Do I need an ultrasound?

Anonymous

Do I need an ultrasound?

ruthiew

Last year I received a callback after my screening mammogram (3D) for focal asymmetry. When the technician met with me, she said there were four areas of concern. After the first x-ray, she told me three of the four areas were no longer a worry, but she needed another picture of my right breast. She took the picture, left the room, and when she came back, she said things were looking better, but she needed one more x-ray at a different angle. She took the image, and her face lit up with a smile. She told me she would be right back, but she was sure I would be able to go home soon. When she returned, she told me I was fine and that I did not need any more tests until it was time for my annual mammogram. I was thrilled, but later became incredibly anxious; why no ultrasound or six month follow up? I did get a second opinion, but after viewing my films, was told again I did not need any further screening.

I had my annual mammogram this past week, and did not receive a callback. The test result was sent to me online, and when I looked, it said benign stable architectural distortion in the right breast, Birads 2. Naturally, I googled A.D., and almost passed out when I saw that 1/2 to 2/3 were cancer -the room literally began to spin. I called my doctor's office the next day. The nurse told me there were absolutely no changes from last year's mammogram. I mentioned that nobody used the term "distortion " last year, and she said that there was a distortion present - that was what was diagnosed during the additional work up. (Thinking back to last year, I recall hugging the tech at my follow up appointment, and going home to celebrate. I just knew the additional pics revealed that I was fine, but did not get a specific diagnosis.) So I continued my conversation with the nurse. I asked for an ultrasound or a six month follow up. She said she would give my message to the doctor and get back to me. I was told yesterday that my doctor talked to the radiologist and that the area of concern was perfectly stable and I did not need to do anything for one year. I suppose I could get a second opinion, but I fear that someone will just look at my films and say I am fine. The nurse also told me to stay off Google - I know she is right, because Google does not know my specific story. My husband tells me the same thing!

I also have heterogeneously dense breasts, but without other risk factors, that doesn't seem to mean anything to the doctors. I am 55, without biological children ( although I do have a beautiful teenage son adopted at the age of six months), but the doctors do not seemed concerned about the risk of no biological children, since that small concern is balanced out by starting my menstrual cycle late(15), and an early menopause at 48.

Although I am finally starting to relax and enjoy the news that my results were good, I am still worried a small lump is hiding in that dense tissue. My husband said radiologists do not use the term "benign" unless they are sure. Although I still wonder last year how they knew the distortion was benign without an ultrasound!!!

So what should I do next? How do you go about getting an ultrasound or a six month check when the doctor will not order one? Is this worth pursuing? I live two hours from Philadelphia - is it worth going to the hospital there to see if they will do an ultrasound, or should I accept my results? My annual physical is in five months, so I will get a clinical exam at that time. I do monthly self exams, and I exercise and eat pretty well.

Thank you for reading all of this!

Ingerp

They’re so super careful with breast issues I’m sure if you were told “benign” it really is. I’d celebrate your good news!!

Wildplaces

Ruth,

Without trying to concern you - dense breast are difficult to read on mammograms (sensitivity drops from roughly 80 to 40-50%). Which is one of the reasons mammograms are not used that much in under 50s. The general consensus is that an MRI with contrast is a better but more expensive tool.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC58720...

An ultrasound is great if you have a sharp ultrasonographer and they differ in skill level.

I too would wonder about " benign arhitectural distortion" - I understand that maybe they mean not much has changed but its a weird and unclean way to report it. This is what I picked up on arhitectural distortion

https://www.appliedradiology.com/articles/inapprop...

(Yes from google - I am not a radiologist.)

I dont think you are trying to diagnose yourself, so I find the Dr Google comment unnecessary - I think you had a test, got a result and you are asking GOOD questions on follow up. Keep in mind the nurse is not a radiologist so when she says its like last year she means it was reported Birads 2 - well you knew that, no new info. Clinical exams are very difficult in dense lumpy breasts - your knowledge of your breasts in those cases is better then the examiner but that means you are looking for a lump that is big enough to feel.

Djmammo is a retired radiologist who posts here - I have asked him general questions and have found him kind and knowledgeable.

TRUST your gut and push to tie up any loose ends that worry you.