What if it's not cancer - How does the MRI know

HopeHeal

There is something strange in my most recent dx imaging reports.

The ultrasound doctor personally told me after the u/s that she saw no masses or calcifications and that the biopsy doc "must have gotten them all." The 3D mammogram report does not list calcifications either, except in an "addendum" about calcifications that were never mentioned in the original report; perhaps the addendum is about a comparison to the first mammogram done somewhere else. The MRI did show a mass but MRI's cannot be relied upon to determine cancer vs benign tumors.

So, without new calcifications since the biopsy, how can this be cancer? I feel no lump except for a healing injury to the breast due the biopsy. The mass is said to be at the 1 o'clock but cancer is said to be hard and at 3cm I would feel it.

WHAT IF THE MASS IS NOT CANCER (perhaps the biopsy cells were a small collection that was removed) and I was misdiagnosed, being pushing through the system?

moth

Did you have an excisional biopsy? Are you scheduled for a lumpectomy?

HopeHeal

No, I only had a stereotactic core biopsy which showed malignant cells, but am ordered to start chemo before any surgery. Is it possible the tumor has not created any more calcifications in the 3 weeks since it was biopsied?

moth

If the pathology results showed malignant IDC cells then you have cancer. Neoadjuvant chemo is increasingly being used to shrink masses, assess aggressiveness of the cancer (based on response to chemo), and make a more effective/smaller surgery.

MRI, ultrasound, mammogram, CT and PET all "see" different things and can show different results so this is not unexpected in some ways. No reason though why you can't follow up with your MO with questions. You should feel confident about what's happening and why.

Beesie

Hopeheal, I looked back at your previous posts.

You had a biopsy that found grade 3 IDC. So you do have breast cancer.

Calcifications are one presentation of breast cancer on mammograms but cancer can be present with no calcifications. In any case, calcifications usually do not show up on ultrasounds and to my understanding MRIs also do not show calcifications, although an MRI will show if there is an underlying condition (whether DCIS or benign) that is causing the calcifications. To my understanding (which admittedly is far from expert), with MRIs it can be difficult to distinguish between DCIS (which usually does not form into a lump) and many benign conditions. But masses are different and I think the enhancement pattern can be quite predictive of whether or not a mass is cancer.

Do you have a copy of your MRI report?

Breast MRI enhancement curves https://radiopaedia.org/articles/breast-mri-enhancement-curves

"Following administration of gadolinium, there can be three possible enhancement (time intensity) kinetic curves for a lesion on breast MRI (these are also applied in other organs such as prostate MRI). These are sometimes termed the Kuhl enhancement curves.

• type I curve: progressive or persistent enhancement pattern
  • typically shows a continuous increase in signal intensity throughout time
  • usually considered benign with only a small proportion of (~9%) of malignant lesions having this pattern
• type II curve: plateau pattern
  • initial uptake followed by the plateau phase towards the latter part of the study
  • considered concerning for malignancy
• type III curve: washout pattern
  • has a relatively rapid uptake shows reduction in enhancement towards the latter part of the study
  • considered strongly suggestive of malignancy"

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Edited to add: I was writing this up as the previous two posts were being posted so I was addressing the opening post only. To the more recent post, if you have a solid mass, it would not necessarily be associated with calcifications. And again, the MRI would not identify calcifications even if there are some.

exbrnxgrl

HopeHeals,

Your biopsy revealed malignant cells that are grade 3. That is cancer, or am I misunderstanding your post? What system are you being pushed through? Who is “ordering” you to do chemo? You are the ultimate decision maker every step of the way. No system can push you anywhere and no one can order you to do chemo. You and your doctors are a team but you are the team leader!

Beesie

HopeHeal, I just looked though your older posts again to see if you commented on the MRI results. On March 20th you wrote:

"my bilateral MRI confirmed a 3.3 cm tumor which I was surprised about since my initial mammo and ultrasound showed nothing. However, the 3-D mammo done my new facility revealed the tumor as well."

So it sounds as if this mass has shown up on both the MRI and a 3-D mammo. If chemo has been recommended prior to surgery, I would expect that the MRI and 3-D mammo imaging is highly suggestive of malignancy. But certainly you should look at these reports to see how the mass is described and you should talk to your MO if you are concerned. And as exbrnxgrl said, the treatment is your decision. If you want to have surgery first to confirm the diagnosis, you can insist on that. Neoadjuvant chemo is recommended for triple negative tumors and HER2+ tumors that are over 2cm in size, but it is less common for ER+/HER2- cancers.

HopeHeal

Beesie, when I posted that about the 3-D mammo I was initially going by what the nurse said. However, in going over the curve on my report today it describes a washout pattern, so I guess I have my answer.

HopeHeal

Thank you to everyone for your helpful responses. Still have to do a scan to stage and the sugar uptake solution in those will confirm what I already now know due to the washout pattern.

Beesie

I'm glad the information I provided was helpful. I think with MRIs, it is non-mass enhancement where it can be difficult to distinguish between benign and malignant (usually DCIS) whereas with masses, MRIs are thought to be more reliable than other imaging.

As for calcifications, I was thinking more about that. On mammograms, DCIS usually presents as calcifications. On MRIs, DCIS usually presents as non-mass enhancement. So both modalities may "see" that something is there but they visualize it and present it differently.

HopeHeal

Interesting, and all together create the picture. My MRI report also stated the mass was irregularly shaped. I think benign masses are more round.

HopeHeal

Exbrnxgrl, the reason I felt pushed was due to being assigned to an oncologist by the team I am working with without being told the results of my imaging and also not being presented with a choice of oncologists. As such I do not know if MO was assigned because she is the best for my case for for some other reason.