Subtle Architecture distortion measuring 14 mm

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hickjen01
hickjen01 Member Posts: 13
edited July 2020 in Not Diagnosed But Worried

Hi! I'm a 46 yr old mother of one. Mammogram in June, results show as follows:

Impression: There is architecture distortion identified within the left breast in the upper quadrant which is demonstrated along the posterior third adjacent to the pectoral muscle. This is identified best with tomosynthesis. This is not demonstrated on the craniocaudal views. This is a far posterior lesion. For further assessment, recommend compression of this area in the left breast in the MLO projection as well as a true lateral view. In addition, recommend a cleavage view of the left breast in hopes of better evaluating the medial portion of the left breast. The dedicated left breast images should be performed with tomosynthesis. Additionally, recommend ultrasound of the left breast from 6 through 12:00 for further assessment.

Comparison: May 24, 2019, May 14, 2018, Dec. 16, 2016

Breast Density Type D: The breasts are extremely dense, which lowers the sensitivity of mammography.

Findings: Exam was reviewed with computer aided detection. Multiple bilateral dermal calcifications. Within the upper quadrant of the left breast with tomosynthesis adjacent to the pectoral muscle, there is subtle architecture distortion which measures approximately 14 mm. On the tomosynthesis grid, this projects medially. No obvious finding however is identified on the craniocaudal views however it is difficult to encompass the entire posterior aspect of the glandular tissues on the craniocaudal view.

Going tomorrow for new mammogram imaging and bilateral ultrasounds.

I'm concerned about the wording of the architecture distortion and 14 mm lesion mentioned.
Should I be concerned about a malignancy diagnosis?

Thanks for reading.

Jen

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  • Moderators
    Moderators Member Posts: 25,912
    edited July 2020

    Dear hickjen01,

    Welcome to the BCO community. We are sorry that these changes and the concern they are raising for you have brought you here. We are glad that you reached out. You may want to check out this link to common imaging questions in this same forum for additional information. Keep us posted on what you learn.

    The Mods

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited July 2020

    hick - hold on until you have the results from the diagnostic mammo and the ultrasound. It's hard to wait, but try not to jump to conclusions.

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  • hickjen01
    hickjen01 Member Posts: 13
    edited July 2020

    Update: I am scheduled for a needle biopsy next Tuesday. Bi-rads 4

    Second mammogram results with bilateral ultrasound results:

    Oval appearing heterogeneous predominately hypoechoic lesion is seen in the 12:00 position with irregular hazy margins apporximate .72x 1.3 x 1.5cm which appears wider than tall and shows "Dirty" acoustic shadowing and more central homogenous hypoechogenicity as well as eccentric internal color. Doppler signal concerning for neoplasm not seen with prior breast ultrasound study in 8/26/19.

    Left mammogram: Left true lateral view with tomosynthesis shows heterogeneous

    Incidental left axillary lymph node is seen 2.1 cm length with smooth well-demarcated margins and showing internal color doppler signal in the sagittal plane.

    Impression: Abnormal left axilla mammographic and left breast ultrasound imaging findings concerning for neoplasm versus scar.

    After the bilateral ultrasound, radiologist came in to discuss what was found and said that he couldn't rule out breast cancer without a biopsy. So, I am very concerned that it is in fact BC.

    The area is small, deep and near the pectoral muscle. The surgeon I saw this morning wasn't comfortable with biopsy because of the location and size. He is referring me back to the hospital for biopsy.

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  • Beesie
    Beesie Member Posts: 12,240
    edited July 2020

    "After the bilateral ultrasound, radiologist came in to discuss what was found and said that he couldn't rule out breast cancer without a biopsy."

    Just so that you know, what the radiologist said applies to any imaging that a radiologist assesses to have a greater than 2% risk of being cancer. 2% is the dividing line between monitoring with short-term (usually 6 month) follow-up versus being sent for a biopsy. BIRADs4 is assigned to any imaging where a biopsy is recommended.

    image

    As you can see, BIRADs4 covers a wide range, from >2% all the way up to <95%. I don't know where the radiologist would assess your imaging in that range. On average, I believe approx. 25%-30% of BIRADs4 biopsies are malignant.

    Good luck with the biopsy. Please let us know how it goes.


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  • hickjen01
    hickjen01 Member Posts: 13
    edited July 2020



    thank you Bessie. Is there anything in the reports to suggest BC? I’m worried because of the biopsy. I’ve had cysts in the past in my right breast so this is completely different looking. I’ve had cysts drained and removed in my right breast. The concerned area is in my left breast. Lymph node in my left armpit is 2cm.

    Can you tell me how long it usually takes to get the results from the biopsy? Days? Weeks?

    Thank you for replying.

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  • quinnie
    quinnie Member Posts: 221
    edited July 2020

    Hickjen01: Both my biopsies took 2 days for the results. I know it depends on the hospital etc. I hope for good results for you. Let us know

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  • hickjen01
    hickjen01 Member Posts: 13
    edited July 2020

    Update: Meeting with surgeon on Monday morning to discuss needle aspiration biopsy results and doing an incisional core biopsy.(remove the entire area of concern?

    What could this mean?

    1) Needle aspiration biopsy inconclusive?

    2) Has only here had a needle aspiration biopsy and then require core biopsy of the area? If so, I'm interested in hearing your story. I've had an aunt to be diagnosed with DCIS, but it was contained in the cyst, so they staged her a 0.

    3) Could this be DCIS- early cancer?

