Left breast asymmetry on mammo

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deelove
deelove Member Posts: 10
edited October 2020 in Not Diagnosed But Worried

Hi all, I am new here so I apologize if this has been discussed before.

I had a mammo with tomosynthesis and breast US last month which showed on mammo scattered areas of fibroglandular densities. Right breast was normal, no issues. Left breast showed an asymmetry in the subareoloar region. Ultrasound findings- US demonstrates a normal appearing tissue in the subareoloar region of left breast. No axillary lymphadenopathy. Normal appearing tissue in left breast requires additional evaluation.


Once they received my mammo and US findings from 2016- final assessment was made after comparison- scattered areas of fibroglandular densities. Right breast was again fine. Left breast there was a NEW asymmetry measuring 2 centimeters seen in the MLO view only in the poserior of the left breast located 9 centimeters from the nipple. Additional mammographic views and US is recommended.


I have to schedule these studies but have been worried sick to my stomach about BC.

How common are these findings and how often are they benign?

ANy little piece of mind will help :)


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

    Callbacks due to asymmetry are very common - I have answered so many posts on this topic over the past few weeks, including one earlier today.

    10% of mammograms results in a callback. 95% of callbacks are benign. Asymmetry most often turns put to be nothing - often it's just caused by the way the breast tissue is squished in the machine. In your case it sounds as though the asymmetry was seen in one mammogram view only, and only on the mammogram with no corresponding area of concern on the ultrasound. Anything is possible, of course, but that description makes it highly likely to be nothing at all.

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  • deelove
    deelove Member Posts: 10
    edited September 2020

    Beesie, thank you so much for your response .

    That certainly brings me peace of mind. I scheduled my additional Mammography studies and left Breast US for next week, Thursday October 1st. I expect to be a bit of a mess until then. Hoping for the best.

    All my love to all the ladies on this forum.


    I do not understand how we do not have a cure for Cancer-


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  • deelove
    deelove Member Posts: 10
    edited September 2020

    I thought it best to post my report :)

    Mammogram and Left breast US on 8/20/2020:

    HISTORY:
    Patient is seen for non-bloody discharge in the left breast.

    FILMS COMPARED:
    This is a baseline study.

    TECHNIQUE:
    The following mammographic views were obtained: bilateral synthetic views, bilateral craniocaudal with tomosynthesis, bilateral mediolateral oblique with tomosynthesis, left craniocaudal spot compression magnification, left lateromedial, and left lateromedial spot compression magnification.

    Computer Aided Detection was used in the interpretation of this mammography study.

    Technologist: Heather Cantore

    DIAGNOSTIC MAMMOGRAM WITH DIGITAL BREAST TOMOSYNTHESIS FINDINGS:
    There are scattered areas of fibroglandular densities.

    In the right breast there are no masses, asymmetries, or suspicious calcifications.

    There is an asymmetry in the sub-areolar region of the left breast.

    ULTRASOUND FINDINGS:
    Ultrasound demonstrates a normal appearing tissue in the sub-areolar region of the left breast.

    Ultrasound scanning reveals no axillary lymphadenopathy.

    IMPRESSION / RECOMMENDATION:
    There is no evidence of malignancy in the right breast.

    Normal appearing tissue in the left breast requires additional evaluation. To assess stability, old films are requested.

    ASSESSMENT: BI-RADS Category 0: Incomplete: Need Prior Mammograms for Comparison

    Component Results


    Comparison Results posted 9/10/2020:


    HISTORY:
    Outside films have been made available for comparison.

    FILMS COMPARED:
    Comparison is made with prior exams dating back to 01/14/2016.

    FULL FIELD DIGITAL MAMMOGRAPHY FINDINGS:
    There are scattered areas of fibroglandular densities.

    In the right breast there are no masses, asymmetries, or suspicious calcifications.

    There is a new asymmetry measuring 2 centimeters seen in the MLO view only in the posterior of the left breast located 9 centimeters from the nipple.

    IMPRESSION / RECOMMENDATION:
    There is no evidence of malignancy in the right breast.

    New asymmetry in the left breast requires additional evaluation. Additional mammographic views and an ultrasound is recommended.

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

    Component Results

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  • deelove
    deelove Member Posts: 10
    edited October 2020

    Update- I had my repeat mammogram and left breast ultrasound yesterday 10/01/2020-

    The radiologist came in to the room to speak with me after the US, first thing she said was "So your fine", you a few Cysts in your left breast and one looks complicated so I want to do a fine needle aspiration. We scheduled that for next week Tuesday.

    I have 4 cysts, the one that is going to be aspirated is less than 1cm in size, which is why she cant determine if its a simple cyst so she wants to be thorough and have it looked at and possibly biopsied if it looks suspicious once it has been aspirated.

