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Bostonmama
Bostonmama Member Posts: 15
edited August 2019 in Not Diagnosed But Worried

I was diagnosed with Atypical Ductal Hyperplasia after a stereostatic biopsy and lumpectomy. I had a follow up MRI this week . Got a call the next day saying ,"the MRI showed nonmass enhancements" I am schedued for a mammogram with tomosynthesis next week. Anyone have any experience with a situation like this? TIA

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

    Bostonmama

    Could be additional areas of ADH, DCIS or hormonally related enhancement if you are still cycling. The good news is that its not an enhancing mass. They may want to bx this area at MRI if nothing shows on the next mammo/US.

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  • arizonaboundgal
    arizonaboundgal Member Posts: 88
    edited August 2019

    Hey Boston. I had an area of non mass enhancement that ended up being LCIS and ADH. Hope all works out great for you!

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  • Bostonmama
    Bostonmama Member Posts: 15
    edited August 2019

    djmammo- I was curious of your opinion. The mammo and US were completed and now they are requesting another biopsy. I feel this may just be scar tissue or collection of fluid. I had a small amont of nipple discharge and am having pain and tenderness. Thoughts,please.

    I need to add that is July I had a chest CT that showed nodules in my lungs. They suggested MRI in November.

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

    Bostonmama

    "I feel this may just be scar tissue or collection of fluid"

    Can you post the latest reports?

    Is there a reason you disagree with their interpretation? Is it from your review of the images?

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  • Bostonmama
    Bostonmama Member Posts: 15
    edited August 2019

    PROCEDURE: RIGHT DIAGNOSTIC MAMMOGRAPHY AND TOMOSYNTHESIS WITH CAD

    TECHNIQUE: RIGHT digital diagnostic mammography and tomosynthesis was
    performed. The images were evaluated with computer-aided detection. CPT
    77061, 77065, 7025F

    HISTORY: RIGHT BREAST ABNORMAL MRI + RIGHT MRI workup patient with
    history of atypical ductal hyperplasia diagnosed in April 2019 in the
    upper outer quadrant. Patient underwent excisional biopsy without
    residual ADH without further graded pathology. Patient underwent breast
    MRI August 14, 2019 demonstrating diffuse asymmetric subthreshold
    enhancement involving nearly all RIGHT breast parenchyma with associated
    nonenhancing skin thickening/edema, as a result a RIGHT breast
    diagnostic mammogram with tomo synthesis and RIGHT breast ultrasound was
    recommended.

    COMPARISONBreast MRI August 14, 2019.FINDINGS:

    Composition: The breasts are heterogeneously dense, which may obscure
    small masses.

    Mammogram: Diffuse skin thickening and with slightly increased breast
    density from comparison mammogram April 20, 2019. Surgical change in the
    upper outer posterior third of the RIGHT breast at site of excisional
    biopsy with associated architectural distortion. There are no suspicious
    microcalcifications.

    Ultrasound: Targeted RIGHT breast ultrasound demonstrates diffuse skin
    thickening predominantly in the upper outer upper central breast with
    palpable areas of firmness notably in the upper outer quadrant of the
    RIGHT breast with somewhat indistinct diffuse regions predominantly at
    the 9 o'clock position 4 cm from the nipple and at the 12 o'clock
    position 2 cm from the nipple. Targeted RIGHT axillary ultrasound images
    normal-appearing axillary lymph nodes. The LEFT breast was scanned for
    comparison demonstrating normal breast parenchyma distinctly different
    from sonographic appearance of the RIGHT breast.

    IMPRESSION:
    Diffuse skin thickening with increased mammographic density as well as
    indistinct diffuse hypoechoic areas throughout the RIGHT breast, may be
    attributed to lymphovascular congestion. However, given imaging
    characteristics as well as physical examination, would recommend RIGHT
    breast ultrasound-guided core biopsy in the upper outer quadrant to
    ensure benign process within the breast parenchyma.

    These findings and recommendations were discussed with the patient as
    well as Dr. practitioner Bea for Dr. Whitworth by Dr. Dana Bonaminio. On
    August 21, 2019.

    Cerner:4BXD
    ACR Category: BI-RADS 4, Suspicious abnormality, biopsy should be
    considered. CPT 3344F
    Recommendation: Biopsy dense


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

    Bostonmama

    MRI's are best when performed before surgery so that there is no confusion as to what findings are due to pathology and which are contributed by the surgery. One would hope most if not all acute post op changes would have subsided between April and the August MRI. No scarring or fluid collection is mentioned

    It would depend on the differences between the pre and post op mammo and US (in the areas not disturbed by the surgery) as to whether there has been any significant changes i.e. the skin thickening and diffuse increased density. These are suspicious findings (if not post op changes) especially if they enhance on MRI. No scarring or fluid collection is mentioned in the report.

    Assuming your docs have excluded IBC from their differential, the other case I have seen similar to this was diffuse involvement of the entire breast with a rather uncommon form of DCIS diagnosed by needle biopsy. For this reason alone, thought admittedly an uncommon entity, it is more than reasonable to biopsy the area of concern.

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  • Bostonmama
    Bostonmama Member Posts: 15
    edited August 2019

    djmammo- Thank you so much for your time and input in reviewing and helping me with this . Biopsy on Wednesday, results the following Tuesday. I will update.

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  • Bostonmama
    Bostonmama Member Posts: 15
    edited August 2019

    Thanks. Hope you are managing all this too.

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