lump in breast

Dear Mithali_jain, Welcome to the BCO community. We hope that your friends makes out ok. We can't really say what might be going on but we are sure that it is an anxious time. Here is hoping that the news is good for your friend. The Mods

Hi M_j:

It is too early to tell. In the US and Canada, the radiologist will review the mammograms and may assign a "Bi-Rads" score, based on the level of suspicion raised by what he sees. The Bi-Rads score can provide a very rough estimate of the likelihood of malignancy. The radiologist may also make further recommendations for additional imaging (e.g., ultrasound), tissue biopsy, and/or follow-up imaging in 3- to 6-months time. She might also be referred to a Breast surgeon (specialist) at some point, who considers all clinical information and imaging results and makes a recommendation re next steps.

She can request a complete copy of the radiologist's report from the mammogram for her review and records.

If there is an area of concern to be biopsied, one cannot be certain of malignancy until a pathologist examines the tissue. The good news is that of those recommended for biopsy, around 80% have a benign result.

It is very stressful and worrisome, but it is important to take things step by step. You can find a lot of information on the main site and ask questions here as more information comes in.

Best wishes,

BarredOwl

Hi M_j:

Please be cautious of preserving the privacy and safety of your friend/relative by not submitting information that can identify her, such as her last name, facility, referring physician, etc. All such information should be masked or you should delete it and type the information in.

Please keep in mind that we are layperson patients with no medical training, and she should look to her treating team for medical advice.

Here is a link to a summary document from the American College of Radiology ("ACR") regarding mammography and ACR BIRADs categories:

http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/BIRADS/01%20Mammography/02%20%20BIRADS%20Mammography%20Reporting.pdf

Please note that there are separate Bi-Rads systems for categorizing (a) density; versus (b) likelihood of malignancy.

(a) Density: In your friend/relative's case, based on the reference to "heterogeneously dense" and "Type III" designation in the report, it looks like density on both sides corresponds to ACR type "c": "The breasts are heterogeneously dense, which may obscure small masses."

Because fibroglandular breast tissue is dense, it appears white on a mammogram. Unfortunately, areas of concern also appear white. So dense tissue can make it hard to detect a problem (can't see white against a white background). The higher levels of density may also confer some increased risk of breast cancer, although this is still being studied. You can read more about density categories and see representative images that illustrate the different degrees of density in the ACR document above.

(b) Findings: The report starts by listing nodular findings in descending order of concern, followed by listing calcifications and microcalcifications in descending order of concern.

On the left, two intermediate density nodular lesions, measuring approx. 12 mm each in upper, outer quadrant (BIRADS IVb), and a small cluster of "pleomorphic microcalcifications" in central aspect of the left breast with associated small soft tissue shadow (BIRADS IVb) are moderately suspicious. As explained in the ACR document, Category 4B designations are associated with a >10% to ≤50% likelihood of malignancy. These very broad categories are not very helpful to patients. One way to look at Category 4B finding is that more likely than not, it will be found to be benign.

The right nodule (6 mm) is given Category 3 (probably benign), a designation associated with a very low chance of malignancy of > 0% but ≤ 2%. In the ACR document, a Category 3 designation alone may lead to a recommendation for "Short-interval (6-month) follow-up or continued surveillance mammography." You can read more about Category 3 in the ACR document.

Consistent with a Category 4 designation, tissue biopsy of the lesions on the left is recommended. "USG" is probably "ultra-sound guided" and "FNAC" is "fine-needle aspiration cytology".

She may wish to request additional explanation of the proposed biopsy procedure and what it entails. For example, it is not clear to me how the "pleomorphic microcalcifications" on the left would be located for purposes of USG biopsy, unless visible by ultrasound (currently unknown) and/or associated with a palpable lump.

Hoping for benign results.

BarredOwl