In office ultrasound as opposed to Radiologist Ultrasound

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luvmimom
luvmimom Member Posts: 23
edited March 2018 in Not Diagnosed But Worried

Hello. I just came from my semi annual breast exam with a clinician and she had an ultrasound machine in her office. She took at one cyst and saw it was a cyst, then she took a look at another section where she felt a tiny lump and said it's sending an echo back like a cyst but from one angle it looks triangular maybe. But she's not a radiologist. Is this wise to get these ultrasounds done in office. Does it cause more worry then good? Because now I am freaked out. One minute she was reassuring, the next not so much, then she said 95% of patients she sends to radiology come back with benign conditions. I've never had this done in office before, but she's new so I was curious. I go for a follow up MRI and ultrasound next week.

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  • djmammo
    djmammo Member Posts: 2,939
    edited March 2018

    luvmimom

    My opinion is biased but in a dedicated breast center you will be more likely to encounter techs who are ACR certified in breast imaging who scan breasts every day all day long, and radiologists who read them all day everyday. They are also more likely to to have the best ultrasound equipment with the proper high frequency transducer that should be used for breast (18MHz). Is you doc a breast specialist or GP? ObGyn?

    If you are having an MRI soon then I would not worry too much about this US. The next US should probably be after the MRI so they can follow up anything worrisome seen on the MRI.

    One caveat though: depending upon your insurance the second US may not be paid for if it is done too soon after the one in your doctor's office. I would call them and ask.

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  • luvmimom
    luvmimom Member Posts: 23
    edited March 2018

    Thank you for your reply. They scheduled me for a follow up Mammogram and Ultrasound. Whatever she found was about 2mm in size. She is a Physicians Assistant. We have a breast clinic where I had been evaluated for years by a nurse practicioner who had been there forever. She is new and said today "She is learning on the job" I'm an anxious type, so I'm wondering if an ultrasound in office causes more anxiety. She said it looks similar to a cyct and her machine is about 10 years old. The shape and size had her concerned enough to do follow up.

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  • luvmimom
    luvmimom Member Posts: 23
    edited March 2018

    Should I be demanding an MRI before the ultrasound?

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  • djmammo
    djmammo Member Posts: 2,939
    edited March 2018

    luvmimom

    The radiologist should be the one determining the order of the imaging studies performed. Sometimes the insurance companies will disagree and alter the sequence of events. If this finding is truly 2mm it may not be identified on MRI. We are taught that tiny foci of enhancement measuring 5mm and smaller are too small to diagnose as benign or malignant on MRI. Personally I think I would stand a better chance of making a decision about something that small on US than I could on an MRI. And it could be biopsied more easily on US.

    I see this question often on the forum " Should i demand a _______?". Reminds me of when I bring my car in for a problem and I insist I know whats wrong and what should be done after which the mechanic with 25 years experience goes on to explain to me that I have no idea what I am talking about.

    Also I am concerned about a PA in a private doctor's office performing and interpreting breast ultrasound especially if learning "on the job". Real US tech students have a tremendous amount of supervision by senior techs and radiologists during their training over a period of years. Oh well.

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  • luvmimom
    luvmimom Member Posts: 23
    edited March 2018

    Thanks so much ... your information is really helpful. If this ends up benign definately brings up an important point about too much info in the drs office. The nurse practitioner she replaced did breast care for years, was on the tumor board, and always just sent me to imaging when she felt something. My mom died of ILC so I'm extra anxious. She said it was small, 2mm, similar to a cyst, but somewhat of a triangle shape, in an area of increased density on mammo (which us why she was extra cautious in that area) and if it were cancer would be invasive and not in situ... but could be cyst or complex cyst. My head spun. Looked like a round cyst to me, but at one angle it did have a sharp edge. Anyway, I think its best to ask to go straight to the experts next time.

    That said, if she's found early cancer by being extra vigilant I will be singing her praises no doubt. I can't feel the lump she felt ... she said no one would have felt it in a regular breast exam. And my mammo 3 months ago came back ok. Even the dense part. We shall see.

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