    She did say she is not concerned and I can have this done at my earliest convenience but I opted to have it done ASAP (next week) as this entire situation has caused me so much anxiety and grief.

    I dont know how common this is, Cysts, and how common it is to have them aspirated/biopsied and the likelihood it is actually Benign. Im petrified....anyone have similar stories you can share with me?



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

    Cysts are extremely common. Over 50% of women have fibrocystic breasts, and most of those women at some point develop one or more cysts. I've had more cysts that I can remember - I started to develop them when I hit peri-menopause. Some I had aspirated (usually because they were so large) and some were just left and eventually shrunk on their own (the fluid in the cyst absorbs back into the body).

    Simple cysts usually don't require any follow-up - they are benign.

    Complex cysts, cysts that are misshapen or may contain large solid components or may have internal septations, can be more concerning and usually require an aspiration or biopsy. I seem to recall reading that the malignancy rate for complex cysts is something like 3% (but I would have to go back and dig that out).

    Complicated cysts fall in-between. I'm glad that your Radiologist used the term "complicated" because too often anything that isn't a simple cyst is just called a 'complex cyst' and there really is a difference between complex and complicated. "Complicated" simply means that while the cyst might be fully fluid filled, the borders may not be completely round or oval or even. Or the borders might look round or oval like a simple cyst, but there might be little bits of debris floating inside the cyst. Most complicated cysts are similar to simple cysts but they have just one small thing that is off. The complicated cysts I've had were small ones - and they can be difficult to biopsy - so my Radiologist recommended 6 month follow-ups rather than aspiration. None of those ever grew or became concerning and all eventually shrunk/went away. The malignancy rate of complicated cysts is less than 1/2 a percent. The following study found a malignancy rate with complicated cysts of 0.4%:

    Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy?


    As someone who has had more than my share of cysts, including complicated cysts - and who has had numerous other breast issues - I can tell you that I never worried for a second about malignancy when I found out that I had cysts. For me, a finding of a cyst, even a complicated cyst, was a relief!


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  • deelove
    deelove Member Posts: 10
    edited October 2020

    Thank you Beesie. For all of the detailed information :)

    Moments ago I received the results on MyChart, here they are:


    Narrative

    HISTORY:
    Patient is seen for additional evaluation requested from prior study.

    FILMS COMPARED:
    Comparison is made with prior exams dating back to 2016.

    TECHNIQUE:
    The following mammographic views were obtained: left mediolateral oblique spot compression with tomosynthesis, left synthetic views spot compression with tomosynthesis, left mediolateral, and left mediolateral spot compression with tomosynthesis.

    Computer Aided Detection was used in the interpretation of this mammography study.

    Technologist: Olga Gomez

    DIAGNOSTIC MAMMOGRAM WITH DIGITAL BREAST TOMOSYNTHESIS FINDINGS:
    There are scattered areas of fibroglandular densities.

    There is an asymmetry measuring 6 millimeters in the left breast at 9 o'clock located 6 centimeters from the nipple.

    ULTRASOUND FINDINGS:
    Sonography was performed in the left breast at 9 o'clock 6 cm from the nipple in transverse and longitudinal planes. Ultrasound demonstrates a complicated cyst measuring 7 millimeters in the left breast at 9 o'clock located 6 centimeters from the nipple.

    Sonography was performed in the left breast at 8 o'clock 5 cm from the nipple in transverse and longitudinal planes. There is a complicated cyst measuring 11 millimeters in the left breast at 8 o'clock located 8 centimeters from the nipple.

    Normal appearing lymph nodes in the left axilla.

    IMPRESSION / RECOMMENDATION:
    Complicated cyst in the left breast is suspicious at the 9 o'clock position. Aspiration is recommended. This is likely a tiny complicated cyst. The patient has been scheduled for this breast aspiration and possible biopsy at the Koman Family Outpatient Pavilion Breast Imaging Section on 10/6/2020 at 8 am. An Epic message was sent to the referring physician with the findings and recommendations. Findings and recommendations were discussed with the patient at the time of image interpretation.

    Complicated cyst in the left breast at 8 o'clock located 8 centimeters from the nipple is probably benign. A unilateral mammogram and ultrasound is recommended in 6 months.

    ASSESSMENT: BI-RADS Category 4: Suspicious Abnormality

    Component Results

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  • deelove
    deelove Member Posts: 10
    edited October 2020

    I had my FNA last Tuesday 10/06- I am going to post the results. I hope this is useful to those going through the same as I was :) I was incredibly terrified of what this may be, I even cried the day of the procedure as the physician explained to me what was going to be done. I was a mess but I do feel somewhat relieved now.....All my best to you ladies...

