Diagnostic Mammogram or Ultrasound

kayan1

Hello all! I haven't been here in several years but I used to frequent this forum due to my fibrocystic breasts. At any time of the month, I'm likely to feel fibrosis (thickened tissue) or cysts in both of my breasts. I had lots of imaging in my mid-30s and then stopped after it was the same thing over and over...dense breast, mammo can't see anything, have a u/s and then biopsy.

Now in my forties I know I have to get back on the rollercoaster again. I did a screening mammo a few days ago and no surprise got a call back for a diagnostic mammo and possibly ultrasound. The report says I have "extremely dense" breasts lowering the sensitivity of my 3D mammogram.

My question is should I do the diagnostic mammogram or just go directly to the ultrasound to view the questionable area? I'm going to ask the doctor this as well but I don't understand a diagnostic mammo for very dense breast. Can a diagnostic mammo diagnose or rule out anything that an ultrasound can't with dense breasts?

Any insight on this would be great, thanks!

Beesie

You should have the diagnostic mammo as well as the ultrasound.

Mammograms and ultrasounds "see" different things. And even with extremely dense breast tissue (which is not at all uncommon for pre-menopausal women), mammograms can still spot some things that ultrasounds can't. The best example of this is calcifications. Calcs are very common and usually benign, but they can be a sign of DCIS or a very early stage invasive breast cancer. Most often, ultrasounds don't show calcifications at all. In my case, even with extremely dense breast tissue, my diagnostic mammogram spotted the calcifications that led to my diagnosis; my ultrasound was completely clear and showed nothing. Another example would be architectural distortion. While a mass might not be seen by a mammogram because of dense breast tissue, the presence of a mass might cause the breast tissue to appear distorted or uneven. That would provide a target area for the tech to focus in on with a diagnostic mammogram, which provides a close-up magnified view and therefore might see something that the screening mammogram missed. The tech would also focus more closely on that area with an ultrasound, which might miss a small mass if the tech didn't know specifically where to look.

But just to be clear, there is no screening modality that can diagnosis breast cancer and if something is present, most often screening alone cannot rule out breast cancer. All that screening does is look into the breast to see if something unusual or abnormal is present. Depending on how the lesion appears, in some cases - with simple cysts (completely round and fluid filled) or with benign calcifications (larger and coarse, for example) - the Radiologist can be quite certain that the lesion is benign. But often, even if something looks quite benign or looks highly suspicious, follow-up is required to confirm this. With something that looks quite benign, the follow-up might be another screening in 6 months to ensure stability. Or a biopsy might be recommended - anything with a 2% or greater risk of being cancer is recommended for biopsy. With something that looks highly suspicious, a biopsy is required to confirm a diagnosis. There are some benign lesions that mimic the appearance of cancer, so even some highly suspicious lesions do turn out to be benign. It is helpful to the Radiologist's assessment to have more than one modality of imaging, because those two different views can sometimes help define what the lesion might be.

GreenHarbor

To add to Beesie’s excellent information... a diagnostic mammo involves multiple views from different angles. They also swap in different size plates to squish you with. This will give the the radiologist more info when he/she reads your films. My advice is to do both the 3D mammo and ultrasound since you haven’t had either for a while. Anything concerning is compared to previous films, so it could be beneficial to you down the road. Best of luck with your decision - check back and let us know what happens. ❤️

bcincolorado

I have very dense tissues and on my non cancer side they did a 3D mamo and they read mine right away for me because of my history. Then had me take some additional films and then do an ultra sound as well to be extra sure after that due to a an area. You can end up with both and my insurance covered it all as a result.

kayan1

Thank you all! I appreciate each response. And yes different angles should give them more information. Didn't think of it that way.

@Beesie you painted a clear picture indeed. The idea of using both the diagnostic mammogram and the u/s to determine whether I need a biopsy resonated. I was so focused on the u/s looking at the spot to determine whether or not I need a biopsy. But you're right that having the diagnostic exam take a closer look for calcifications, etc. gives added information the u/s will not give assisting in the overall risk assessment.

Looks like the 3D the technology is better than it was 11 years ago during my previous exams. Before I received a lot of blank looks and "we don't see anything" (even with palpable lumps). This is the first time a mammogram has identified anything so hopefully the diagnostic exam will give further info.

Thanks again everyone for your input! Next week I have both exams booked back to back.

kayan1

Just wanted to follow up and say that I did receive the diagnostic exam followed immediately by ultrasound. The radiologist needed both forms of imaging before making a recommendation.

Both were clear but it was immediately evident via the ultrasound. The mammogram picked up on overlapping breast tissue that when examined further was nothing but it took many pictures and angles to get there due to breast density.

But I do see the value in having both because you don't know what the mammo is going to see that the u/s doesn't and vice versa.

Beesie

Great news! Thanks for letting us know!

LivinLife

Super!

AlwaysBelieve

Just wanted to jump on here & thank all of you for such great information!

I’m glad you got good news!!

~AB

Jons_girl

that’s great news! I would have asked for both. I have extremely dense tissue.

Glad all is well

5ingys

hello everyone, I received my dreaded callback after my 3D mammogram. I was told it’s for “density” or “dense”. Can’t remember what was said. I am now having anxiety through the roof. My appointment isn’t for a few days. How many people have had call backs because of dense breasts and been normal

LivinLife

Ahhh... so this answers the question I asked you in a different thread. I'm in my upper 50's now and have had "extremely dense breasts" ever since I've been getting mammograms in my early 40's. Just began getting 3D mammo's a few years or so ago. I'm not sure I've heard of anyone getting a callback for dense breasts only with no other suspicious findings.... so I can't really help you with that. I've had many callbacks though that was due to microcalcifications, etc. they saw; otherwise no callback.

Beesie

5ingys, I just replied to your same post in a different thread. It's the same people here who go from thread to thread so it's better to keep your comments to one place so that all the responses to your concerns are questions are together.

Jons_girl

I think it can go either way on a call back. I have extreme dense tissue. My situation was different tho cause I felt my tumor. Then went for Diag mammo which didn’t see my tumor but since they felt tumor too they then did ultrasound which saw tumor and blood source to tumor.

Please keep us posted on how all goes for you. We are here to support you! Hope all is benign.