for routine mammo Oct 12 and was about 2 months late on getting it due to being in a new job. The mammo result said there was a mass, and they strongly favored a cyst, 2 cysts abutted together, or an intramammary lymph node. I've had to have an ultrasound before, so I was not too worried about this. I had the U/S Nov. 8th at the first available appt. The technician ran it by the radiologist, and I was told they would send a report to my dr. A week later I had not heard anything, nor was I able to see a report in the hospital portal. On the 8th day, a Friday, I had the hospital re-fax the report to my dr office. I called there and was told my dr had not reviewed the report, and she was out of the office for the day. Desperate to know SOMETHING, I told the person on the phone to just read me the report, that I was a nurse, and would understand it... and that I understood the dr has final say in what it all means. So she told me I had multiple cysts. I asked her if on the report it said anywhere about needing further tests or follow-up. She said NO. So I felt OK about that.  Over the weekend, I got a very serious letter from the hospital saying I needed further tests ASAP. So I called my dr office again, and spoke to the same person who AGAIN told me I had cysts. I asked her to mail me the report. She also told me I needed a biopsy ( but did not know which kind). I was very disturbed by this lack of communication. 

I called hospital and scheduled the biopsy for Nov 27th, still not knowing if it was a core or a fine needle aspiration. The scheduler did not know either, except she did note "Asp" in her system. 

Today the U/S report finally came in the mail. I read it and am a lot more nervous than before. "In the upper-outer right breast is a 1.4 cm lobulate hypoechoic mass. It contains some blood flow. There are several cysts within the right breast. the largest is present within the upper outer retroareolar region measuring 1.6 cm. IMPRESSION: a 1.4 cm hypoechoic right breast mass which contains vascularity. Ultrasound-guided core biopsy is recommended.

How the heck did the person at the dr office get "just cysts" out of that?

Bi Rads cat 4. 

I read that fibroadenomas can have blood flow, but the more superficial ones with blood flow are likely to be benign. Retro areolar does not seem superficial to me. 

I will definitely be asking the radiologist some questions when I get there.

How sore will I be next day? I took the rest of the day off from work.

CaliKelly

Very annoying lack of communication at your Doctor's office! All I can answer is the biopsy didn't really make me very sore at all. Definitely ask your radiologist about the report, especially you're in the medical field and understand the lingo. I had to look up half the words!Best wishes to you for only good news!

Salamandra

Ugh these communication faults are so aggravating to what is already a difficult circumstance! I'm so sorry and angry on your behalf.

I was fine the day after the biopsy. Apparently some women have more difficulty with the busy, depending on their situation and position of the lump and skill of the team, but I think the likelihood is you will be fine to go to work.

Birads-4 had plenty chance of being benign. Hoping for the best for you!

Spoonie77

I know you said you are/were a nurse, so maybe you already know this and it will not be as helpful for you as it was for me when I was reading my own US report. The vocabulary choices that are listed in each individual US report definitely give clues.

------

Radiology Assistant - BI RADS

http://www.radiologyassistant.nl/en/p53b4082c92130/bi-rads-for-mammography-and-ultrasound-2013.html

"The margin of a lesion can be:

• Circumscribed (historically well-defined).
  This is a benign finding.
• Obscured or partially obscured, when the margin is hidden by superimposed fibroglandular tissue. Ultrasound can be helpful to define the margin better.
• Microlobulated. This implies a suspicious finding.
• Indistinct (historically ill-defined).
  This is also a suspicious finding.
• Spiculated with radiating lines from the mass is a very suspicious finding.

The density of a mass is related to the expected attenuation of an equal volume of fibroglandular tissue.
High density is associated with malignancy.
It is extremely rare for breast cancer to be low density.

BI-RADS 4

Suspicious Abnormality - Biopsy Should Be Considered:

This category is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy.
BI-RADS 4 has a wide range of probability of malignancy (2 - 95%).

By subdividing Category 4 into 4A, 4B and 4C , it is encouraged that relevant probabilities for malignancy be indicated within this category so the patient and her physician can make an informed decision on the ultimate course of action."

------

I'm glad that you'll be getting a biopsy done soon. The waiting is the hardest part.

After my own biopsy I was not very sore, although I did need ice packs and anti-inflammatorys for the pain. It was manageable for me. The bruising and such didn't appear until about day 3 and wow, were they a doozey! Looked like just the left side of my L boob had been in a horrendous car accident. Weirdly enough, bruising healed and pain faded, only to have some severe pain show up about 2 weeks later. This, nurses told me was probably a hematoma and I'd have to just live with it until it resolved. Kinda sucked as it took a long time for that pain to go away. But the basic procedure itself and days following it were not too bad. Hope you don't have many complications and it's a quick turn around for your results.

Hang in there and keep us posted!

(((Hugs))))

Moderators

Oedgar-

We're so sorry you find yourself here with worry, but you've come to the right place for support! Like others have mentioned, the waiting is the hardest part. Please keep us posted on how your biopsy goes, we're all here for you!