    A f/u mammogram after cyst aspiration shows the following:

    HISTORY:
    Patient is seen for follow-up after cyst aspirations. FILMS COMPARED:
    Comparison is made with prior exams dating back to 01/14/2016.

    TECHNIQUE:
    The following mammographic views were obtained: left mediolateral.

    Computer Aided Detection was used in the interpretation of this mammography study.

    Technologist: Rebecca Dutton

    DIGITAL DIAGNOSTIC FULL FIELD DIGITAL MAMMOGRAPHY FINDINGS:
    There are scattered areas of fibroglandular densities.

    Follow-up examination was performed for the complicated cyst in the left breast, 8 o'clock seen on 10/01/2020. The finding does not persist on the present exam following ultrasound guided aspiration.

    There is a stable asymmetry measuring 14 millimeters in the posterior inferior region of the left breast located 9 centimeters from the nipple, appears slightly smaller than exam from five days ago. This finding could not be seen today by ultrasound imaging.

    IMPRESSION / RECOMMENDATION:
    Small complicated cyst in the left breast is benign, and resolved following aspiration. Findings and recommendations were discussed with the patient at the time of image interpretation.

    Stable to slightly smaller asymmetry in the left breast is probably benign. Follow-up in 6 months is recommended with left diagnostic mammogram. This was explained to the patient.

    ASSESSMENT: BI-RADS Category 3: Probably Benign Finding(s)

    Component Results


    Here is the report for the FNA procedure:


    Left Breast Ultrasound Guided Aspiration

    CLINICAL HISTORY:
    Patient is seen for an ultrasound guided aspiration of a cyst at 9 o'clock in the left breast, 6 cm from the nipple and a cyst at 8 o'clock in the left breast, 5 cm from the nipple and a cyst at 3 o'clock in the left breast, 6 cm.

    CONSENT:
    Risks and benefits of the procedure were discussed with the patient and informed consent was obtained. A time out confirming correct patient identity, site, and procedure was performed by attending physician.

    PROCEDURE:
    The patient was positioned on the ultrasound table and the left breast was prepped and draped in the usual sterile manner. High resolution real time ultrasound imaging was performed. The cyst to be aspirated was localized in the left breast at 9 o'clock, 6 cm from the nipple. 1% lidocaine was utilized for local anesthesia. A 18 gauge needle was inserted and the needle tip was advanced into the cyst using real time ultrasound guidance. Pre and post cyst aspiration images were obtained. The cyst collapsed. A total of 1 cc of fluid was obtained. The aspirated fluid was discarded.

    SECOND SITE:
    The cyst to be aspirated was localized in the left breast at 8 o'clock, 5 cm from the nipple. 1% lidocaine was utilized for local anesthesia. A 18 gauge needle was inserted and the needle tip was advanced into the cyst using real time ultrasound guidance. Pre and post cyst aspiration images were obtained. The cyst collapsed. A total of 1 cc of fluid was obtained. The aspirated fluid was discarded.

    THIRD SITE:
    The cyst to be aspirated was localized in the left breast at 3 o'clock, 6 cm. 1% lidocaine was utilized for local anesthesia. A 18 gauge needle was inserted and the needle tip was advanced into the cyst using real time ultrasound guidance. Pre and post cyst aspiration images were obtained. The cyst collapsed. A total of 1 cc of straw fluid was obtained. The aspirated fluid was discarded.

    The patient tolerated the procedure well. Antibiotic ointment and a dressing were applied. Post discharge instructions were given to the patient orally and in writing. The patient left the office in good condition.

    CONCLUSION:
    Successful ultrasound guided aspiration of a cyst at 9 o'clock in the left breast, 6 cm from the nipple and a cyst at 8 o'clock in the left breast, 5 cm from the nipple and a cyst at 3 o'clock in the left breast, 6 cm.

    Component Results

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

    Sounds like everything went very well. Since you had 3 cysts that were all successfully aspirated just prior to the repeat mammogram, it seems to makes sense that some asymmetry would remain but that it would appear smaller than on the previous mammogram, which had been done before the aspirations.

    I'm sure all will go well with the follow-up imaging in 6 months. Come back and let us know!

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  • deelove
    deelove Member Posts: 10
    edited October 2020

    I will keep you all updated- thank you Beesie.

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  • Tiger98
    Tiger98 Member Posts: 186
    edited October 2020

    that is great news Dee! I have also been dealing with asymmetry so I have been following your story.

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  • deelove
    deelove Member Posts: 10
    edited October 2020

    Thank you CUGymGirl. I hope the same for you, all benign.

    I hope my story will help others going through the same or similar.

    I will certainly update in 6 months after my next Mammogram :)

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