really confused about this US report

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ANG1587
ANG1587 Member Posts: 32
edited March 2015 in Waiting for Test Results
really confused about this US report
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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    Hi everyone,

    so sorry if this is in the wrong place. I am a 27 year old mother of a 19 month old who nurses once a day. A month ago I found a pretty large lump in my breast. I have had little lumps that have come and gone with my period that I never became worried about but this one seemed different. First, it's in a place that I have never had a lump before. It way up on my right breast right where the breast starts and about the 1 oclock positition so more towards the sternum than the armpit so you can get a visual. That is 1 oclock on the right breast, correct? I also had another tiny lump around 10 o'clock right breast an inch or so from the armpit (I was not as concerned about this). The US tech felt the first lump and measure it with her little ruler (about 2.5 cm) she had no problem finding it. Then she measured the tiny one near the arm pit. She scanned the whole breast and I was able to see on the screen when she had the transducer over each spot a circular black area compared to the white breast tissue around it. I am not imaging this, lol

    anyway the report mentions ONE "slightly lobulated, hypoechoic nodule at the 10 o'clock position corresponding to a palpable area, this appears to be a benign INTRAMAMMARY lymphnode." Birads 2.

    So here is my question. That 10 oclock nodule is not the large palpable lump that i came in for originally. And it says it's a intramamary lymphnode. I thought intramamary lymphnodes were towards the center of the chest? If it were reffering to the 1 oclock nodule then that would make sense to me (even though a 2.5 cm lymphnode seems rather large to me) OR if she describe the lymphnode as axillary, that makes sense at a 10 o'clock position in the right breast.

    I am seeing my gynocologist next Wednesday and I will go over this with her, but am I missing something?? It only refers to one lump ( the tech confirmed she felt two and then went ahead and manually, with a ruler, measured both). And the huge one (huge to me anyway) is not even mentioned, that's the 1 oclock lump in right breast closer to sternum.

    Sorry, I'm just frustrated because either, a) they are missing something or b) I'm severely confused and I am missing something

    Can anyone shed some light on this?

    thank you so much for reading

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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    I may be getting confused with the terms intramammary and internal mammary nodes...

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  • windingshores
    windingshores Member Posts: 704
    edited February 2015

    I had hard lumps during breastfeeding that were in the milk duct and were just milk cysts. I had trouble finding an MD who would treat this reasonably and got a lot of lectures that I should stop breastfeeding so an accurate mammogram could be done, should avoid pregnancy until that was possible etc. I finally saw Susan Love's associate, Helen Cooksey, who just did a watch and wait to see if they got bigger, and they didn't. I stopped nursing at some point. I don't remember if the cyst disappeared before then or not.

    This may not be relevant to you, but just wanted to mention it.

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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    windingshores,

    thanks for your response! I did have a blocked milk duct which lead to mastitis when my son was 2 weeks old, I had an ultrasound for that too. I guess this could be a cyst of milk, it doesn't hurt. My PCP who referred me for the US is less than helpful, I was assigned to this practice when I enrolled in my insurance policy in december. I will definitely be finding a new pcp. I trust my obgyn and will discuss the report and have her examine me personally. It's just frustrating and i have had other non breast related issues overlooked in the past that turned out to be significan't. So I find it hard to trust all doctors inmediately.

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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    kayb- thanks for the response and the clarification! I don't want to make a big deal out of nothing but I also don't want something significant to go unnoticed! My grandmother had breast cancer that went undiagnosed for some time so that, of course, scares me! I sometimes feel that the practitioners think "she's 27 and lactating" and don't want to look further. But I love my obgyn, super cautious and super patient! So I'm looking forward to seeing her and getting her opinion.

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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    hi again,

    just figured I'd throw this question out there since I honestly haven't an iota of an idea...

    how long does it typically take for a radiologist, upon receiving films, to view, write a report and sign?

    The tech walked out of my room at 9:36, to hand over the films to the radiologist. I had gotten a text from my mom so I remember it well. Anyway, after reading the report for the millionth time (I know, obsess much?), I noticed that at the bottom, the radiologist had signed it at 9:41.

    Is 5 minutes a normal amount of time to go over films and write a report?

    Again, I'm sure it is but it's just another thing to obsess about admidst all of this uncertainty regarding the large lump that's not even mentioned on the report! My gynocologist appointment next week can't come soon enough!


    Thanks again for your help, ladies. :)

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  • BLinthedesert
    BLinthedesert Member Posts: 678
    edited February 2015

    Dear Ang, I think that there are "normal" lumps and bumps that "usually" are obvious to radiologists, and then there are things that look different than "usual". Radiologists are trained to look for the abnormal stuff. While you certainly need to follow-up and make sure that you feel comfortable with any diagnosis that you receive, I also think that most of the time (not all of the time for sure) diagnostic specialists are trained pretty well to discern "normal" from "abnormal". It is certainly not a perfect system for sure, and it is more complicated if there is a note that says, "heterogeneously dense breast tissue makes sensitivity of mammogram .... " .

    Regarding how long it takes to read ... it depends on the number of views that they take, but the "signed" time could have been automatically generated when they opened the file on their screens (they read them off of a computer these days - most of the time - the image goes directly to them as soon as the machine takes the picture).

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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    ah gotcha ;). The part that confuses me the most is why the large palpable lump was not mentioned in the report. I remember the tech measuring the diameter of a big black spot once she got the transducer over that lump (she dragged the curser across the spot) and measured the other black spot when she had the transducer over the little one. (I'm only assuming measuring it what she was doing as I remember my obgyn doing the same to measure the baby when I was pregnant) I figured both would be mentioned in the report even if they were benign findings. I thought all cysts and "findings" would have been mentioned regardless of suspicion.

