Call Back Mammogram - interpreting report

Erica14

Hello. I had a 3D screening mammogram and was called back for additional images/ultrasound. The area of concern is the same spot where I had a benign duct removed 7 years ago (incision just around areola)

Here's he report: "Focal distortion is seen in the 9:00 subareolar right breast. In 2014, patient had a lateral subareolar duct excision, and she has had some focal distortion in this area on prior mammograms since the surgery. However, today the distortion appears more pronounced. This may be secondary to positional differences and likely accentuated by the 3D imaging technique compared with prior 2D studies. However, additional imaging evaluation is advised to exclude a more worrisome infiltrating process."

Questions: What is focal distortion? The differences in 2D and 3D technology is mentioned, however, my previous mammogram was also 3D, so should I assume this change is not related to 3D? Of course I'm concerned...does this sound highly suspicious? I've been told all "non-normal" screening mammograms are Birads 0 - which mine was. Any other insights? I've been told nothing more from my doc. My next appt is on Tuesday. THANK YOU for any thoughts.

kathabus

Hi Erica--While I am not a medical professional....I don't see this as a highly suspicious situation from reading this. In fact, I don't think it's even suspicious. It sounds like they think it's because of your positioning and they want a second look, hence the birads 0. If they felt it was suspicious, they would have actually written.....suspicious. I know it's hard not to worry, but I honestly think they just doing their due diligence before they give you the all clear. That's how it reads to me Please let us know how you make out on Tuesday!

canadaliz

Hi Erica, Let me help you with the terminology. BIRADS 0 means incomplete test needing additional imaging. It has no relationship to findings or grading of any image. It fully means that there is not enough imaging to grade. As for focal distortion--that's a bit different and more specific. That means that there is 'something' disrupting the normal/accepted patterning of the way the tissue 'should' be sitting. Now, that can be many many conditions. The area of interest is beneath the nipple at the 9 o'clock position.

I'm 3 years out and went for my regular screening and the doctor found an area that needs more attention and investigation so I am having an ultrasound assisted biopsy next week. It is a BIRADS 4A. so between 2-10% malignant but important to biopsy due to my history of malignant breast tissue. If I hadn't had BC already we would have waited and watched for 6 months. Again, I have had several biopsies that proved to be nothing of concern. One was a cyst closing in on itself and getting a thick consistency that was difficult to read on the screen and 4 others were fibroadenomas--thickening of the breast tissue but no malignant potential. When I was first diagnosed in 2018 I went for a regular mammogram/ultrasound and was told right then and there I was BIRADS 5 and no question, it was BC. Anything that is to be biopsied has to be above BIRADS 3.

That is a bunch of number stuff but most important is: focus on now not what hasn't happened and, truthfully, is unlikely to. Over 80% of breast tissue anomalies are not malignant. Your report says 'to exclude' so the doctor is acting with an abundance of caution without specific suspicion of anything sinister or trust me it would say 'to further investigate highly suspicious infiltrating mass presenting with significant positional distortion" like mine did.

Now make a cup of tea, take a breath, and roll through this. Tuck your head down and let the fear blow above you. Spring is upon us on Saturday and soon enough this rough patch will be behind you. I am glad your doctor is being so caring.

Yours, Liz

Beesie

To add to what the others have said, it sounds as though the radiologist is being very cautious and conscientious but doesn't have a serious concern.

You have known focal distortion in this area because of the previous procedure. The only issue is that the focal distortion appears more pronounced. The radiologist is suggesting that this is likely due to your positioning in the mammogram machine, accentuated by the 3D mammo. Although you've had a 3D mammo before, if the way your breast was squished into the machine places this distortion at just a slightly different angle, then the area of distortion will look different - it might look larger or more pronounced - and 3D imaging will accentuate whatever is seen. Think about looking at something that is pressed down under glass. If you change the angle of what is under the glass, or if you shift the glass slightly, what you see under the glass will look quite different. That is what the radiologist suspects is going on.

Good luck on Tuesday and let us know how it goes.

LivinLife

Welcome Erica! I agree with the others. I know little about the medical aspects of these things and yet it seemed clear to me it's just a second look... likely positioning, etc. I sure hope that's the case for you! Please try to distract yourself until your next appointment. Let us know how that goes all right?

Erica14

Thank you all so much!!! You really have no idea how helpful your replies are when waiting for results (well, actually, you all DO know, which is why it's so helpful!) I, too, am thinking the report didn't sound too concerning, but the emotions, and googling, can play mind games. I didn't know that one could have anything but a BIRADS 0, 1, or 2 on a screening mammogram. So, I've learned something already (I thought the 2-6 came with the diagnostic mammogram). So that makes me feel less nervous after all. I've heard of "architectural distortion", but not "focal distortion" - I wasn't sure if it was the same thing? The fact that the area of interest is the exact location of my scarring from previous surgery gives me more peace. I'll try to enjoy the sunshine today and give google a break. You all are the BEST!

canadaliz

Erica, This is a sisterhood (and a few brothers). We are here for each other. Any time. Any day. In the moments that you have fear, imagine all of us around the world, joining hands, gaining strength as we form a strong chain of knowledge, hope, love and support. Picture yourself stepping up and holding hands, a woman on each side of you, holding you up. Giving you a silent nod of wisdom. Together we get through our fears and trials. Together we celebrate the victories. We have blazed a trail ahead of you and are here to help you navigate your way. We have your back.....and front.

Much love, Liz

hopeful23

canadaliz, loved what you said. It was beautiful and comforting. Thank you!

Erica14, thinking of you and wishing you the very best!

Beesie

Focal distortion is architectural distortion that is in just one area, i.e. there is one 'focus' of distortion.

Erica14

Thank you so much! The support here is such a beautiful thing.

LivinLife

Yes truly beautiful words canadaliz!!!!

Erica14

I had my diagnostic mammogram today. Everything is fine! The distortion seen on the screening mammogram, when magnified, was identified as scar tissue along with normal aging breast tissue.

I do know that if I ever have any other issues in the future, I'll be coming back here. This is truly a wonderful place for support and information! Thank you!

Beesie

That's great news! Congratulations!!

And thanks for coming back and letting us know.

LivinLife

Wonderful Erica! and yes... thanks for letting us know!