Can you feel your titanium marker?

Mrs_Emm

i was posting here almost 2 years ago d/t some physical changes I discovered in my breast. After lots of imaging and a core biopsy, it turned out to be fibrocystic changes in the breast i was being seen for, and a fibroadenoma in the other breast that the radiologist said he removed all of during that procedure. After it was all said and done, I had ignored my breasts because of the anxiety I experienced during that whole ordeal. A couple months ago I decided to do bse, and I felt something in the breast I had the fibroadema removed from. I waited two months and its still there, fairly close to where I had the biopsy, its small between the size of a bb and a pea, and its hard. I'm thinking its probably scar tissue from the biopsy, or maybe the clip? Is that even possible? I have extremely dense breasts and I have an appt coming up in mid January to have a 3-d ultrasound that my hospital is trialing, but you know, I still have a nagging anxious feeling. So has anyone else had this experience, can you feel your clip or maybe hard scar tissue? My anxiety is compounded a bit because the hospital I'm going to for the scan missed the mass in my breast, while it turned out benign, what if it hadn't been? My new insurance no longer covers the breast center I had been going to for the other stuff, so I'm limited to this other place that I don't have a lot of faith in.

djmammo

Mrs_Emm

"I'm thinking its probably scar tissue from the biopsy, or maybe the clip? Is that even possible?"

Yes and no. The markers themselves only measure a few millimeters so probably not the marker itself. Many (most?) of these markers are imbedded in some material that will absorb fluid, stop bleeding, make it more visible on US, keep it in place etc. Add to that the small hematoma that forms at a biopsy site plus the healing of the tissue at the biopsy site and you can feel a small knot for quite a while.

If this is something that concerns you, and ultrasound will tell you what you are feeling and when the marker is seen inside the "knot" you will know that you are feeling all of the above. If something is seen without a marker in it then it could be something new.

Mrs_Emm

thank you for your reply! I was thinking the marker should be too tiny to be felt, but I had just assumed any material it was suspended in would have desinigrated by now, so your point is pretty reassuring. Are you familiar with the 3-D ultrasound softvue? I hadn't heard of it before, but I'm wondering how it compares to technology like the sonecine as far as accuracy and enhanced views in dense breasts. I've had the sonecine twice, and I felt really confident w/my results after, so I hope the softvue is just as good or even better

MelissaDallas

I can't feel mine.

djmammo

Mrs_Emm

I haven't practiced anywhere that had an automated scanner but I am familiar with this concept. My med school had one in the 80's that was experimental. It recorded to a large laser disc and you could scroll through the images on a screen. I don't believe there were any computer reconstructions for US back then like there are today but I like the idea of the breast being suspended so that the tissue is fully "expanded". The images can be reconstructed in any plane you so can match the images up to mammo or MRI in coronal, sagittal and axial planes.

The idea of an automated study is that you can then do screening breast US like screening mammograms. The pt comes in and has the scan and leaves like a mammo yielding more studies per day. The studies are batch read like the screening mammograms. We only did hand held diagnostic studies.

Meow13

No, I still have it can't feel it.

Mrs_Emm

djmammo- thanks again for taking time to explain things, it gives me a lot of reassurance! One last question for today... So I've read that while we all have intramammary lymph nodes, they cannot always be visualized on imaging. On my last sonecine, they saw a one, but never mentioned it in the report. I understand per their response when I asked why it wasn't mentioned, that it looked normal, but for future imaging, it seems to me that it should have been documented, for comparison purposes. Especially when changing facilities, how would anyone know if it changed if there is no documentation? As a nurse, I was taught if it wasn't documented it wasn't done, is it standard protocol to only report on abnormalities?

Melissa and meow13, thanks for the input. I was fairly sure that the chance would be very slim that someone would have been able to, but curious minds. I'm betting/hoping its scar tissue. I'll know for sure in a few weeks!

Andie1209

My marker migrated 2 cm immediately following my needle core biopsy! The ultrasound tech who was in charge of applying pressure afterwards was at one point applying pressure sideways to my breast...not sure if she somehow caused it to move that much!? I can’t feel it and haven’t had any issues so far. I am going to see a breast surgeon to make sure they agree with the B9 results and to make sure the radiologist actually hit the mass...a little nervous he missed since the marker is 2 cm away from it

djmammo

Andie1209

Was this after a stereo bx? There are 4 causes with which I am familiar for "migration" immediately after the bx.

One is the marker gets dragged back through the breast along the biopsy tract when withdrawing the needle if it does not completely exit the needle when deployed.

Two if there is rapid bleeding from the biopsy site the marker gets washed down the tract away from the biopsy site.