    I guess what I really want to know is what it is. I guess that's my control issue surfacing ;) and it keeps getting bigger, I don't want it to grow to a size where it will disfigured me. I guess what I was expecting was "finding was consistent with a cyst" or "dense tissue" or something!

    It's like going to the dermatologist with a rash and a mole and having only the mole addressed.

    edited to add: I also worry about the possibility of a clogged duct, I do NOT want mastitis again!-in the past I would let little things go but now that I have a child I feel it's my duty to protect my health so I can protect him, ya know what I mean?

    Thanks for taking the time to respond BLinthedesert! I very much appreciate it :)

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  • BLinthedesert
    BLinthedesert Member Posts: 678
    edited February 2015

    Ang, It is very important that you, as a patient, feel comfortable with any information you receive, it is your right - and you sometimes need to push to make sure you get what you need. Best wishes, I hope all of your questions are answered. And, I hope all turns out to be nothing serious -- cancer or inflammation!

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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    thanks so much BLinthedesert! I'm pretty confident everything is just fine, but I just want a firm answer from a doctor. My appointment is next Wednesday, for my annual, with my OBGYN who I am very comfortable with. So what I am going to do now, is accept the uncertainty for now, since there is nothing I can do in this week wait that will change my circumstances.

    Thanks again and take care :)

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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    So I just wanted to update incase someone with a similar situation comes across this post :)

    I saw my obgyn for my annual and SHE actually initiated conversation about my ultrasound report, asking if I had any questions. So I had her feel the lump, she did, and then said it was odd that it wasn't mentioned at all in the report, only the small one that I wasn't concerned about. So she referred me to see a breast surgeon, which I'm thankful for. I'd rather bypass going through another general imaging place.

    It was a nightmare getting my PCP to send the request for authorization to my insurance. I wish my obgyn could have, but thats the terms of my crappy HMO. I won't bore you with details, it makes my blood boil thinking about what transpired!

    March 27th is my appointment. Kind of bummed it's that far out by the front desk told me to call periodically to see if there had been any cancelations. I'm grateful to have ANY appointment.

    I'm sure this will all turn out to be nothing, but I won't ever be sure with out seeking out a doctor.

    Have a great rest of your day, everyone :)

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  • ANG1587
    ANG1587 Member Posts: 32
    edited February 2015

    And shortly after I posted this the surgeons office called and fit me in this monday! so thankful :)

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  • ANG1587
    ANG1587 Member Posts: 32
    edited March 2015

    So I go for my appointment with the breast surgeon tomorrow. Not sure what to expect. The receptionist basically said it could be just a consultation or could be some diagnostic imaging/testing based in what the doctor deems appropriate at the time.

    I'm basically just writing this out to myself so I can hopefully stop thinking about this situation over and over in my head. Kind of a cathartic thing for me I guess...I'm not even concerned about what it is at this moment in time, more so frustrated that this very obvious lump hasn't been addressed or identified! Clearly I have control issues ;)


    it feels good to "write" this out :)


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  • ANG1587
    ANG1587 Member Posts: 32
    edited March 2015

    so I promised myself I'd keep updating this for anyone who comes along to read this and for myself!

    I went to the breast specialist who I love! She was thorough, patient and had incredible bedside manner.

    Anyway, she did a thorough breast exam and felt the lump. She could even see the lump through my skin. (It's a right around my third rib closer to the sternum so I guess a lump this size isn't hard to see through the skin on a very bony area, I'm pretty skinny).

    She said she was surprised that this lump didn't end up on the report so she reviewed my films and said that nothing even showed up in that area. So she did her own ultrasound and showed me everything. it's up high near my pec muscle so she said it's very dense in that area and was not able to discern a lump. I thought she was going to tell me "it looks like dense tissue so let's watch it for 6 months."

    Instead, she said she is sending me for an MRI. She is sending me to the hospital for it because they practice "interventional readiology" and will be able to biopsy anything on the spot where as the other local imaging places aren't equipped to do that.

    I asked her if it could be a cyst or fibroadenoma and she said, "no, it would have been very obvious on the ultrasound, especially a cyst." So that concerned me a bit.

    she said that the only thing she can come up with based on the ultrasound alone is "dense ridge of tissue" but was not confident because the other breast was nothing like that and she can feel some edges on this lump/mass. So she said "I want to investigate this further."

    she also wrote me a script for a mammogram because she believes her "radiology colleagues will want a mammo before the mri," even though she feels it is unlikely to yeild any answers given the location of the lump and my dense breasts.

    I told her my concerns about the mri not being approved and she said "don't worry, it will be approved."

    So now here I am waiting. Oh and here's the kicker! My mri is schedule for Friday the 13th! My first ultrasound at a different imaging Center was last month Friday the 13th.

    so all in all I'm feeling a little crazy. This lump is so obvious and feels so different compared to the rest of my breast and every practitioner had no problem feeling it and were equally shocked it wasn't caught on film. It makes me feel like a hypochondriac or munchausen or something :( I almost convinced myself to skip the mri and just watch and see. But I'm not. I want an answer and so does my doctor.

    My grandmother died from breast cancer. I'm not sure which type though but I'm thinking it was lobular because it recurred in her bladder. I'm no expert, though. I really felt confident that this was a fibro but now I have no idea. I'm praying the mri sheds some light and it is in fact a dense area of tissue.

    On a good note, she did mentioned that the breasts aren't fully mature until after the first pregnancy, so maybe my breasts are still settling?

    We'll see. I hope they just biopsy it Friday so I'll have some answers at my follow up app on monday.

    Again, so grateful to be directed to and in the wonderful care of a very persistent and kind breast surgeon.


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