BiRad 5

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Deenster
Deenster Member Posts: 13
edited August 2019 in Not Diagnosed But Worried

Hi all,

A few weeks ago I noticed a fairly large lump in my left breast. Since my grandmother died from stage 4 breast cancer, I got myself to the doctor fairly quickly and was sent for a 3D mammogram and ultrasound. I knew without the radiologist saying it was cancer that that’s what he was implying, but yesterday I was called by my doctor and told that the BiRad was 5 and need to get a core biopsy ASAP. The report says the mass is 25 mm and spiculated with microcalcifications and a large area of distortion accompanying the mass.

I know a score of 5 means probability is greater than 95%, but wondering if anyone has been in the 5%? I keep reading how fat necrosis mimicks cancer, and wondering if this could be a possibility as I was in a car accident about 2 years ago where I did hit the steering wheel but didn’t cause any bruising on chest. Can most radiologists clearly see the difference between the two with these tests? I know I’m pulling at straws, but hoping for a light

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  • Moderators
    Moderators Member Posts: 25,912
    edited August 2019

    Hi Deenster,

    We are so sorry you find yourself here and worrying, but we're really glad you've found us. We are sending good thoughts your way that you will be part of that 5% -- please keep us posted with what you find out. We're here for you no matter what!

    --The Mods

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  • djmammo
    djmammo Member Posts: 2,939
    edited August 2019

    Deenster

    There is a recognizable difference between IDC and fat necrosis especially on mammography.

    IDC has microcalcifications and fat necrosis has large ring shaped macrocalcifications. Also fat necrosis does not cause the architectural distortion seen with IDC. We rarely see post traumatic fat necrosis in the breast unless there has either been a history of direct blunt trauma with significant bruising or there has been prior surgery.

    The only time there is actual confusion between the two is after a lumpectomy + radiation. The surgical scar can be spiculated and when newly forming and small, the calcifications associated with fat necrosis can look suspicious for a local recurrence but eventually the difference is obvious.

    Let us know how the biopsy goes.

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  • Deenster
    Deenster Member Posts: 13
    edited August 2019

    Thank you for this info. I was really hoping for that miracle that it could be fat necrosis based off of some things I’ve read, but doesn’t seem it’s going to be. The mass is 25mm with a large distortion around it, but the radiologist said it doesn’t look like the lymph nodes are affected, so I guess I’m looking at DCIS

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  • Georgia1
    Georgia1 Member Posts: 1,321
    edited August 2019

    Hi there Deenster and so sorry you're at this confusing, nerve-wracking stage. 25 mm is still pretty small, about an inch, so once you have the biopsy results you can put an action plan together. We're here for you.

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  • djmammo
    djmammo Member Posts: 2,939
    edited August 2019

    Deenster

    DCIS usually presents as calcifications only, without a mass.

    2.5 cm is the size when masses become palpable on a self breast exam. With mammography we try to find them before they become palpable.

    At surgery they will take at least one lymph node to check for microscopic spread.

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  • Deenster
    Deenster Member Posts: 13
    edited August 2019

    Well, since it is a 5, I decided to schedule my biopsy with an NCI center in Philadelphia. Unfortunately, because I didn't do the testing there, I hit a roadblock. They wanted me to bring the images and reports in today before they schedule the biopsy for the radiologist to review, because they often don't agree with radiologists from outside facilities and don't like the images. So I wait while they are reviewed and decide if they agree with the findings. Is this the norm

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  • Ingerp
    Ingerp Member Posts: 2,624
    edited August 2019

    I never got a second opinion--trusted my medical team and I knew I wasn't dealing with anything extreme. I'm sure it's the NCI's protocol to want to review everything before taking the next step. It's probably also extremely likely they'll agree with the initial findings.

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  • djmammo
    djmammo Member Posts: 2,939
    edited August 2019

    Deenster

    I practiced in a breast center that accepted referrals from several of the surrounding states. We always reviewed their images before scheduling to save them a trip if the patient did not require a biopsy. And yes we disagreed with a number of the reports accompanying the images.

    This is a protocol that is not only practical but protects the referral center from medico-legal problems down the line.

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  • Teddy88
    Teddy88 Member Posts: 102
    edited August 2019

    Deenster: For three years in a row, my affected breast has required biopsies and each time its fat necrosis (to DJ Mammo's point - yes exactly - I had lumpectomy and rads.)

    The first year, the doctor ran the biopsied tissue back through the lab as it presented so much as you describe that they were surprised it was not cancer. Keep the faith - and whatever the outcome - you have lots of people here on your side standing by and with you! . Love, Belle xx

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  • Deenster
    Deenster Member Posts: 13
    edited August 2019

    What wonderful news not once but 3 times, as scary as that had to be for you! That was really what I was hoping it was for me.

    The NCI center called today and they unfortunately agree with the findings and scheduled me for a biopsy tomorrow morning and already asking if I’ve seen a breast surgeon, so it sounds like they’re already sure.

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