Three, some people say if the the breast is taken out of tight compression too fast after the bx might displace the marker.

Four, some say there should be a delay between the bx and the post bx mammogram to give it a chance to "set" as the mammo compression may cause a shift.

Since the stereo is not imaged in real time, there is no easy way to know which of these could be the cause.

When done under ultrasound one can see the marker as it is deployed and you can tell if it is being dragged out when removing the bx needle.

djmammo

Mrs_Emm

Bottom line is you are correct, everything seen should be mentioned whether normal or abnormal but if it is clearly visible on your mammogram I wouldn't worry too much about it not being in the US report. The intramammary nodes become important after a mass is seen in the breast. They do not always enlarge with a cancer in the same breast but if there is any change in them with a mass present they need to be biopsied as well.

Andie1209

My biopsy was an ultrasound guided biopsy. I know they took 5 samples and the 6th click (which I’m assuming was the marker being inserted) immediately followed the 5th click (there were breaks/pauses between all of the other clicks). The radiology report states that although the marker migrated 2 cm, there were notable changes to the mass documented on the mammo following the biopsy. I’ve reviewed the pictures and I can see what appear to be air bubbles around the white/grey ‘mass’ (assuming the missing tissue presents like an air pocket/bubble on the mammo) but I really don’t see chunks missing out of the mass but I’m not a radiologist

Mrs_Emm

djmammo- I had my 3d mammogram and the softvue 3d ultrasound last Thursday. I got the results today, and it appears to me that the bb I feel in my left breast may not be related to my previous biopsy. I have a couple questions regarding my results, if I may ask here instead of the interpretation thread:

Mammogram:

Heterogeneously dense

There is a new density identified in the upper aspect of the left breast, best seen on the MLO view. Located at posterior depth, and is 8.6 cm from nipple. It is localized to the deep central aspect of the breast on the CC view. A biopsy marker is incidentally noted in the upper inner left breast. Right breast unremarkable.

Softvue 3d ultrasound:

There is a subtle hypoechoic area at the 1:30 axis of the left breast. Which measures 0.6x0.5cm. This is located approx 5.2 cm from the nipple. The area displays some internal stiffness and persists on reflection images. The mammographic appearance of the breast correspondes to the sonographic appearance.

Impression: asymmetry in the deep upper central aspect of the left breast

So I would next have diagnostic mammo and US. I'm not very familiar w/tissue stiffness, and if it bears much significance? Also, is central asymmetry or the subtle hypoechoic area more or less suspicious than anything else? I understand you cannot offer me much insight into what's going on, and that obviously I'll need to be patient and wait for the next steps, but from your trained eye, what if anything does this say to you? Thanks!

Meow13

No I can't feel the marker. It still there 1.5 years.

djmammo

Mrs_Emm

The evaluation of tissue stiffness is called elastography which showed up about 5-7 years ago approximately. Click the link for an article explaining it.

There is no mention of a mass per se on either exam but what they do see on the mammo is borne out by the ultrasound so one has to wonder if this might be something very early. A few spot films and a directed hand held US will likely be next. If the findings persist they will likely want to biopsy it.

Mrs_Emm

djmammo, thanks for that input. So, I read the link you posted, but I was unable to determine, does normal breast tissue demonstrate stiffness, or is tissue stiffness an abnormal characteristic, not necessarily indicative of malignancy, but malignant tissue tends to demonstrate stiffness? I hope that made sense. Two more questions, what does it mean when it says it persists on reflection images? And I gather that the hypoechoic area could possibly indicate a lesion of some sort, but what does it mean when it is described as subtle? Is that just that there is definitely a more solid area there but shape was not able to be viewed on the images, or perhaps it could be an error that occurred when the image was captured? I know I won't know anything for sure until I have the diagnostics, but I have a curious mind. Thanks so much for taking the time to explain these things, I truly appreciate the information and it helps me to process what's going on without feeling anxious!

djmammo

Mrs_Emm

"So, I read the link you posted, but I was unable to determine, does normal breast tissue demonstrate stiffness, or is tissue stiffness an abnormal characteristic, not necessarily indicative of malignancy, but malignant tissue tends to demonstrate stiffness? I hope that made sense."

***The article states "...breast tissue stiffness was significantly associated with breast cancer". Cancers are stiff. As it starts to grow the tissue becomes stiff before a mass is visible. Elastography can apparently detect that.

"Two more questions, what does it mean when it says it persists on reflection images?"

***I have no idea what "reflection images" are. Technically all US images are reflections. Probably a term made up by the company that made that machine.

