Bi-Rads 4: Your Opinions

fleur-de-lis · August 2016

Hi Ladies,

I received a MRI report which states the following, I am scheduled for MRI guided biopsy next Wednesday

I would appreciate any advice or experiences you might like to offer.

Like anyone who has dealt with breast issues ( previous Phyllodes tumor in the right breast in 2009, some atypia and ALH on surgical path report at the time) I researched some of the findings on the net, via the 2013 MRI BIRADS edition.

Report: Findings

There is asymmetrical background parenchyma like enhancement in the left breast relative to the right. There is moderate parenchyma enhancement and minimal background enhancement on the right.

In the upper outer aspect of the left breast there is a 9mm area of heterogeneously enhancing non- mass like enhancement with rapid wash-in and plateau kinetics. This represents an interval change as compared to previous MRI's

The irregular shape, heterogeneous enhancement aspects along with the rapid and plateau kinetics make the odds of this lesion being malignant. I have read somewhere between 55-67% likely hood of a cancerous finding.

I know that false positive findings are quite common on MRI's....sadly, I have small, dense breasts....so I know that complicates findings all the more

Any advice? Or tales from the front? If you had finding along similar lines, what was your DX. Per biopsy, or surgerical findings?

Thank you in advance!😬😊

Lisa123456 · August 2016

That sounds very much like findings on my recent MRI. Only mine was focal non-mass with plateau. I also have small dense breasts that are full of tiny cysts. My MRI had BI-RADS 4a and I, too, researched the lingo trying to figure out what it all means. The MRI radiologist recommended a mammo, US, and the US-guided biopsy. I went for these today, but the radiologist I saw today thought he didn't have enough of a view for a US-guided biopsy and recommended an MRI-guided one that they'd schedule soon. To him, it looked like a spot of slightly suspicious dense fibrocystic tissue.

From my research, it could easily be an ILC, which is pretty terrifying, to say the least.

Good luck,

Lisa

fleur-de-lis · August 2016

I already thought about that one, hoping that it might be something of a lower grade, like DCIS, or LCIS......after my Phyllodes removal in 2009, they found some ALH in the right breast....lefty has never "acted up" before...geez😫

Nothing showed up on last years MRI or mammo.

After seven years of trying to manage menopause symptoms, I started the absolute tiniest dose of BHRT... In the ole "va- jay jay"....went years without it, but due to vagus nerve problems and hot flashes that would not stop( actually had a nasty one the day of last years MRI....it was like I had gone running on a 90 degree south Texas day, the radiologist felt horrible for me) I just started this tiny dose last month.....so you could not contribute this to the cancer, if present...but the radiologist did note that this needs to be regarded in the findings. She felt the vaginal dose that I was on to most likely not go systematic.....my E panel, for E1,2 and 3 combined was a total of 15. Most menopausal women without any supplementation have higher tested levels of estrogen

I was only on the vaginal product for one month.

I tried everything to avoid it......but perhaps it was for the best...as I read that many women who, in the past, were on the tiny dosage ( not the huge doses that were common in my Mother's Day) had their cancer's discovered earlier...so, well, who knows

fleur-de-lis · August 2016

Lisa, just read your post closer on my iPhone.....so you just discovered your LCIS a few months back....big hugs to you!

Have you made any plans or decisions yet regarding your findings?

So, being that your findings had a "more benign element" to them, do you believe that the above report. ( in my case) suggest something, how should be say it...a bit further along?

Sounds like I might be heading for a BMX either way, at the very least......wish this would have shown up last year, in a smaller area, etc

I thought about a PMX after the Phyllodes, but was torn as to what choices I had for reconstruction.....with Factor V Leiden ( genetic clotter) flaps can and do fail. Implants with silicone scare the bejesus out of me...I do not like their fillings....if it was "just silica or silicone" I would have considered breast augmentation years ago! But it is the chemical additives that concern me. There are silicone sensitivity tests that you can pursue on your own...since I would only consider saline, which still has a silicone outer shell.

It's never easy....thinking out loud here

Lisa123456 · August 2016

fleur-de-lis, I was diagnosed with LCIS two months ago (through a mammo). That was quite a shock, as I never thought I had any risk factors for BC. Actually, cancer in general has always been on my mind, and I've been checking myself for suspicious moles for as long as I can remember, mostly because I tanned excessively when I was young, never having used sunscreen.

Needless to say, when my LCIS was discovered, I spent days and nights researching it, along with ILC because lobular neoplasia does turn into ILC and there's disproportionately greater risk of developing ILC in either or both breasts. My BS refused to do an excisional biopsy for LCIS and the MRI that I had 2 weeks ago was supposed to be a "baseline" MRI to facilitate surveillance in the future. But it flagged this area in my "good" breast and the description is strikingly similar to yours.

