Normal ultrasound but bad mammo

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ceciliaj
ceciliaj Member Posts: 3
edited June 2021 in Not Diagnosed But Worried

Greetings! My story is a bit weird so I would appreciate it if anyone can offer some guidance or suggestion.

During my annual checkup, I found a breast lump in my left breast, the rating is bi-rads 3, I know I should not worry about this results but I ordered a MRI just to be on the safe side. (I live in China, so it's not that expensive to order those tests and the waiting period is relatively short)

Two months later, I got my MRI done and got the results, the lump on my left side is not mentioned in the MRI report, instead, the report says I have bi-rads 4c lump on my right breast. I immediately went into panic mode because bi-rads 4c in my opinion is very close to a breast cancer diagnosis. So I went to see my doc again, he felt my breasts and said he could not feel any lumps, on top of that he ordered another set of ultrasounds and mammo for me.

Strangely enough, the new ultrasound still cannot locate any mass on my right breast even after I told the technician where to look (I also did another ultrasound in another hospital just to be on the safe side, but they couldn't see the mass either). However, my mammo results came back with a similar bi-rads 4b diagnosis for the right side "lump"

My doctor reviewed the results and the films of both MRI and mammo, he said there's nothing he can do at the moment, not being able to see the lump on ultrasound or feel the lump physically, he can not do biopsy or surgery. In addition, he said, he cannot see an actual lump on the films of MRI and Mammo, so he suggested me to go back home, exam myself every week and go back to him for another ultrasound 1 month later.

I live in Beijing and this is one of the best physicians in the breast cancer area in China so I'm pretty sure it's not a misread. But knowing the results of MRI and Mammo, I can hardly not think about it let alone waiting for another month.

What do you guys think? Any thoughts? Many thanks in advance.

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  • flashlight
    flashlight Member Posts: 698
    edited May 2021

    Hi ceciliaj, Could it be that they mixed up your mammogram report with another patient? I can understand why your doctor is unable to do anything at this time. He cannot do a biopsy on something he can't see. Can you still feel a lump? Did you have the mammogram done at the same facility?

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  • LivinLife
    LivinLife Member Posts: 1,332
    edited May 2021

    Wow ceciliaj! I know some imaging picks up some things and other images will not see it though geez! Since it was seen on mammo are they unable to do a stereotactic biopsy? I've had 3 of those though even as I type that question I'm thinking I'm not completely thinking about this correctly....? Hopefully someone will come along who has more knowledge in these areas... Sending support for now!

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  • moth
    moth Member Posts: 4,800
    edited May 2021

    Hi cecilaj, my suggestion would be to:

    get the actual imaging from the MRI & mammogram, not just the report, confirm that it's yours (as someone mentioned above in case there's a patient error) and then get a second radiologist to read the scan and report on it.

    You absolutely should get a biopsy on this if you are getting anything with a 4 on either of the reports.

    Interventional Radiology does both mammogram guided biopsies and also MRI guided biopsy but if the same spot is being identified on both, mammogram guided is easier. If necessary, you can have a wire guided biopsy where an interventional radiologists first places a wire during imaging, and then a surgeon does an excisional biopsy.

    I think your doctor is not well informed. You need a referral to interventional radiology.

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  • ceciliaj
    ceciliaj Member Posts: 3
    edited May 2021

    Hi All,

    Thank you all so much for your replies. Am super grateful for a community like this

    Flashlight : I initially thought it's a mixup too, but the MRI and Mammo report indicate the same position for my right side lump and it's done at two reputable hospitals. The weird part is no one can feel my lump, not the two doctors I saw, not myself. I guess that's why both of the doctors send me home? Yes, I already got a second and third opinion even and they all tell me to go home and wait.

    Livinlife: Yes, isn't that super odd? The doc told me that they do have mammo guided biopsy, but the fact that the lump is only stated in the report, he cannot see it in the actual imaging makes it not possible to do one. I honestly think the radiologist and my doc should sit down together so that the radiologist can just tell them why she/he reported a lump and where the doc can find it. Is it too naive? I mean he's from Peking Union Medical College Hospital, it's the best if not the second-best hospital in China. he could have thought this, right?

