Confused

Alsmom2 · January 2020

Hello I was wondering if someone could help give me input. I always havea mammogram and US—-very dense breast tissue and lots of cysts on both sides. Had some drained a couple years ago also had an infection after a draining—can’t remember what side I’ve had it done maybe three times—no scarring/distortion showed up on my last mammogram. I stupidly was late getting my mammogram the year—18months. Well this time I went they wanted me to go get and MRI and now I'm getting an MRI guided biopsy next week. The breast surgeon told me not to go off antidepressants so I am pretty sure she thinks I have cancer. No family history no real medical problems and I'm 45 and premenopausal.

Most recent breast imaging: 11/2019

FINDINGS:

The tissue of both breasts is extremely dense, which lowers the sensitivity of mammography.

There are multiple masses in the right breast central to the nipple anterior depth. Ultrasound demonstrates multiple masses central to the nipple anterior depth. These correlate with mammography findings. Most of theses are cysts. F/U US recommended

for probable complex cysts at 3 o'clock (8 x 6 mm), and 11 o'clock (9 x 8 mm)

Additionally, there are regional calcifications in the right breast at 9 o'clock middle depth.

There is architectural distortion in the left breast at 1 o'clock posterior depth. This abnormality was not seen on ultrasound.

There also are regional calcifications in the left breast central to the nipple anterior depth.

Additionally, there are multiple masses in the left breast central to the nipple anterior depth. Ultrasound demonstrates multiple masses central to the nipple anterior depth. These correlate with mammography findings. Most of these are cysts. F/U US

recommended for complex cysts at 12 o'clock (15 x 14 mm), and 1 o'clock (8 x 4 mm)and 3 o'clock (5 x 4 mm)

No other significant masses or calcifications are seen in either breast on the mammogram or bilateral ultrasound. Digital Breast Tomosynthesis (DBT) images were obtained and used to assist in the interpretation of this examination.

IMPRESSION:

INCOMPLETE NEED ADDITIONAL IMAGING EVALUATION, ULTRASOUND IMPRESSION: PROBABLY BENIGN

The multiple masses in the right breast central to the nipple anterior depth are probably benign.

The regional calcifications in the right breast at 9 o'clock middle depth are probably benign.

The architectural distortion in the left breast at 1 o'clock posterior depth is indeterminate. An MRI is recommended.

The regional calcifications in the left breast central to the nipple anterior depth are probably benign.

The multiple masses in the left breast central to the nipple anterior depth are probably benign.

MRI with/without Contrast

IMPRESSION: SUSPICIOUS OF MALIGNANCY

1. 2 cm spiculated mass in the left breast at 3:00 within the middle 3rd. Although the enhancement kinetics pattern is not overtly suspicious, the morphology of this lesion raises suspicion for neoplasm. While this could represent a radial scar,
possibility of a neoplastic lesion is not excluded. I would advise stereotactic biopsy for further evaluation

2. Multiple complex cysts are identified in both breasts

3. No obvious significant adenopathy is identified.
MRI BI-RADS: 4 Suspicious for malignancy

I know I won’t know anything until the biopsy next week but I’d like to prepare myself. Has anyone had a similar situation? I appreciate any feedback!

blah333 · January 2020

Well - do not get too twisted up over the phrase "suspicious for malignancy" that sounds so severe here. I thought for BIRADS 4 they usually say "suspicious abnormality" -- it just means something more suspicious than your cysts, that from the imaging they can't tell is cancer or not, biopsy is the only way to tell. My impression is that because your breasts have so many masses, and now there are regional calcifications (which - when they appear in clusters, are associated with DCIS) and also architectural distortions can also raise a red flag.

It's good you are getting checked out. It sounds like your breasts have a lot of activity going on! Seems like they want to check on that 2cm mass as well as a few complex cysts just to make sure no cancerous activity is going on. Most Birads 4 biopsies come back as benign. However I would not be surprised if you have to undergo more biopsies in the future. They are stressful but better than blowing them off. I wouldn't feel too bad about waiting 6 extra months between mammograms, cancer can take a long time to grow.

There is also a thread called "Interpreting your Report" where a former breast imaging person DJ mammo can give you more feedback about the text you shared here.
https://community.breastcancer.org/forum/83/topics...

Yogatyme · January 2020

blah is right. It is hard to tell with dense breasts and it is likely you will have inconclusive mammograms. Not everything that shows up on mammogram or us is malignant. Remember, these are screenings and only biopsy will give a definitive answer. As for encouraging you to stay on the anti-depressant, I doubt that has anything to do with thinking you have cancer. Anti-depressants have to be titrated down and you don’t need the potential effects of that while going through the diagnostics. Hoping for the best for you.