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited July 2020

    If your biopsy was a fine needle biopsy they often don’t get enough tissue for diagnosis, thus inconclusive.

    Core biopsy and excisional (incisional) biopsy are two different things. Core biopsies are bigger gauge needles that extract more tissue (cores) than a fine needle. Excisional biopsy is usually done to remove the entire “iffy” area seen on your imaging. They are often done after a needle or core biopsy turns up something like atypical cells and they want to make sure there is nothing worse going on in the area.

    Could it be DCIS? Yes, but it could also be something benign like atypia, complex sclerosing lesion or other benign things

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  • hickjen01
    hickjen01 Member Posts: 13
    edited July 2020

    thanks Melissa for the detailed description of biopsies. It looks like I will be having the area of concern removed in it’s entirety. Still very hopeful that’s only a complex cyst! I’ll update again after my next biopsy.

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  • hickjen01
    hickjen01 Member Posts: 13
    edited July 2020

    I met with surgeon today. The core biopsy was inconclusive due to not having enough sample to test. The FNA biopsy showed “Atypical/Abnormal ductal cells”

    My surgeon has scheduled me to have an excisional biopsy to remove entire area of concern. My surgery is on Thursday morning.

    Would anyone care to share your story about atypical/abnormal ductal cells found in the FNA biopsy?

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  • Beesie
    Beesie Member Posts: 12,240
    edited July 2020

    That's really odd... it's usually the reverse. FNAs (using a needle & syringe) often don't capture enough tissue to find anything or make a diagnosis. Core needle (a device that sounds like a staple gun) biopsies, because they use a larger gauge needle and because usually several samples are taken, generally provide enough tissue to make a preliminary diagnosis.

    You wrote on the 16th that you would be meeting the surgeon today to discuss the FNA results and the next steps, which would be either a core needle biopsy or an excisional biopsy. So I'm confused. When did you have the core needle biopsy?

    For ADH, atypical ductal hyperplasia, on average approx. 20% of excisional biopsies end up finding either DCIS or invasive cancer, with the remaining 80% confirming the finding of atypical cells only.


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  • hickjen01
    hickjen01 Member Posts: 13
    edited July 2020

    on the 16th I wrote that I would be meeting the surgeon on Monday (today) to discuss results. I apologize if it seems like my posts are confusing...
    I had the needle core biopsy (staple gun lol) and FNA on the same day. The core biopsy sample didn’t survive (surgeon said not enough tissue was submitted) The FNA showed atypical/abnormal ductal cells. The size of the area was 14 mm.

    My excisional biopsy is schedule for this Thursday. Will I know results from that the same day, or will I have to wait a few days for those results?? This waiting game is hard!

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited July 2020

    Isn't an excisional biopsy the same at a lumpectomy? Your doc should be able to give you most of the information after surgery. My doc did frozen sections and didn't close until the results were back. Some things may require further testing. If you think you'll be too groggy from the anesthesia, be sure to have the doc talk to someone else who can relay that info to you. Good luck.

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  • hickjen01
    hickjen01 Member Posts: 13
    edited July 2020

    I’m new to all of this... so I’m not sure of the technical terms. I’m reading the Pathology reports. My breast surgeon today said that he wants to go in and get it all out. Is that the same as a lumpectomy? I have no idea...

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  • Beesie
    Beesie Member Posts: 12,240
    edited July 2020

    An excisional (or surgical) biopsy is almost the same surgery as a lumpectomy but the objective is to remove the area of suspicion for diagnostic purposes rather than remove a known cancer, so there can be some differences. Because there often is a good chance that cancer won't be found, the surgery is done with more focus on cosmetic results and less concern (if any at all) about surgical margins. On the other hand, surgical margins are critical with a lumpectomy. Sometimes the term 'lumpectomy' is used for both procedures since they are so similar but it is more accurate and much clearer to use the separate terms, excisional biopsy when the goal is to make a diagnosis, and lumpectomy when the goal is to remove cancer after a diagnosis has already been made.

    I have to disagree about the likelihood of getting the results immediately. I've had several excisional biopsies and have never received the results right away. From reading this board, I can't think of many cases where someone has received their excisional biopsy results right away. Usually the tissue is sent to the pathology lab and it takes several days to get the results. Sometimes during a lumpectomy frozen samples are done on surgical margins or sentinel nodes but even then, the results are preliminary and it takes several days to get the final pathology results, which could differ from the quick assessment done on the frozen sample. Because the results can change, I think it would be rare for a frozen sample to be done during an excisional biopsy, when every cell of the removed tissue will need to be closely examined under a microscope.

    hickjen, I'm afraid this means you will likely have to wait a few days for the results.



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  • hickjen01
    hickjen01 Member Posts: 13
    edited July 2020

    thank you Bessie. Your explanation is helpful. The waiting is hard... my yearly mammogram was June 12, but I didn’t receive the results until early July.

    July 9th-Diagnostic mammogram and bu-lateral ultrasound

    July 14- Core and FNA biopsies

    July 23- Excisional biopsy due to FNA showing “atypical Ductal cells”

    So I will most likely won’t have a complete answer until next week. Ugh...

    family history: 4 maternal aunts with BC (1death from BC) 1 maternal cousin diagnosed with metastatic BC at age 29

    My mother died at the age of 43 (not from BC) All of her sisters have been diagnosed with BC. It’s likely she would have been diagnosed as well if she would have lived longer... just my personal opinion.

    (2) Paternal aunts with BC

    I have extremely dense breast tissue- Category D... I’ve been having mammograms for 10 years... this is the first one to have come back with bad results.

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