Architectural distortion.. biopsy Tuesday

I was fortunate enough in 2013 to have a benign result on a double biopsy of righty for microcalcifications. You all gave me confidence and some sanity so thank you. I've had clear diagnostics since and went back to screening three years ago. My first 3D was December 2017 and all clear. I fell off the wagon for insurance reasons but here I am back with a finding that was not present on my 2017 images.

Architectural distortion has a bad rap so I thought I'd come back here for experiences and even hopefully djmammo to take a gander at my report. I find it worrisome but what do I know... biopsy on Tuesday, result appointment on the 11th. Time moves so slow during these events.

*commentary about the radiologist and breast specialist below results.

EXAM: POP MAMMO DIG DIAGNOSTIC RIGHT (US IF NEEDED PER RAD REC(R92,R92.1,R92.8), POP US BREAST UNILATERAL RIGHT LIMITED

CLINICAL INDICATIONS: R92.8 (Other abnormal and inconclusive findings on diagnostic imaging of breast) .

COMPARISON: Comparison is made to prior exams

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

FINDINGS:

Diagnostic evaluation was performed to further characterize questioned right breast architectural distortion seen on prior screening evaluation dated 2/3/2020.

Spot 3-dimensional imaging of the right breast today demonstrates a persistent area of architectural distortion seen on right spot MLO slice 34 and right CC spot slice 33 in the superior central right breast at 12:00 approximately 5 cm from the nipple.

Sonography was pursued to further characterize.

Real-time evaluation of the entirety of the upper right breast was performed by myself and no definitive sonographic correlate was identified on real-time evaluation. A limited saved image of the right breast at 12:00 6 cm from the nipple performed by

the sonographer demonstrates a small area of ill-defined echogenicity that represents normal appearing breast tissue on real-time evaluation performed by myself. No definitive suspicious solid or cystic mass was seen in the right breast on real-time

evaluation.

Tissue sampling under stereotactic guidance/3-dimensional guidance of the architectural distortion in the right breast as detailed above is recommended.

Digital breast tomosynthesis was used in the interpretation of this examination.

The mammogram was also reviewed by R2 image Checker computer aided detection (CAD).

ASSESSMENT: BI-RADS 4: Suspicious

MANAGEMENT:Biopsy is recommended.

Tomosynthesis guided right breast biopsy of architectural distortion in the superior right breast as detailed above is recommended.

The findings and results of the evaluation were discussed with the patient at the time of the examination by Dr. Jay G. Patel. Patient exposed understanding regarding need for tissue sampling of the right breast.

The patient will be provided a lay person version of this report verbally and/or by letter.

B4/5 Biopsy recommended

**commentary, radiologist said to my face he saw what the us tech saw and was concerned, report reads differently.

Breast specialist I've seen since 2013 is incredible and found it right away via ultrasound based on tech measurements and provided US and diagnostic photos. She said we'd hope for benign results but may have to have a different conversation. She opted for US guided biopsy since it was visible there.

Does this verbiage lean one way or another? I know it won't change anything but the conversation will keep my brain busy.

Thank you for taking the time to read this.