Birads category 5 on ultrasound

Hi Hap,

Sorry you are here having to ask these questions. Your information is correct - 95% of BIRADS 5 comes back malignant, unfortunately. I know it's hard to wait for test results. Try to stay busy and with people who support you this weekend.

Karen

Hap, the waiting is the worst, especially now that no phone call and the weekend is here. Good to have stuff to keep busy. Does the walking help the anxiety? I too am "in the waiting room" this weekend. Will have to give walking a try. I too was given bi rad 5 and I have heard that 95% are cancer. I am hoping you will be that 5%. Hang in there. This site is great and we seem to do lots of waiting together! :-)

Here's a chart that may be helpful:  http://breastcancer.about.com/od/diagnosis/a/birads.htm

Keep in mind that there is a percentage of benign findings even with a Bi-Rads 5 rating, and the fact that you're doing so many things right -- diet, exercise -- are all in your favor.   Plus, Bi-Rads 5 is the opinion of 1 radiologist.  There's always a chance he's being overly aggressive in how he's seeing your imaging, and someone else might have rated it differently.      Deanna

After years of receiving "all clear" mammograms, I found my approximately 2 centimeter lump myself during a self-exam.  Later, my oncologist told me that mammograms are only 70% accurate.  Now, who forgot to mention THAT??  However, she also said that it was only one tool in the arsenal of diagnostic tools: the "golden rule" is mammogram, ultrasound and biopsy for any new/unidentified breast lump. 

She, then, went on to explain that mammograms tell them if there is something there that wasn't there before: that's why having regular mammograms is important.  They use them to compare to past mammograms to detect changes.  In and of itself, one mammogram doesn't tell them much, but a series of them may.  An utrasound has a better accuracy track record than a mammogram - it's around 85% accurate - but it can often miss something very small that is brewing if it is not big enough to be palpable, that's why it is not used in- and of itself as a screening tool.  Therefore, if a "change" is detected via mammogram, an ultrasound will indicate what that change consists of: fluid, solid tissue or a combination of both.  Sometimes this is enough to determine if the lump is obviously benign or obviously malignant; however, there are a large "grey" area where it is hard to determine what the lump is definitively.  That's why biopsies are done; biopsies tell them exactly what they are dealing with.

[And MRIs are not used as a single, diagnostic screening tool for breast cancer because of the high rate of "false positives".  A number of things can "light up" an MRI and not all of them are cancer.  But... an MRI in conjuction with the above tools can provide important, additional information about the extent - or not - of breast cancer if breast cancer has been already been definitively diagnosed.]

Although the size of the lump is important to staging, staging is comprised of other things, as well.  The grade is important, too: is it a "sluggish" cancer or an aggressive one?  Is there lymph node involvement?  All these things, and others, will be considered before you are staged and your treatment protocol will not be decided until you are staged and your hormone receptor/HER2 status determined.  However, once the lump grows bigger than 2 centimeters, you are, no longer, considered to have a small cancer, although it may still be considered "early-stage".  But keep in mind that - just because you may have a "larger" cancer - doesn't mean it isn't treatable.

In addition to what Selena said about u/s, it would literally take hours to do a total u/s on most breasts, and even then it could miss something.  If you've had an u/s, you know how the radiologist or rad tech will go back and forth over an area, trying to locate and image something they know is there.  It would be a fluke and next to impossible to find things with this method at random.

And another reason MRIs aren't used as a screening tool is b'cuz they're just too expensive.  In many cases, insurance companies will only authorize their use if you already have a bc dx.

Here's how BCO explains bc stages:  http://www.breastcancer.org/symptoms/diagnosis/staging.jsp

Also, keep in mind that the size per imaging is only approximate.  The actual dimensions of your lesion might turn out to be a bit different in either direction.     Deanna  

I think it was pretty unprofessional for the radiologist to say that -- there is no way that they can be 99.9% certain by any radiographic modality.  

Second opinions are always a good idea, especially for pathology.  

As hard as it is, try to keep occupied on something else!

Good luck, sending positive energy across the ether! 

hap_k 

I would like to add, that if you must get off estrogen, ask your doctor about getting on Evista or Fosamax, both bone builders and the Evista is good for our breasts.  

If you have to, at some time in the future, go on Tomoxifen, that also will not hurt your bones. 

nanatwo6 ... I know just how frightening this process can be when you feel perfectly healthy one day, and then your world turns upside down the next.  Take a deep breath and calm yourself.  You are fortunate you have a daughter to guide you through this journey.  Don't borrow trouble .... you do not have cancer until the pathology report says you have cancer, so even with a birad 5 it has to be confirmed by a biopsy. 

The tests and the waiting for results can be grueling, and worrying will only add to your stress.  Please try to relax and do something to occupy your mind and treat yourself well.  There will be others along to help answer some of your questions, but I would suggest starting your own thread.  This thread is about a month old, and will probably not get too many responses.

In the meantime, here's a gentle *hug* to let you know we'll be here for you.

(((Hugs)))

Diane

( I apologise as new to this) ... Thought I accidentally hit post for first part of this but it may be lost in cyber land!
Quick overview, have very dense breasts and after second Mamo ( normal for me) ordered ultrasound and told then it didn't look good. Radiology consultant rushed results and he called me 2 days later Ti say benign. Admitted he was surprised and recommended lumpectomy to prevent possibility of it turning into a problem in the future and scheduled an appointment with Oncology surgeon for a few days later.