    Moth: Thank you so much for your suggestion! I completely agree that I need a biopsy, but my dilemma is that now that I have seen 2 docs, they both told me the same thing, go back home and wait. I spoke with another reputable doc today, she told me the doc I saw is very good in this field, so she concurs with him on the waiting suggestion, if I insisted on going to see her, I would need to do another set of MRI, ultrasound at her hospital. Sigh, my boss already thinks I'm over reacting it so if I ended up getting the same results, I guess he would not like it. I know it's silly to think about work when my health is in the line but with a clear ultrasound, would wait for an extra month do that much harm if it's indeed BC?

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  • Beesie
    Beesie Member Posts: 12,240
    edited May 2021

    cecilia,

    Sorry that you are going through this.

    What you should know first is that non-palpable lumps are extremely common. So the fact that you and the doctors can't feel the right breast lump lump isn't unusual and should be irrelevant to whether or not you can have a biopsy.

    To moth's point, in North America (and elsewhere, I believe), radiologists perform most needle biopsies. And it's radiologists who are educated and trained to review and assess breast imaging. I don't know the area of speciality of your doctor, but I assume he is not a radiologist. Mammogram-guided biopsies are common. Since your MRI and mammogram both refer to the lump, obviously the radiologists who reviewed and assessed that imaging could see the lump. So unless things are very different in China with regard to medical specialties, it is one of those radiologists who should be doing the biopsy.

    What is the specialty of the two doctors who've told you to wait? Do either work at the same hospital or facility where you had the MRI and mammogram? If not, can you see a doctor at one of those facilities, or do either of those facilities have radiologists who do biopsies?

    The confusion to me is not the imaging. Having something show up on one imaging modality and not another is common. The confusion stems from the fact that your doctors are not seeing in the imaging what the radiologists (who are the experts at this) are seeing. And the confusion is compounded by the fact that your doctor is making the decision on the biopsy (and would be the one to do it?) rather than the radiologist (who is the expert at this). On top of this, your doctor is not speaking to the radiologist.

    I'm in Canada. I've had numerous biopsies. In most cases, the radiologist who reviews the imaging is the one who recommends the biopsy (a BIRADs 4 is in effect a biopsy recommendation) and performs the biopsy. Once my doctor orders the imaging, she in effect hands the process over to the radiologist and does not get in the middle of the process.


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  • flashlight
    flashlight Member Posts: 698
    edited May 2021

    ceciliaj, I had a 3D mammogram where they saw something suspicious. I had an ultrasound that day and they confirmed there was a mass. I was given the choice for the radiologist to do the biopsy or a breast surgeon. This hospital facility had a nurse navigator come out and talk to you about the procedure. The radiologist appointment was 2-weeks out and the surgeon was 3-4 weeks. I decided to have it done by the radiologist. If you wait one month would you have to wait for a possible biopsy to be done after further testing? Did you have more confidence in this new doctor? Maybe one month isn't too long to wait if you will have more facts to work with. I understand about the work problem. I did it myself for most of my career. Best wishes. let us know how you are doing.

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  • ceciliaj
    ceciliaj Member Posts: 3
    edited June 2021

    Hey Guys,

    It's been a month (almost) and I want to share some updates. My official appointment is next week but I just went to another hospital for a second opinion. They ordered me another ultrasound testing(I know!), and the results came back all clear again. The doctor heard my story and set me up with a meeting with their on-call radiologist, the radiologist says there's something there, but he feels the 4c rating is too high, and combined with the fact there's still no showing on my ultrasound after 1 month, the doc and the radiologist feel I should go back home and recheck in 3 months

    I want to get another MRI done in this hospital but they told me it's not necessary.

    I guess I'm still going to my original appointment since It still doesn't feel like a closure for me. I feel a little bit at ease now but I just don't feel right and feel something wrong in my right breast. I think I will still need surgery or biopsy otherwise the stress and anxiety would never go away. :/

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  • Calvin71
    Calvin71 Member Posts: 24
    edited June 2021

    Does the Radiologist ever come out and speak to you ? They ordered ultrasound guided biopsy yesterday . Original mammo showed speculated margins 8mm . Breast has had like 6 surgeries . They have been commenting on same scar tissue and fibrogpandular tissue for 3 years now . Tons tiny lumps in there . While having the diagnostic mammo I did see the mass on screen . Not white but kinda grayish . Any input appreciated

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  • flashlight
    flashlight Member Posts: 698
    edited June 2021

    Calvin71, Yes, the radiologist sat down with me after my ultrasound confirmed a mass. He then explained about the needed biopsy and who might do it. Have you seen a breast surgeon? Maybe that is where you might find more answers.

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