Mammogram BI-RADS 2 but ultrasound BI-RADS 4?

ohgoodness

Hi all - I hope everyone is doing well

I'm a late-30s BRCA neg. woman with heterogeneously dense breasts who had on-and-off mild left breast pain for about three and a half years. A breast ultrasound (US) in late 2017 found nothing of concern. In late 2018 I had a very early, super uncommon Stage 1A ovarian cancer removed surgically with a unilateral saplingo-oopherectomy (no chemo). All my pelvic ultrasound scans have been clear since then, including a full chest/abdominal MRI in February of 2021. I'm very lucky-unlucky

My most recent mammogram and ultrasound were done on the same day within an hour of each other. The 3D mammogram came back as "area of benign fibroglandular tissue - no concerns, BI-RADS 2: benign".

The US seemed fine at first. The doctor even came in after reviewing the images, saying everything looked good and was about to send me home. In casual conversation I mentioned that my ovarian cancer (of which she was aware) had been estrogen-producing. She said she wanted to take one more look with the US probe. I was shocked when she said "hmm well I did notice one little thing in the area where the pain is. It's almost certainly nothing!", and "it's 99% not an issue". And suddenly ...she had me scheduled for a guided core biopsy! As I was leaving both she and the US tech were saying how they see "it" but it's "nothing to be concerned about". But I was so shocked at how quickly the conversation turned to a biopsy. They said it was really because of my history of cancer and "just to be safe".

The US report says "5 cm from the nipple there is a 0.7 x 0.4 x 0.9 cm on US - indeterminate hypoechoic mass, BI-RADS 4: suspicious for malignancy". No other description of the mass.

I'm absolutely so stressed over this! Has anyone else had wildly different US and mammogram BI-RAD scores? Should I also be requesting a breast MRI or anything else?

Thanks in advance!

moth

ohgoodness, different imaging modalities do show different things, so it's not totally unusual to have something show on ultrasound that didn't really show on mammo. Your radiologist's explanation makes sense to me: out of abundance of caution, due to a previous cancer history they want to check any abnormalities. I think a biopsy is your best move right now. (btw, as I understand it, they need to categorize it BIRAD 4 for a biopsy to be approved by insurance; so it's not necessarily that *they* think it's malignant. It's that there's no codes for "this is probably nothing but we just want to be 100% sure esp given patient's medical history")

I hope you get your biopsy done quickly & get benign results!

ohgoodness

Thank you, moth!!

I guess that would also explain why the biopsy referral request itself doesn't include much detail. They told me verbally there were no microcalcifications and no vascularity, but didn't put that in the docs - but did include written mention of the BIRAD score twice.

I'm super grateful to have proactive, thoughtful doctors on my side and I'll definitely get the biopsy. It's just hard - and I'm sure you can relate - to feel like a human pincushion with medical tests. And the anxiety is no picnic! Keeping my fingers crossed tightly.

Sending you good health wishes now and forever!

quinnie

ohgoodness, My first cancer was not detected at all on the mammogram, but since it was a palpable mass they did an ultrasound and it was seen on that. My second cancer was seen on the mammogram but not on the ultrasound. So lesson here is that each diagnostic tool has its purpose and it may take all 3 tools (MRI) to get the whole picture. Good Luck

ohgoodness

Hi ladies,

An update: it was benign! Thanks so much for all of your feedback!

Ended up being ductal hyperplasia (NOT atypical) with some stromal fibrosis. Huge relief and hoping that everyone else that is seeking answers gets a big ol' benign, too. Sending everyone on this board wishes for good health and good luck!

LivinLife

Awesome on b9 results!!!!!