So, yes, unfortunately, from looking at your MRI report, both you and I have about 75% chance of having something nasty, such as ILC, discovered.

Regarding the BMX and reconstruction, everybody on this board says it's a very personal choice. For me, I wouldn't do the reconstruction at all because from what I've read so far, it's sounds like asking for trouble. I'm 49, slim (5'6" and 96 lb), with tiny breasts, completely comfortable with my body. I've never wanted bigger breasts, so I wouldn't subject myself to extra surgeries with potential complications and possibility of cancer recurrence in reconstructed tissue. If ILC is discovered in my other breast, I'd definitely go with BMX, no reconstruction, but maybe a huge tattoo (a.k.a body art) down the road to cover the scar. (just to clarify: I'm not a tattoo person and wouldn't think of having one under normal circumstances, but in this case it kind of makes sense).

Good luck,

Lisa

fleur-de-lis · August 2016

thanks for your though response, hope that you will follow up on the thread and let me know how it turns out for you....if the MRI biopsy results in a higher grade neoplasm, then things such as surgery, I believe, will need to be revisited by your surgeon.....there are times when women and their doctors believe the case to be true DCIS, but the path report after the lumpectomy finds IDC. Not likehaving the thought of that one .......settling into one DX. Based on the biopsy, and finding out that there is something lurking around in there that is nastier than we thought....a double whammy of sorts.

Regarding reconstruction, I will most likely just do a lumpectomy if it is DCIS or LCIS and take it from there...I have to research more reconstruction methods and issues.....if a higher grade neoplasm is found, then I will proceed to a complete BMX, let it heal, get thru treatment and then consider fat transfer in Miami. I spoke with the center years ago, after that monster Phyllodes was removed, so, at least I know that they take my insurances.....but we will cross that bridge when the time comes.

I have a serious condition that is really going to hamper my treatment options

Common Variable Immune Deficiency can, and does render us unable to "correct" all the cellular damage that Rads can do to healthy cells...we are considered "sensitive to radiation" and should limit exposure. I image this also includes Proton therapy, although there is some differences to the application and nuclear structure of the treatment...so I don't know

Regarding my previous comments regarding breast augmentation, I pursued a visit with a couple different plastic surgeons in the past. I'm very tall 5'10 and about 120 pounds in my youth. I am still 5 foot10 and closer to 150 pounds which is probably right size for someone like me who is very small boned yet tall. I have small breasts only a A-B cup and was looking to just look more balanced....I never gain any weight in my breasts...my gym even noticed this. There are several reasons why this might be...one of which is that fact that I am a DES daughter, and PCOS even thought I have never really been overweight, exercise 5 days a week and have a low A1C....but I am a reactive hypoglycemic.....and a disordered insulin metabolism is a contributor to developing neoplasms....which is why I take Metforim. I never went thru with any breast enhancements

fleur-de-lis · August 2016

Just as a follow-up, if anyone reads this.....I saw my hematologist yesterday regarding my MRI results, he shared a few things with me that I did not know....

There are what are considered "rare" benign breast lesions that can present as a neoplasm, but actually are not....one such type is a hemangioma. He believes there is a possibility that this is the issue here.

I looked up the findings per the Bi-Rads manual....and it is possible. Rare, but possible......he has seen quite a few the last few years. In the past, very, very rarely.

Wonder, oh wonder "why" there is an uptick of unusual breast neoplasms now? It isn't enhanced ability to discover these little nasties....they were pretty good at catching these way back in the 60's when they presented.

I am wondering about all the DES usage back in my mother's generation.....many women born before pre mid-1964 had mothers who took the drug. For what-ever reason, our mothers might not have shared this information with us. They may not remember, and the doctor was always right back then, so most would have not ever questioned what it was they were taking. Getting a baby on the planet and starting a family was the main concern. Totally understand that emotion...the strong desire to be a mother.

Hemangioma's can be malignant, but they are typically a larger mass by then.

Due to the fact that I had a Phyllodes removed from my lefty 7 yrs ago "sorta" sets me up for any other type of lesion that presents with the sarcoma type presentation....scary crap, since angiosarcomas are nasty little creatures. And radiation can add to the chance of an angiosarcomas 5-12 yrs after the fact. They state that it is a low level of possibility, but I have to feel that there is genetics behind my original Phyllodes, and this might give me a pre-disposition to sarcoma "type" lesions.

That Phyllodes and I was hustled over to M.D Anderson genetics department...It's fairly rare, so they probably want to see the genetics behind all patients who present with this tumor

Moderators · August 2016

fleur-de-lis, thanks for sharing your update, and the new information that your hematologist shared with you!

Bi-Rads 4: Your Opinions

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