MRI Results BIRADS 4 for NME

Hopscotched1

Hello. I'm a high-risk gene carrier (CHEK2), 40 year old female. Dr. has me on close monitor—mammogram 1x a year, and contrast MRI 1x a year. Last year, MRI found an 8 mm fibroadenoma on left breast, biopsied via ultrasound-assist, and confirmed as benign—recommend to monitor. This year, just last week, MRI returned with BIRADS rating of 4, suspicious on a non mass like enhancement, 2.3 cm, linear and beaded, located in upper, outer breast in posterior area. Everything I'm reading suggests this could be nothing, or it could be stage 2 breast cancer. I'm terribly worried, have done lots crying, and I'm trying my best to keep chin up, or at least level-headed. MRI-guided biopsy is in two weeks. I can hardly go one day without worry. Is a non-mass like enhancement of this size and distribution feature likely cance? I worry it's ILC. Does DCIS present this far from the nipple?

djmammo

Hopscotched1

Is a non-mass like enhancement of this size and distribution feature likely cancer?

Cancer usually presents as a mass on MRI, linear non-mass enhancement in a ductal pattern usually seen with DCIS and the atypias, occasionally papillomatosis.

Does DCIS present this far from the nipple?

Yes, it can.

**Please send me a link to the reference that mentions "stage 2 breast cancer" associated with this finding as well as the one describing preferential location of DCIS. Thanks.

Hopscotched1

Thank you for your reply. As I re-read my post, I recognize I sounded a little panicked. My apologies—I didn't mean to incite fear amongst other readers. I'm just feeling panicked myself—it's difficult to sift through all this information with a clear head.

I have read Information in some links suggesting that lesions that present in upper outer quadrant are likely DCIS or other malignancies. It's how I am reading them, perhaps, I am applying a logical fallacy to my thinking as I read, looking for supportive data or analysis that suggests one outcome over the other.

The only link I am reading about stage 2, is just the standard staging performed on a lesion, specifically the size of it. I am reading that anything > 2 cm is typically staged at 2.

Again, thanks for your reply. I look forward to your response.

djmammo

Hopscotched1

I've read your PM.

Statistically most of the glandular tissue in anyone's breast in is in the UOQ so statistically any abnormality benign or malignant would be found there more frequently but cancer, DCIS, fibroadenomas etc can occur anywhere in the breast. As far as prognosis is concerned relative to location, if the tumor grows in an area rich in lymphatics it may get to the axilla more quickly than from elsewhere.

Again statistics plays a role in the statement about staging. As you have probably read grading is the evaluation of the cells that compose the cancer and staging refers to its behavior/spread outside the breast. The larger the cancer when it is found the more likely it has spread outside the breast, 2cm might the statistical break point but it really is just common sense but you cannot assume a stage from a picture of the tumor, and try to draw conclusions before the workup is completed.

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I discourage people from Googling symptoms and x-ray findings, as there are far too many things to misunderstand without having logged the 10,000 hours required to make sense of it all. Plus no matter how much research you do on line it will not affect your diagnosis. It will be biopsied and you will have an answer whether you Google or not. It will not affect your outcome and no one has ever said Googling made them feel better about everything.

I do encourage people to Google their final diagnosis and the treatment regimens that have been recommended as everyone needs to understand their disease plus you will likely be asked to provide input as to which of the available treatment regimens makes sense to you and fits your lifestyle. This type of online research will make a difference and does affect outcomes.

FabFive

I have such a similar situation and it has been such a pain! I have a Non Mass like enhancement that they found last year and it was .6 cm then they rescanned in January and it was 1.2 cm, they tried to MRI biopsy it and it and they couldn't get it so they rescanned a few weeks ago and it had grown to 2.5 cm. I actually had it biopsied last week and it came back as benign and PASH-like. So yes it is totally possible for an NME on MRI that is that large to be just benign breast tissue changes. Good luck!

Hopscotched1

FabFive,

Thank you for the reply! Thank goodness it came back benign for you! All that waiting must have been so frustrating, and scary. I am usually very level headed about this sort of stuff, but I just lost it the other day, and I haven’t really been able to get it together. 4 or 5 days of crying and letting my imagination run wild has left me puffy-eyed and drained so I think I’ve had enough of that. Dr. Google is not helpful. Time to enjoy the rest of summer; I’ll find out before Labor Day what dx awaits me.

