Increasing Architectural Distortion

Dena_01 · March 2019

Hi, I have a pretty simple question that I cannot seem to find an answer to..here is a little back story. (Thanks for taking the time)

To keep the story short, the distortion was found in 2015 at a spot I had a biopsy on maybe 15 years prior. I had a steroVAC core biopsy after 3D mammos showed distortion in many views, US with no correlate and MRI showed a 12mm enhancing nodule at the location of distortion. Biopsy came back benign but classified as discordant by 2 different radiologists since they were expecting cancer or a radial scar. Advised to excise. Met with breast surgeon who was ok with me watching and waiting.

2016 - MRI - Review of the prior MRI examinations demonstrate a smaller area of distortion when compared to the prior studies. Adequate biopsy

2017 - (Had ACL reconstruction so I missed this year of testing)

2018 - Mammo - 2 biopsy clips are identified in the left posterior 12:00 axis demarcating
the site of previous concern. Tomosynthesis images again reveal significant distortion surrounding the biopsy clips.

2018 MRI - Enhancement at the site of biopsy is again noted without significant change when compared to priors.

2019 - Mammo -

THE AREA OF ARCHITECTURAL DISTORTION WITH CALCIFICATIONS IN THE LEFT 12
O'CLOCK POSITION, APPEARS MORE PROMINENT THAN ON PRIOR STUDIES.

In the left 12 o'clock position, there is a prominent area of architectural
distortion spanning approximately 2 cm x 3 cm. There are metallic clips
located centrally within this. There are some punctate calcifications
related to this area which do not appear appreciably changed. There are
similar appearing calcifications scattered bilaterally. Bilaterally, no
skin thickening or nipple retraction is present.

2019 US - No correlate

Current recommendation --

RECOMMENDATION: Bilateral contrast-enhanced breast MRI is suggested at the
next available appointment. Surgical consultation is highly suggested, regarding the area of increasing
distortion and calcifications in the left 12 o'clock position.

While it has been told to me it may be a radial scar, the thing has doubled in size in just the last year. How quicklky can those things grow?

Any help or stories relating to distortion or radial scars I would much appreciate

djmammo · March 2019

Dena_01

In general if you leave a cancer untreated for 4 years it gets much larger, develops satellites and would probably have gone to the lymph nodes by now. You've had 2 MRI's so far, if they were suspicious on those scans I would think they would have done something sooner. Also at 2 x 3 cm a cancer that was present since 2015 that size should be visible on US by now.

Let us know what the next study shows. Since there has been a change it should probably be biopsied under the modality that shows it best.

Dena_01 · March 2019

Thank you so much. I assume that would be the sterobiopsy again. I will let you know what the MRI shows next week. And the great surgeon follow up.

Thank you for what you do here and wish ing everyone nothing but the best 💝

Dena_01 · March 2019

Hi DJMammo -

Just checking in.

MRI results -

The amount of fibroglandular tissue is Extreme fibroglandular tissue.
The background parenchymal enhancement pattern is Marked. The enhancement pattern is symmetric.

There is no skin thickening. The
nipple areolar complexes are symmetric.

There is no suspicious adenopathy in the visualized axillary regions or
along the internal mammary chains.

There is enhancement at the previous biopsy site in the upper central to medial left breast yet has not grown significantly.

RECOMMENDATION: Surgical consultation regarding the architectural
distortion in the left breast which appears more prominent on mammogram
from 3/8/2019 as compared to prior studies.

Met with breast surgeon today and scheduled for wire guided lumpectomy on 4/24. I just want to get this confusing area out and move on.

Increasing Architectural Distortion

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