MRI Screening - BIRADS 4 biopsy recommended

blaketots

I had a biopsy in 2015 which came back as consistent with a ruptured cyst wall and fibroadenomatoid change. It was in my left breast at 2:30, 9 cm from nipple. I had ultrasound followup every six months for two years with no findings. I have dense breast tissue and some other factors that make me high risk - I have 27.8% lifetime risk. My mother was diagnosed with DCIS in 2020 and had a lumpectomy. As a result, I started getting high risk screening in 2020. My schedule was to get a mammogram in January and an MRI in July each year. I did that in 2020 and all was fine I had my mammogram in January of this year and it was fine. I didn't get my scheduled MRI in July this year as I had a conflict. I finally had the MRI yesterday (3 months late). I got a call back within 20 minutes of leaving the appointment They are having me come back next week for an ultrasound which will be followed by either ultrasound guided biopsy or MRI guided. The MRI report is as follows:

At approximately 2:30, 2C there is an irregular enhancing mass measuring 0.6 cm anterior to posterior, 0.5 cm transverse and 0.6 cm craniocaudal. It demonstrates predominantly medium persistent enhancement with a component of rapid washout (122%).
This is new when compared to the prior study. No additional morphologic or kinetic abnormality. Scattered T2 hyperintense subcentimeter nonenhancing masses are seen throughout the left breast consistent with cysts.

I have tried to research the kinetic terminology and see that rapid washout is usually associated with malignant lesions especially when the lesion is described as an irregular mass. This is in the same breast and at a very similar location to that prior ruptured cyst which was also at 2:30 position.

It's hard to not worry. Anyone with better understanding of this MRI language - insight is helpful. I'm a realist and like to use data to know what I'm dealing with.

Moderators

Hi blaketots,

We're so sorry you find yourself back here and worrying, but we're all here for you while you figure out what's going on. We're sure someone will be by soon who can weigh in with their experience and offer you support.

Try to stay positive and busy while you figure out what's going on. We're sending good thoughts your way! Keep us posted.

--The Mods

Salamandra

Hey blaketots,

Hopefully when you were set up with high risk screening, the docs discussed with you the high rate of false positives with MRI. It's a wonderful technology, but it comes at a price.

Realistically: in order for insurance to cover a biopsy, scanning has to have a result of birads 4 or birads 5. If the docs thought it was cancer, it would be birads 5 - requiring a biopsy to rule out other causes. If the docs think it could be cancer, it will get a birads 4 if there's even small chance it could be malignant

Realistically: even if it is cancer, that size is tiny and an MRI finding means it is most likely very early stage, and thus more likely to be an extended pain in the butt than a near term life threatening condition

Realistically: if you like to use actual data, there's nothing to be done but wait for actual data. The biopsy results will almost certainly be actual data, although if it is malignant, it will just be the beginning of a lot of data that will take even more time to trickle in.

Realistically: you are in a position of uncertainty. The odds are in your favor on every level (that it will be benign, that if malignant it will be early stage, etc etc), but you can't know until you know.

Honestly, I would say that a true realist should be optimistic under these circumstances and avoid putting further mental and emotional effort into it until they have actual data. But ironically I think that's not a realistic expectation for most humans. For most of us, waiting for biopsy results is a terrifying time, no matter the actual odds. Hang in there!

blaketots

Update: I went for my ultrasound and the mass could not be found. They scheduled me for an MRI guided biopsy in November. I went for that biopsy and the radiologist decided they would not perform the biopsy due to it's proximity to my chest wall and the danger of puncturing my lung. I went to the breast center at Mayo for a 2nd opinion in December. They agreed to try the biopsy which I finally had last week. I noted that my biopsy marker clip is within about 1cm to 2 cms away from my prior biopsy marker clip from 2015.

My pathology report came back as follows:

The specimen is received in formalin labeled "left breast 5
mm, 3:00 enhancing mass" and consists of multiple cores of
tan/yellow to tan/white fibrofatty tissue which range from
0.3 cm to 4.7 cm in length.

FINAL DIAGNOSIS:
Left breast, 5 mm 3:00 enhancing mass, core biopsy:
Atypical lobular hyperplasia involving nodular sclerosing adenosis.

Additional findings of microscopic fibroadenomatoid nodule,
columnar cell change and pseudoangiomatous stromal
hyperplasia.

Negative for malignancy.

Comment: Immunohistochemistry performed on block A1
demonstrates focal loss of expression of E-cadherin
consistent with atypical lobular hyperplasia.

My doctor sent me a message and recommended tamoxifen for five years. I have a virtual visit with her on Feb 10 to discuss it in more detail. I already had a genetic counseling virtual appt scheduled for Feb 8, so I think we will be moving forward on DNA testing. She hasn't mentioned removing it, but I plan to ask about it at the Feb 10 appt.

I'm concerned about how close this new finding was to the prior biopsy site.

pato58

yes, I would tell them to remove the lesion completely.