The Mods

Snowchick

Hi Oedgar! I am saddened and disgusted in reading the failure in accurate and timely communication that you've received. Results usually aren't disclosed until ordering physician has reviewed the reports. It's unfortunate that there wasn't a provider to cover in your doctor's absence. As to how this was handled, I would voice concern to your doctor or his/her office manager, whoever is more likely to address this. I am happy to read that you've been vigilant and proactive in following up, keep on doing that!

Just to clarify some misunderstanding from the report you posted, the largest cyst (1.6 cm) is located within the upper outer retroareolar region. The hypoechoic mass (1.4 cm) is located at the upper-outer right breast. You should be able to request a return call from radiologist or the doctor who ordered the imaging -- either could review the reports with you and answer any questions that you may have.

Personally, I have found fine needle biopsies easier to deal with (less painful) than core needle biopsies. Core needle biopsies done by breast surgeon were easier to deal with (less painful during and less bruising after) than ones done by radiologist. But that's just my opinion from my own experiences, every situation is different.

I would definitely suggest taking the day off work, you'll want to rest, ice and de-stress a bit. Depending on your job duties, number of samples taken, biopsy location, you may want another day. I went to work 10-hr shift the day after 2 core needle biopsies (multiple samples taken at both Bx sites) on same breast and tucked ice packs in my bra all day long. My breast was accidentally bumped hard that day at work, and I bled through steristrips. In hindsight, I should have had minor job duty modifications for a few days due to biopsy sites. Lifting and reaching were incredibly painful. I developed hematoma that was horrible. Ice packs will be your best friend! They'll help with pain, swelling, bruising. After a few days of ice, heat can also help too. I didn't have any instructions for after biopsy other than that day to go home and rest, apply ice 10 minutes every few hours, take Tylenol as needed for pain, wait 24-hrs before showering. Found out a week later at Dr appointment that I wasn't to be lifting, pushing, pulling or vacuuming. Whoever does your biopsies, make sure they give you any instructions in writing.

Just to let you know, you may be asked to sign consent for titanium marker placement. This is commonly done during breast biopsies to clearly mark the site for future reference. If a marker (or "clip") is placed, placement is verified with a mammogram.

I found out the hard way that my insurance denied my biopsies and biopsy imaging because prior authorization was not done. Depending on your locale, you may have to call your insurance to check coverage. I thought as long as a Dr. said it was needed and scheduled it that it was all taken care of.

I wish you peace and the best of luck next week! I am proud of you for being persistent. We excel at taking care of others, now we must also be our own best advocates. Please let us know how everything goes. Sending good vibes and benign wishes your way. ❤

Oedgar

Snowchick.. I had no idea the insurance could deny it! I have Blue Cross PPO and so far they've never denied anything... don't require referrals to specialists.. etc. I need to look further at this of course. I am a little concerned about my work. I do not lift heavy things usually but at times there is a fair amount of reaching and bending. It's a small informal company so imagine I could get help if needed. If we'd not had the holidays, I would have insisted on a callback from the nurse at least. I think I spoke to an unlicensed person. Oh well the biopsy is upon us now and I plan to ask the radiologist if he will biopsy both lesions or just the one. Thank you all for your support!

Oedgar

Was just reading that radiologists should make a distinction between lobulated and microlobulated. My report says lobulated, which seems preferable to me. I also wish there was a distinction made in the Cat 4 sub ratings on my report.

Oedgar

A small update. I had the biopsy, and it was not terrible. I did not feel much of the lidocaine, and only a pinch when the 2 biopsies were taken. I did feel the movement of the probe, but not pain. I bled a good bit and have a rather interesting bruise. While I was on the table, they told me the preliminary result was a benign fibroadenoma. But the radiologist stressed that it's a prelim result, and there have been times when the final report is not benign.

I called my dr today (Friday) at 4 pm to see if they knew anything else. They had the same preliminary result, but said my sample was in inter-departmental review. I asked if that is normal, or should I be worried? They said that was normal.

Do any of you know anything about this?

Thanks.

djmammo

Oedgar

Intra-departmental review? Some things are double-read in radiology and pathology in many facilities especially things like breast. Before a report is issued two different pathologists have to review the slides and come up with the same diagnosis independently.

Inter-departmental review? The pathologist and the radiologist often review a case together. The pathologist may say to the radiologist "To me it looks like X under the microscope, is that what it looks like to you on the imaging studies?" and in that way establish concordance.

Oedgar

I have a small update. My dr's office has told me the pathologist says the feel that the samples (2) removed in the core biopsy are benign fibroadenoma, but they can't be sure about the rest of the mass? If they did not think a core biopsy would get enough tissue then why did they not just tell me to see a surgeon from the beginning? I am so confused. I am working on scheduling that appt now.

MomOf2G1B

This makes me so angry! I guarantee you the girl at the doctors office never read it for real. I had a situation like this at my old GYN office. The MA appeared to be very catty and had set aside my general health and well being to be catty with me. Telling me that reading my report was doing me a favor because she was in the middle of something. It was very weird.

I hope everything works out!