Beesie · January 2020

The fact that this is the result from an MRI makes this situation different than assessing the results of a mammogram. MRIs are more sensitive and accurate than mammograms, particularly for those who have dense breasts.

The concern is the spiculated mass. From what I've read, on MRIs, these represent breast cancer about 60% - 80% of the time, although as noted in your report, they could be radial scars, which are benign. The fact that "the enhancement kinetics pattern is not overtly suspicious" is favorable and likely leans this more to being a radial scar than would usually be the case. Still, I'd guess the odds are probably 50/50 that this is cancer.

So be hopeful, but be prepared.

The suggestion that you post this in djmammo's thread is a good one. He's the expert around here.

Alsmom2 · January 2020

Thank you guys for all you're responses! I really am thankful I stumbled across this forum! I did post a message to djmammo and here is his response:

A very common scenario: Cancer vs radial scar.

Although a biopsy is always necessary to tell the difference, the fact that it was not seen on US makes cancer less likely and RS more likely. It would be difficult to miss a 2cm cancer on US.

I really appreciate everyone taking time to respond. You guys really have an amazing thing going here. I am still worried of course but have talked myself off the ledge after reading a bunch of threads. Cancer is still super scary but also is treatable andthe treatment options have come a long way too.

I’ll post my results when I get them. Blessings to all!

WC3 · January 2020

At this point, your doctor knows about as much as the report details. You have an area in your breast that has some characteristics commonly seen in malignant lesions, which may or may not be cancerous and requires more investigation.

There are a lot of reasons your doctor would advise you not to go off your anti depressants at the moment. I don't think it necessarily indicates that your doctor thinks you definately have cancer. S/he more likely just does not want you to become overwhelmed with depression and worry over something that has not been confirmed to be cancer.

Alsmom2 · February 2020

Hello so I just wanted to give an update in case anyone reading has a similar story. I got the results from my MRI guided biopsy and it said it was a radial scar. I went for a follow up with the breast surgeon and she basically said she didn't really think we could trust the path report because my MRI was so suspicious. Well that scared the hell out of me—I knew I would need it removed and there was a chance it could have some cancer cells mixed in but the way she acted freaked me out. Then after I start crying and saying they took 11 pieces of a 2 cm area (I realize these are small 9g needle) she pulls up the MRI and says yes it looks like they're right in the spot! I was like what the heck???

So anyway I had the wire localization and excision yesterday. She acted the same way after the surgery saying she's just glad it's removed and we'll have to wait for path. I have an appt next Friday so I guess I should know by then. I do appreciate her being cautious.

Doesn't having a radial scar make you more at risk for breast cancer in the future???

Path Report

Left Breast Biopsy 3:00; MRI Guided Breast Biopsy: Benign breast parenchyma showing fibrocystic changes with portions of radial scar, duct ectasia, apocrine metaplasia and usual ductal hyperplasia. .

No Evidence of atypical hyperplasia or malignancy

Comment: Deeper levels are examined. Immunohistochemical stains (p63 and SMMS-1) performed on block A3 to evaluate radial scar lesion. P63 and SMMS-1 highlights myoepithelial cells confirming radial scar and benignity. Clinical correlation and appropriate follow-up is suggested.

QA Review--Key portions of case are reviewed by one or more pathologists atpart of Pathology QA process.

Clinical History: Left breast spiculated mass seen on MRI. LMP 1/21/2020. HRT: none. Left breast cancer vs benign lesion.

Gross Description: A. The specimen is received in formalin, labeled with pt name and left breast MRI guided biopsy 3:00 (2cm). It consists of multiple cylindrical cores and fragments of tan-yellow soft tissue, measuring in aggregate of 3.0 x 2.5 x 1.0 cm. The specimen is submitted in its entirety for microscopic examination in cassette labeled as A 1-3.

I also send two messages to djmammo and these are his responses:

Well that's good news. All radial scars are removed just in case as there is a very small malignant potential (although I personally have never seen one come back after excision with an upgrade to IDC).

11 samples with a 9g (large) needle is far more material than I would routinely obtain with five 18g (skinny) core samples.

It looks like the pathologist is convinced its a radial scar. They can enhance on MRI. There is always the chance that there are abnormal cells inside the radial scar and that's why they are all routinely removed and examined in their entirety.

Calvin71 · June 2021

did you ever have surgery there ?

Alsmom2 · July 2021

I had many cysts drained on both sides and cannot remember but think that might have been where one was at one time.

Confused

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