Interpreting test results

Hi Djmammo,

Hoping you could help me out again. I had an MRI completed and below are the results. My dr has given me an order for an ultrasound guided biopsy, but I’m fairly certain she did not read the entire report. They found increased uptake at the 8:00 position, but the MRI and US found calcifications in the 3-4:00 position. I’m not sure what I’m supposed to do at this point and I’m not confident in my GP. Even the MRI location isn’t consistent as under assessments, it says 7:00.Any thoughts?

MRI Bilateral Breasts With and without Contrast

History: Left breast density

Technique: 1.2mm axial sections were obtained with 3D T1 techniques. 4mm sagittal sections were obtained with T2 fat suppressed techniques. 4mm axial sections were obtained with STIR techniques. 1.5mm axial sections were obtained with T1 3D techniques before and after the administration of 20cc of ProHance injected through the right arm. Five sequences were obtained at 1 minute intervals after the injection of contrast. Subtraction sequences were generated.

Comparison: the report of the patient's mammogram of 12/12/19 and the ultrasound study of 12/12/19 have been reviewed.

Findings: no lesions are seen in the included portions of the upper abdomen. The included portions of the lower chest have a normal appearance.

At the 8:00 position of the left breast, there is a 7mm focal area of increased uptake with contrast material. This is of some concern.

There are no other areas of increased uptake identified.

This area of increased uptake is not the location described on the prior studies. Still, correlation with all of these studies should be helpful in further assessment.

Assessment: Suspicious, ACR BIRADS category 4. There is an area of suspiciously increased uptake at 7:00 in the left breast.

Recommendations: I would suggest correlation with the mammogram and ultrasound studies, and the decision on biopsy should be based on all of the findings, if there is a suspicious area on the mammogram and ultrasound study, then biopsy can be guided based on those findings.

I appreciate your candidness. I have the same concerns. I too felt the report was lacking and I am not in the medical field. I was also wondering who is supposed to compare the reports, if they did not. Based upon this persons signature, they should be qualified, but I wonder and have wondered this entire process if the holidays are literally getting in the way. My first thought is to call this person and see if I can have them clear this up. Or are there specialists out there that can do this?

Thank you for your time, especially today being a holiday. Happy new year.

Hi DJMammo,

You have been so helpful and I truly appreciate it. I have since received a 2nd opinion and another ultrasound of the spot in my left breast. I will be having a biopsy in the next couple of weeks, but was curious to know your opinion of the new report. Again, I can’t thank you enough for all you do. If it weren’t for you, I would be really struggling to navigate this.

ULTRASOUND FINDINGS:

High-resolution real-time ultrasound scanning was performed.

Ultrasound was performed to evaluate an outside ultrasound finding in the left breast at 3 o'clock 5 cmfn seen on 12/12/19. Today, there is a hypoechoic mass with angular margins in the left breast at 3 o'clock located 5 centimeters from the nipple. This may represent an intraductal process. No internal vascularity is seen.

IMPRESSION:

Hypoechoic mass in the left breast at 3 o'clock 5 cmfn, possibly intraductal, is suspicious. An ultrasound guided biopsy is recommended.

BI-RADS Category 4B: Suspicious Abnormality

I should have included all the information! Sorry. the 2nd opinion included a review of the MRI and they were not able to find something at 8:00, but perhaps at 6:00. They would like to redo the MRI, but that is on hold while I work with insurance. Here is the report on the 2nd opinion of the imaging.

01/09/2020 Addendum:

ULTRASOUND FINDINGS:

Upon further review, a repeat targeted ultrasound of the LEFT breast is recommended to further characterize the elongated hypoechoic lesion labeled at LEFT breast 3- 4 o'clock 5 cm from nipple on outside ultrasound to

exclude an intraductal mass. The recommendation for repeat breast MRI, as noted below, remains unchanged.

BI-RADS Category 0: Incomplete: Needs Additional Imaging Evaluation

-

HISTORY:

Patient is 37 years old and is seen for an abnormal finding on a prior study.

EXAMS INTERPRETED:

Bilateral mammogram with tomosynthesis 12/12/2019 Ultrasound bilateral breast 12/12/2019

Breast MRI 12/27/2019 (limited review)

MAMMOGRAM FINDINGS:

Films from outside facilities demonstrated the findings noted below.

There are scattered areas of fibroglandular density.

There are multiple subcentimeter circumscribed oval masses in both breasts. Their multiplicity and bilaterality suggest a benign etiology, such as

cysts among other benign etiologies. A few scattered similar-appearing small groups of punctate calcifications are also noted in both breasts,

most likely of benign etiology. No suspicious masses, suspicious calcifications, or other abnormalities are appreciated in either breast.

ULTRASOUND FINDINGS:

Submitted ultrasound images from both breasts depict the following: --right breast 6:00, 6 cm FN, a circumscribed oval hypoechoic mass with possible calcifications measured at 6 mm (images 4- 11)

--right breast retroareolar, mild duct ectasia (images 14- 16)

--left breast 4:00- 5:00, 5 cm FN, a circumscribed oval hypoechoic mass

with possible calcification measured at 9 mm (images 17- 24)

--left breast 3:00- 4:00, 5 cm FN, mildly ectatic duct and a portion of the

duct with intraluminal debris versus an adjacent complicated cyst measured at12mmx3mm(images25-38)

The above depicted findings do not demonstrate suspicious sonographic features.

NOTE: Breast MRI was performed at outside facility on 12/27/2019. The written report from that exam stated, "at the 8 o'clock position of the

left breast, there is a 7 mm focal area of increased uptake with contrast material. This is of some concern." No distance from the nipple, image number, or key image given. Upon limited review of the submitted MR images, there are similar-appearing foci of enhancement scattered throughout both breasts, but with a predominance in the lateral region of the right breast. I cannot definitively identify the enhancing focus of concern in the left breast at 8 o'clock described on the outside report. A possible corresponding enhancing focus is seen on image 24/104 of series 8; however, this focus is at the approximate left 6 o'clock position and does not appear unique from the other enhancing foci in either breast.

IMPRESSION:

No mammographic or sonographic evidence of malignancy in either breast.

Patient underwent breast MRI at outside facility on 12/27/2019. The written report from that exam described a 7 mm enhancing focus of concern in the left breast at 8 o'clock. I cannot definitively identify that focus on my limited review of the submitted images, as detailed above. Given this, repeat breast MRI is recommended at this time. If this is not feasible,

then a 6-month follow-up breast MRI should be performed.

BI-RADS Category 2: Benign Finding(s)