Djmammo,

Thanks for restoring the sense in me. I recognize that Googling isn’t getting me anywhere except for making me lose sleep, and steal quality time. I do appreciate your thorough and logicalresponse.

-Hopscotched1

pegasus68

Hopscotched1 - I too am high risk with alternating 3D mammo/MRI screening. Last year my MRI showed 2.0cm of linear/ductal clumped non mass enhancement, and was fearing it was DCIS. Luckily, however, biopsy showed only benign stromal fibrosis and proliferative fibrocystic stuff. Hoping your biopsy comes back benign as well!

Hopscotched1

Hi pegasus68,

Thanks for the reply! It eases my fear seeing responses like yours! Thank you so much. Hoping for benign, indeed.

-Hopscotched1

djmammo

"I'm so glad I Googled my symptoms"

-- no one, ever.

Hopscotched1

Lesson learned. I won’t google my MRI results anymore, promise. 5 days of crying was enough for me. Honestly though, I’m glad I got the crying out of the way now, instead of waiting until after the biopsy. I do at least feel a little more prepared to handle the bad, if it comes down to that. I begin training large groups of people after Labor Day weekend. I’d rather be a bit of a mess now, then all at once during my job, if it does turn out to be malignant.

TB90

I for one was relieved when I googled my symptoms or lack there of. I worried about the worse with a BiRads 5 and then google suggested DCIS. I would have fallen apart without Google. And I have not stopped researching since. We are all unique.

djmammo

TB90

Good to hear. The majority of the posts I see on here indicate regret rather than relief. I believe it is you that are unique. Well done.

berries

Djmammo, would you help me interpret what my MRI results mean? I also have the weird "regional non-mass enhancement" statement that I have googled no less than 100 times. Does this mean DCIS as well? I know for a fact I have both IDC and DCIS, but they do not know how much of each I have in my lesion.

LEFT BREAST: There is a vitamin E marker overlying the upper outer posterior left breast. There is focal susceptibility in the upper outer posterior left breast from a biopsy clip. There is an 8.6 x 5.3 x 4.8 cm area of regional non-mass enhancement in the upper outer left breast, which extends posteriorly to the chest wall and corresponds to the site of biopsy-proven malignancy. The anterior extent of non-mass enhancement is located on series 9/image 87 and series 20/image 55. There are mixed kinetics with areas of rapid initial and washout delayed phase enhancement. There is an indeterminate 1.3 x 0.6 x 1.4 cm oval circumscribed enhancing mass in the central posterior left breast 9.3 cm posterior to the nipple with rapid initial and persistent delayed phase enhancement (series 9/image 111, series 20/image 54). There is an indeterminate 0.6 x 0.4 x 0.5 cm area of clumped non-mass enhancement in the central posterior left breast 7.4 cm posterior to the nipple with rapid initial and persistent delayed phase enhancement, which is located approximately the 1.0 cm anterior to the 1.3 cm mass (series 9/image 114, series 20/image 57). Additional scattered foci of enhancement in the left breast are favored to represent background parenchymal enhancement. The left axilla is within normal limits. 

EXTRAMAMMARY FINDINGS: None 

IMPRESSION/RECOMMENDATIONS: 8.6 cm regional non-mass enhancement in the upper outer left breast, which corresponds to the biopsy-proven invasive and in situ carcinoma with ductal and lobular features and extends posteriorly to the chest wall. Surgical management is recommended. MRI guided biopsy of the anterior extent of non-mass enhancement could be performed, if clinically indicated. 

Second look left breast ultrasound with possible ultrasound guided biopsy is recommended for the 1.4 cm mass in the central posterior left breast. If no sonographic correlate is identified, MRI guided biopsy is recommended. If the posterior mass is difficult to target due to its far posterior location adjacent to the chest wall, the 0.6 cm clumped non-mass enhancement in the inner central mid left breast could then be targeted. 

djmammo

vmb

I replied to your other similar post.