IMLN turns into BIRAD4 irregular lesion?? Please read!

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angela0606
angela0606 Member Posts: 8
edited July 2018 in Not Diagnosed But Worried

I'm currently 27 years old. For several years I've had a palpable mass in my RT breast, 12 o'clockish, right above my nipple. Maybe 2-3 yrs I cant remember, I told my health provider and they referred me to a local woman's health for ultrasound. The lady there was very dismissive saying "ohh it's probably a cyst" and def not cancer because of my age. Well went to ultrasound, the rad report said it was a swollen intramammary lymphnode. It measured something around 0.5x1.4x1.5 i think? I cannot remember exactly and cannot find the report. My health care provider wanted me to get a second opinion, but the second opinion place wouldn't accept my insurance.

So here I am, getting a diagnostic mammogram for a elective breast augmentation, and they want an ultrasound of the lump I mentioned. I've been told for years I have very "fibrocystic" breasts. What worries me is the ultra sound report below. They were under the impression that this is a newly found lump, which it isn't. I feel like the dimensions have changed/evolved of what i was told was an "intramammary lymphnode" a few years ago. Even looking at it on the computer screen, it looks like 3 masses merged together. Its hard to explain. So do I have an enlarged intramammary lymphnode that has morphed into malignancy or was the previous ultrasound wrong and misguided by my age?

* the mammo and ultrasound were done on Tuesday July 17th...biopsy is scheduled for Monday July 23rd. *

mammo reports:

FINDINGS:

Bilateral synthetically generated digital mammography with CAD and

digital breast tomosynthesis. The CAD display and tomosynthesis

images were reviewed. The breasts are heterogeneously dense, which

lowers the sensitivity of mammography.

The patient is a 27-year-old female with a history of a palpable

finding in the right periareolar region. The patient is also

preoperative for upcoming breast augmentation.

There is no focally suspicious mass or suspicious density seen in

either breast. There are no abnormally clustered microcalcifications

seen in either breast. Additional ultrasound evaluation of the region

of the palpable finding within the right breast will be performed.

No radiographic evidence of malignancy.

ASSESSMENT:

BI-RADS 0-Needs additional imaging.

RECOMMENDATION:

Right breast ultrasound

_______________________________________________________________________

What worries me is the ultrasound report:

FINDINGS:

Corresponding to a palpable finding 1 cm from the nipple at 12

o'clock position, there is a hypoechoic solid-appearing lesion. This

measures approximately 0.7 x 1.6 x 1.3 cm. The margins of this are

somewhat irregular to micro-lobular in appearance. While fibroadenoma

is still a possible consideration in this age, given the lack of

smooth margination and coupled with the fact that this is a newly

palpable finding, the appearance is considered suspicious enough in

nature to warrant ultrasound-guided biopsy. Also identified, 2 cm

from the nipple at the 10 o'clock position was an ovoid structure

consistent with a slightly complex cyst which measured 0.2 x 0.7 cm.

ASSESSMENT:

BI-RADS 4 - Suspicious abnormality.

RECOMMENDATION:

Ultrasound-guided biopsy of a right breast mass at 12 o'clock

position, 1 cm from the nipple.

_________________________________________________________

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Comments

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

    angela0606

    "For several years I've had a palpable mass in my RT breast"

    Does it feel bigger to you since you first felt it?

    It was called a "swollen" intramammary lymph node on prior study? It would help to have that report. It should be readily available to you if you request it from the facility where you had it done or perhaps the doctor that ordered it may have a copy.

    Any other US studies between that exam and the most recent you posted above?

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  • angela0606
    angela0606 Member Posts: 8
    edited July 2018

    yes it was reported as an enlarged intramammary lymphnode. I had it ordered through my college health center whom was like a PCP to me, and they are out for the summer. I was going to try to call the hospital to see if I could pick up a copy of it. There's been no other US studies in between.

