Abnormal dx mammo, “normal US,” then abnormal MRI?

CrowLuv

(FYI: Not new here, last year I was around a bit for benign papillary lesion. Got it out, problem solved, never thought I'd be back here)

Before my main question in the title - which I really hope to get help/insight with - I need to give some background info because it's relevant to what landed me in this situation now.

Out of the blue I'm being worked up for suspicious breast findings. I never once, not even for a second suspected "breast problems" for the very poor health and issues I've had for 6 months now.

It started 6 mos ago with intermittent right-side shoulder blade and front right-side chest wall pain, mostly at night, progressively worse, now it is unbearable at night, as in, I can only focus on breathing. (I take Tramadol at night to take the edge off). Very very long story short - labs showed hypercalcemia, got a dx of hyperparathyroidism, surgery to remove adenoma was planned, then further workup found it was a lot more "complicated" and

the surgeon sent me to a well-respected cancer center in the large city I live in. I didn't think cancer, I thought "it's just complicated." Then - during all of this - I noticed a hard lump right above my right breast below my clavicle - it doesn't at all feel "in" my breast, it's ABOVE it.

Next up was consultation with the cancer center endocrine surgeon - HE noticed the lump and said I needed to get it looked into, but it wasn't related to the parathyroid thing, I'd need to go to another department. Next day I find myself in the breast cancer department of the cancer center. WHAT?!

I was STUNNED. I cannot emphasize enough how I didn't think it was related to my breast.

So last week, I picked up my 2019 dx mammogram disc and took it to the breast center at my appt for radiology comparison, and this happened (in this order):

1. Diagnostic mammogram - three abnormal/suspicious findings (architectural distortions, focal asymmetries)
2. Bilateral ultrasound - report said the architectural distortions from dx mammo was correlated to a surgical scar from 11 years ago (this confuses me because the scar is literally on the opposite end of my breast from this "correlation")
3. Breast Cancer center doc not convinced by US, sends me for a breast MRI. Breast MRI is BIRADS-4c, with the abnormal findings correlating with what was found in the diagnostic mammogram.
4. Next up, MRI-guided biopsy of one of the problem areas, and targeted ultrasound and possible biopsy of another one of the problem areas.

What's up with that ultrasound? Can anyone please tell me how a diagnostic mammogram and MRI show abnormalities that led to a BIRADS-4c and upcoming biopsy, and yet the Ultrasound finding was "benign - recommend annual mammography"

This is bugging the crap out of me for some reason. Is this kind of thing common? Any ideas? Thanks in advance for any insight, I'd be so grateful.

MelissaDallas

Yes, it is common, because the imaging modalities “see“ different things. It is common for one type not to see something or poorly see something seen on another type

CrowLuv

Thank you for your response. I was under the (mistaken) impression that ultrasound was superior to mammo for some reason, guess not (I mean maybe for certain things?). Anyway I'm glad my doc ordered the MRI. I'm not going to stress over it (for now at least) bc I'm typically not the fretting type. I was just SO confused/thrown off by that normal ultrasound. Thanks again!

Beesie

An ultrasound is not superior to a mammogram, it's just different. Mammograms "see" the breast one way and ultrasounds "see" the breast a different way. Each modality is better at seeing some things, and not as good at seeing other things. And this means that mammograms may miss some cancers, and ultrasounds may miss some cancers. To my understanding, architectural distortion, which may indicate the presence of breast cancer, is better seen on a mammogram than on an ultrasound, although an ultrasound may see the underlying lesion, which the mammogram might miss (particularly in women with dense breasts).

If you read this board you will find lots of women whose cancer was seen on either a mammogram or an ultrasound, but not on the other.

Good luck with your biopsy. Let us know how it goes.

quinnie

Sorry you are going through this. As Bessie said, diagnostic tests are different. My first cancer was not found on mammogram but was seen on ultrasound. My second cancer was found on mammogram but not on ultrasound. Both showed abnormal on MRI. One was palpable the other not. Let us know how your biopsy goes. Hoping for the best.

CrowLuv

Hi Beesie, thanks for the information - I learn something new every day, especially right now! I'll definitely update about the biopsy, thanks for the good luck wishes.

CrowLuv

Thank you for the kind words and for sharing about your experiences, quinnie - I'm sorry you had to experience all of that - grateful that you shared.