"And I gather that the hypoechoic area could possibly indicate a lesion of some sort, but what does it mean when it is described as subtle? Is that just that there is definitely a more solid area there but shape was not able to be viewed on the images, or perhaps it could be an error that occurred when the image was captured?"

***Cancers in general are hypoechoic on US. Subtle means subtle. What they saw was not obvious, just a little darker grey than the surrounding tissue. Seeing that is probably why they tested the stiffness of that area and that was abnormal so we assume the finding is real and not an error.

"I know I won't know anything for sure until I have the diagnostics, but I have a curious mind."

***Curious is good. Obsessive is bad. Stick with the facts. Do not assume facts not in evidence.

***Let us know what the next tests show.

Mrs_Emm

will do, thanks!

Mrs_Emm

so I had my diagnostic mammo and US today. First the did some compression images, and said the radiologist would look at the images and then decide whether to go ahead with the ultrasound, and he did. After looking for a very long time, the tech couldn't find the area that was described in the 3-D ultrasound report. The radiologist then came, and also could not find anything. I was told that his guess is that it was my previous biopsy marker that was seen on the 3-D. While i am happy that they found nothing wrong, I feel a bit uneasy. If my biopsy marker is in the area of 11:00, why would it be interpreted to be at 1:30 on 3-d.. And is it possible for it to somehow be mistaken for a hypoechoic area? To add to my discomfort, when I inquired to how it all correlated to the area if new density in my mammo, I was told that as women age, our breasts often become more dense...my understanding of how breast density worked was that as we aged density should decrease not increase. Anyway. I feel a bit unsettled, and not sure if I should just accept it was an error by the 3-D or pursue a follow up with a breast specialist.

Mrs_Emm

dj mammo-

So I got the report from the diagnostic tests I referenced in my above post:

HISTORY: Abnormal screening mammogram with mild asymmetry identified

posteriorly in the upper left breast. The patient also had an abnormal

screening whole breast ultrasound examination with a small mass

suggested at the 1:30 position in the left breast. Additional imaging

was requested for further evaluation.

COMPARISON: Comparison is made to the bilateral mammogram and whole

breast ultrasound performed on 1/10/2019. Previous mammograms dated

December 2016 through January 2019 were reviewed.

BREAST COMPOSITION: Heterogeneously dense which lowers the sensitivity

of mammography.

FINDINGS: Mild asymmetry described in the far posterior aspect of the

upper left breast on the screening examination appears less

conspicuous on current diagnostic views. This contains fat and

glandular elements on the spot compression views and most likely

represents benign dense tissues. No definite mass or distortion is

seen. No suspicious microcalcifications are present. A biopsy clip is

incidentally noted more anteriorly within the left breast

corresponding to a previous benign biopsy site at the 11:30 position.

CAD is utilized.

High-resolution ultrasound was performed throughout the superior left

breast to include the areas of concern on the mammogram and on the

previous screening ultrasound study. Scanning was performed by the

technologist and by the radiologist. Dense echogenic fibroglandular

tissues are identified throughout the upper left breast. There is an

island of echogenic fibroglandular tissue noted at the 11-12:00

position of the left breast superiorly which corresponds to the area

of mild asymmetry on mammography. This has benign features on

ultrasound and is consistent with benign fibroglandular tissue. A few

tiny cysts are seen at the 2:00 position of the left breast which are

considered benign. There is an ovoid nodule containing an echogenic

biopsy clip at the 11:30 position measuring 7 mm in diameter. The

lesion measured up to 1 cm diameter on the January 2017 examination

and was biopsied under ultrasound guidance in 2017 with benign

results. No other mass or suspicious lesion is identified within the

upper left breast.

Overall assessment: BI-RADS Category 2: Benign findings.

IMPRESSION:

1. Mild asymmetry identified in the superior left breast on the recent

screening mammogram is consistent with benign fibroglandular tissue.

2. The mass identified on recent whole breast ultrasound likely

corresponds to the benign nodule at the 11:30 position which was

previous of biopsied in 2017 with benign features. No other

abnormality is seen within the upper left breast on targeted hand-held

ultrasound.

2 questions. How common is it that something could be seen on 3d US but not on handheld?

And, as I looked back at my report from last year,in 1/2018, my biopsy marker was identified, but there was no nodule surrounding it. The Dr told me he removed it all during biopsy in Jan of 2017. This was at a different facility than the one I'm currently using, but they have copies of all of my previous records. So, I'm wondering if it is encapsulated in a new nodule, is it standard protocol to just assume it is benign. I guess I'm trying to ask, if it was reported to be removed in 2017, in 2018 there was absolutely nothing mentioned about it being within a nodule, only that it was noted in position, is it something that warrants bringing to the attention of the new facility? Thanks so much.