BIRADS 4-from BIRADS 2

aseal321

Hi everyone, well I have had lots of lumps and bumps along the way. I started having comprehensive mammos/US's at 28...and other than lots of painful cysts, nothing major. I am 40 now, and last year my right breast decided to act up, swelled, and just looked different. Had my first call back mammo, they found "something" in the chest wall. Turned out to be a septated cyst with lots of debris and such. I moved on, same old thing. But then I started having pain in my right breast and some discharge, my dr had me back in last mth, mammo showed some changes again, and I went in for the MRI yesterday. Basically my normal breast issues have started to take a different form it seems, and usually I just go with it, but now I am admittedly worried. Below are my findings, I am waiting on the scheduling call for the biopsy, but from the research I was able to do, the results sound strange. Anyone had these types of results? TIA~Allison

MRI BREAST W/ + W/O CONTRAST BILATERAL:

HISTORY: pt w/ dense breasts, cyst, nipple discharge and chronic pain. Synapse.

FINDINGS:

Extramammary structures: The visualized extramammary structures are without gross abnormality.

Lymph nodes: There is no axillary or internal mammary lymphadenopathy.

Breast Density: Heterogeneous fibroglandular tissue.

Background enhancement: Moderate to severe. This diminishes the sensitivity of MRI.

RIGHT BREAST:
-Within the retroareolar right breast just posterior to the nipple, there is a 6 mm enhancing
mass with rapid washout kinetics (subtraction page 62).
-At 12:00, 3 cm from the nipple, there is a 4 mm enhancing focus with slow persistent enhancement
kinetics (axial subtraction page 68).

Multiple scattered cysts are seen.

LEFT BREAST:
There is no suspicious mass or non-mass enhancement distinguishable from the background
parenchymal enhancement.

Multiple scattered cysts are seen.

BI-RADS CATEGORY 4:

SUSPICIOUS ABNORMALITY-BIOPSY SHOULD BE CONSIDERED

djmammo

aseal321

In general slow persistent enhancement is good and rapid washout is bad. In any event 6 mm is very small and if real, is a nice pickup by the rad who read it.

In these cases we would do a "second look US" in the area of the MRI finding. Knowing that something is there on the MRI, a more focused US exam can be done. If something is seen in that area measuring around 6mm they will do the bx under US. If it cannot be located on US they will want to do it by MRI.

Keep in mind most bx's come back benign, and that cancers under 1.4cm statistically have the best prognosis.

aseal321

thanks djmammo...thats what I have been reading, washout isn't necessarily a good sign. And the focus could be something mimicking the 6mm mass...its a lot to try and and understand. A guided US biopsy is what is listed as the next step, I'm so glad to hear that the MRI will help that process, I just want them to get a good sample and be able to get some answers.

Do you think the mass is maybe a cyst? They were worried about complex cysts in July 19 and then did more imaging in April 19. The MRI came into play because the nipple was showing changes and some discharge...and my dr wanted to get some answers on that. Is the "Background enhancement: Moderate to severe." referring to the dense tissue?

Also...who does the biopsy usually? Sorry for all the questions...and all the help!

djmammo

aseal321

Do you think the mass is maybe a cyst?

Simple cysts do not enhance

They were worried about complex cysts in July 19 and then did more imaging in April 19.

Complex cysts have solid elements that do enhance. They look different from simple cysts and different from solid nodules

Is the "Background enhancement: Moderate to severe." referring to the dense tissue?

Yes

Also...who does the biopsy usually?

The radiologist.

aseal321

thank you, I am so grateful for the peace of mind! I am choosing to think of this as just another "test", until I hear otherwise. Happy Memorial Day!