Anyway, oncology surgeon appt was scheduled for a few days later. I wasn't happy re surgery but after ultra sound had shiwn the possibility iof cancer, a lumoectomy to be safe was a relief!

Met with surgeon and told that they ( the team) believe it was a "sample error" I. E. the small biopsy samples taken missed the malignancy as told it looks and feels ( during biopsy) like malignancy! Pathology report given to me and BIRAD 5.

Told surgery and thorough dissection and pathology report of whole (2cm mass) would happen within 2-3 weeks however now 2 weeks later and not scheduled after many calls, and scared!

Anyone had B9 biopsy and BIRAD 5 and then told they think it's wrong? ( again, I would rather they give me their "professional" opinion (and then deal if right or jump for joy if they are wrong than be kept in the dark).


This is an emotional roller coaster that is impacting myself and my family. The B9 then maybe not plus the uncertainty is hell!


By the way am 48 and not meneupasal yet.

Appreciate any relies .
>Thank you.

Bournepool, let me see if I have this right.  You had a mammo and then were sent for an ultrasound.  After that you had a biopsy. The biopsy was benign - which was a surprise to the radiologist, who thought from the films that your lesion looked like cancer.  The radiologist suggested that you have a lumpectomy (also called an excisional biopsy, which is actually a more accurate/appropriate term since you still have no diagnosis) and referred you to a surgeon.  The surgeon agreed that the films look highly suggestive of cancer, a BIRADs 5, and agreed that you should have surgery. The surgeon also said that he believes that the biopsy sample may have missed the cancer.

If I got that right, then everything that's happened is actually following a reasonable path.  Not an ideal path, since it appears that your needle biopsy may not have picked up a cancer that might be present, but still, a reasonable path. A needle biopsy is the normal first step when something suspicious is seen on a mammogram or ultrasound. But needle biopsies only pick up a few small samples - that's the nature of the procedure - and it's possible that a needle biopsy can miss the cancer.  This is particularly true if the cancer is in a location that is hard to reach with the needle, for example either near the chest wall or near the skin. When that happens - if it's believed that the needle biopsy results may not be accurate - usually surgery is recommended so that all of the suspicious area can be removed and examined.

In my case I had two areas of calcifications that showed up on my mammogram film. Both areas were in hard-to-reach locations but to avoid a possibly unnecessary surgery, my breast surgeon and I agreed to try a needle biopsy first.  The needle biopsy missed one area completely but did get a few samples from the other area.  All that was detected was ADH, a precancerous condition.  But whenever AHD is found, there is a 20% chance that there will be something more serious lurking in there with the ADH.  So after a biopsy finds ADH, usually an excisional (surgical) biopsy comes next.  I had the excisional biopsy, which removed both areas of suspicious calcifications. Both areas contained ADH, and lots of high grade DCIS (pre-invasive breast cancer). One area also had a tiny amount of invasive cancer. So yes, I had benign results from a needle biopsy but then had surgery that discovered my cancer. But my needle biopsy did pick up the ADH and that was the sign that something more might be going on.  

Do you know what your biopsy results actually showed? You said that the radiologist suggested surgery "to prevent possibility of it turning into a problem in the future". That suggests that a pre-cancerous condition such as ADH (there are several others as well) may have been found. If that's the case, then just like in my situation, a more complete excisional / surgical biopsy would be the usual next step.  But even if your biopsy didn't show anything but normal breast tissue, because your films are so highly suspicious, the radiololgist and surgeon are doing the responsible thing by suggesting the surgery.  I've seen that happen quite a few times to other women here on the board.  Some have ended up with benign results after the surgery, and others have ended up with a diagnosis of breast cancer. 

What it all comes down to is that needle biopsies aren't 100% accurate in all cases. In your case, there is a disconnect between what's seen on the films and what the needle biopsy showed. So more investigation - i.e. the surgery - is necessary.  It's not a great situation to be in, but it's not all that unusual either.

There are two things that are strange from what you've described. First is the fact that your surgeon is planning to do a nodal dissection.  Normally nodes are not removed until a diagnosis of invasive cancer is confirmed.  And normally a sentinel node biopsy (SNB) would be done first, not a full nodal dissection.  An SNB removes only 1 or a few nodes, greatly reducing (but not eliminating) the risk of lymphedema.  Lymphedema is a major concern after the removal of nodes, and for this reason, you don't want nodes removed for no reason (i.e. if it turns out that you don't have cancer after all) and you don't want more nodes removed than is necessary. 

Second is that your surgery hasn't been scheduled yet.  Who have you been dealing with at your surgeon's office and what explanation have they provided as to why you don't yet have a surgery date? 

hi, this time last week my life was normal. I had a weird dent on the underside of my breast. I decided to go to gp for form for Mammogram. She did exam and discovered a lump, that afternoon I had mammogram and ultrasound, radiologist said it didn't look great and asked me back for core biopsy the next day. The day after core biopsy I had a Mri. Confirming radiologists original assessment of birad5.

I am now waiting to see Gynae in 5 days to discuss moving forward. The wait is awful.

The last 6 days have been crazy.

This is except from report

Irregular mass with spiculated contours at the junction of the lower quadrants of the right breast, measuring 17 x 11 mm in an axial plane and 15 mm in height. Its enhancement is homogeneous with a plateau type 2 curv. Birads 5.

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