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  • angela0606
    angela0606 Member Posts: 8
    edited July 2018

    yes it was reported as an enlarged intramammary lymphnode. I had it ordered through my college health center whom was like a PCP to me, and they are out for the summer. I was going to try to call the hospital to see if I could pick up a copy of it. There's been no other US studies in between.


    It does feel a little bit bigger. But I've also lost over 20lbs in the past year. I went from 138 to 115. I'm like a AA so its definitely more palpable to me now.

    I remember the dimensions noted above as being similar to what was on the report a few years ago. But the way it looked is what scared me. Lumpy almost wart like, like three wide yet thin bumpy areas within the entire thing. It is going parallel with my breast tissue. I asked her if it was fixed to my tissue she said yes. Upon palpation it feels fixed.

    I recall the ultrasound report years ago showing an oval shape.

    I'm going to call the hospital right now to try and get the previous report.

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

    angela0606

    As a rule, a cancer would have enlarged significantly in that 2-3 year period of time.

    Post the report when you get it, just as it was written.

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  • angela0606
    angela0606 Member Posts: 8
    edited July 2018

    it was on April 9th, 2015

    FINDINGS:

    In the 10 o'clock position on the right breast there is a 1.4x0.9x0.9 cm solid nodule. This appears to have a thin peripheral hypoechoic outer capsule and an echogenic fatty core which makes it appear to be an intramammary lymphnode. There is no posterior acoustic shadow or enhancement. The lesion is wider than tall which typically is seen with nonaggressive lesions. There was no distortion.

    IMPRESSION:

    Nodule in the right breast appears to be intramammary lymphnode. Follow up as clinically indicated.

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

    angela0606

    There should have been a BIRADS number at the end, if not that is an incomplete report. I assume there was no recommendation for a biopsy since it asks for clinical correlation only.

    I don't see the words enlarged, swollen, or abnormal. The description of it implies a thin cortex and fatty core which is that of a benign lymph node. The remainder of the description employs benign language. It is unfortunate that the thickness of that cortex was not measured as is required for the complete evaluation of nodes.

    Where the two studies compared? Did the second US exam give the thickness of the cortex in millimeters?

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  • angela0606
    angela0606 Member Posts: 8
    edited July 2018

    no it doesn't say enlarged or abnormal, that's pretty much what I inferred because of the size and it was palpable. There was no BIRAD score on the report! I dont understand how they can call it both a nodule and a lesion? Like I said, they seemed so dismissive and uncaring because of my age I think. I went back to the college health center where they referred me to Magee Womans Hospital in Pittsburgh for a second opinion. My insurance wouldnt cover it so I never went.

    The two studies have not been compared. I wrote the second exactly as it was written. I dont think there was a cortex, it was wavy looking.

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

    angela0606

    "I don't think there was a cortex, it was wavy looking." What are you basing this opinion on? Are you in the radiology/imaging field?

    Secure the old US study on CD and send it to the place that did the new one and ask them to compare the images. Thats the best way to know if you should be worrying about this lymph node.

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  • angela0606
    angela0606 Member Posts: 8
    edited July 2018

    Sorry if I didn't make sense with that last post. My boyfriend is getting upset with me everytime he sees me on my phone trying to research anything so I posted quickly. He doesn't even want to here about it. I know asking for advice online or looking up similar cases isn't going to change my own biopsy results Monday but its helping me at least cope a little.

    I was deployed for a year in Iraq, I just came back June 8th. So for this expensive breast augmentation, I got the order for the ultrasound and mammo through the VA because since I'm a veteran now, anything through them is free. I wasn't expecting the BIRAD 4 result.

    With the VA, your civilian and military records are separate, they have no access. So I was worried if they knew the lump was there prior to deployment and I end up needing more treatment, they might not financially cover it.

    But i guess what matters most now is the biopsy report. This will tell me either way. I do find it reassuring that it hasn't grown much in three years!

    Last night I did a self exam and noticed that I have lumps everywhere! Some feels like thickening, other spots like little bb's. I'm going to bring this up Monday as well. Maybe it is just fibrocystic changes.

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