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Category:

Breast Imaging

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Question:  #1 11/15/2009		Q:	Dear Lilly and all, my insurance co does not have digital mammograms. I went outside my insurance(kaiser) and paid for one. They said that they were fine and there were no findings of recurrent BC I am approaching the end of my 4th yr. and will start yr 5 after Thanksgiving. I was Trip neg no lymph nodes 1.4cm,stage 1, grade 2 anythng else i need to do? What about Thermoggraphy Thank you
		A:	good for you... no, no thermography. just get clinical breast exam and keep doing your own breast self exams. congrats too. truly something to be thankful for as the holidays approach.L
Question:  #2 11/7/2009		Q:	I am 29yrs old, unmarried.6 months back i found some fibroadenomas in my breast. After ultrasound two times i found that there was increase in size in subareolar about 1mm with in 1 month. also i found increase in number from 4 to 5. Will there be any chances of breast cancer. should i go to a cancer specialist.
		A:	well, there is no way for a patient to really determine for herself what is a fibroadenoma. even if you have had them in the past you cannot assume a new lump is "another one." so make an appt with your gyn this week and request too that he arrange for an ultrasound to be done. L
Question:  #3 11/1/2009		Q:	I think I am just looking for a little reassurance. I had a recurrence of my breast cancer with some spread to my lungs. Last fall I had surgery to remove a 4cm tumor from my chest wall (on same side as previous masectomy and TRAM flap reconstructio). After completing radiation and surgery I had a CT scan which showed the expected surgical changes, some fluid collection near the surgical site and the lung nodules. Now, a year later, I had a mammogram which showed an increased density in the posterior central aspect of the breast adjacent to the chest call, which deomnstrates slightly irregular borders. Could this be due to the radiation and surgery, even though it didn''t show up on the CT scan soon after the radiation was completed?
		A:	it depends if they did a mammogram of the tram flap side (which would be unusual to do BTW) or if you are referring to the remaining healthy breast. if this is the healthy side then it would be unusual for it to be from the surgery and radiation since that side wasn't operated on.
Question:  #4 11/1/2009		Q:	I am 35 years old and had a mammography and a sonomammograhpy done for the first time. My mother died 12 years ago from breast cancer. In the sonomammography a suspicious lesion (lobulated mass with some angulation of the borders measuring 1.1 x 0.7 x 0.6 cm) was seen in left breast at 3 o''clock 4 cm from nipple position posteriorly located. A biopsy was recommended. The Doctor recommended first an MRI, which results were: There is a focal 8mm mildly enhancing nodular structure on the medial quadrant of the breast close to nipple. Kinetic curve analysis was obtained showing the benign type of curve. The finding represents a probably benign abnormality by MRI, no correlating with sonographic lesion seen on the lateral quadrant of the breast. No suspicious enhancing lesions are seen. There are no abnormal areas of regional, segmental, linear or ductal enhancement. There is no abnormal internal mammary chain or axillary lymphadenopathy. No suspicious enhancing lesions are seen to suggest malignancy. Probably benign small delay enhancing lesion on the left breast medial quadrant close to the nipple not seen on mammography sonomammography. A biopsy of a lesion on the left breast at 3 o''clock position prevail. This biopsy is already schedule for next week. Nonetheless, this results are very confusing to me, because it seems that both the sonomammography and the MRI talk about different things. The doctor told me that the biopsy was necessary to make sure everything is alright, since the sonomammography showed that suspicious lesion. What do you think? I appreciate the time you are taking to evaluate my case. Thank you very much.
		A:	sounds like the odds are in your favor to get good news and for this to be benign. don't sweat over this. it would be premature to do so.
Question:  #5 10/18/2009		Q:	I recently had a Breast MRI. I am 46yrs old. At 38 yrs old I had ovarian cancer stage Ic, had a total hysterectomy. I have had no reoccurances. I have been on HRT therapy since ''02. I have had my annual mammograms since then - all negative. My recent Breast MRI states there is "an enhancement of the parenchyma bilaterally which may be due to hormone replacement therapy. A 6 mth f/up is recommended to confirm stability." I have 3 questions: 1. should i continue with my HRT treatment ? 2. What exactly does this report mean ? 3. Should I also get a Breast Ultrasound ?
		A:	the good news in that report is to see the word "bilateral". it is very very rare we would see something that would be worrisome and see it in both breasts and in the same location. so it makes sense that it is density associated with increased estrogen levels. your HRT is keeping recurrence of ovarian cancer away. that's good. only if you tested positive for BRCA 1 or 2 would it be a necessity to stop the HRT.
Question:  #6 10/18/2009		Q:	My father had BC when he turned 23. He survived BC only to die from esophageal cancer at the age of 52 (in 2001). I had my 1st mammogram in 2002 (age 25), Bilateral CC and MLO views, moderately dense fibroglandular pattern w/o dominant or suspicious findings. One of my older sisters had had 3 benign cysts removed and one which they are currently watching. Another older sister is getting watched for something--(she doesn''t know what) and getting a mammogram every 6 months for 1 yr to date. My last mammogram was last year (Jan ''08) and it stated: The fibrograndular pattern is again moderately dense w/0 suspicious findings including clustered microcalcifications, architectural distortion or spiculations. Should I be concerned about the clustered microcalcifications? Should I request any other type of exam to be sure nothing is really there since I have dense breasts, like an MRI or a u/s? Thank you.
		A:	i think you are misinterpretting this report. you wrote "w/o" which means it was without suspicious findings of of cluster of calcifications, etc." So it was fine. you've gone though way past the 12 month time for getting checked again though. time to revisit mammography for your annual screening.
Question:  #7 10/18/2009		Q:	I have my yearly mammogram tomorrow and as usual, have been told to avoid caffeine. Is it really necessary or does avoidance of caffeine lessen sensitivity?
		A:	there isn't any good scientific data to tell us that it helps reduce pain. to really have it benefit, if it benefits at all, you'd need to be off caffeine for more than just a day though. drink up!
Question:  #8 9/6/2009		Q:	Went for a diagnostic mammogram this week. My preion showed the diagnosis of biopsy-proven benign disease. Thankfully, have no current problems. Have been seeing a breast specialist yearly for several years, since I had an open surgical biopsy that left periareolar scarring. The dr orders the diagnostic mammo each year and I bring the films for her to review during the clinical exam. This year the mammography technologist at this well-known breast center told me a diagnostic mammogram for a patient with no current problems and no hx of malignancy is not appropriate, even with the biopsy-proven benign disease. She even used the term insurance fraud. Is this correct? Sure was upsetting. Thank you.
		A:	yes she is. BTW, the term "biopsy proven" means malignant. so avoid using that term. you will confuse people.
Question:  #9 9/6/2009		Q:	I am 40 years old, weigh 300 pounds and take metformin for diabetes. The dr. wants me to have a MRI with contrast of my breast. Is it okay for a diabetic taking metformin to have contrast and will I even be able to fit in MRI machine?
		A:	usually the doctor (radiologist) would have you stop taking it for a few days after the study is done. Breast MRI machines come in 2 "sizes"-- under 300 lb capacity and over. so make sure the one he is arranging for you will be the one for a woman's weigh at or above 300.
Question:  #10 9/6/2009		Q:	I had a mammo and an u/s 6 months ago and had a follow up mammo and u/s of my breast the other day. The findings are that the area in the upper medial aspect of the breast has increased in density and prominence since the prior study. There are also two subtle soft tissue densities seen located laterally in the breast. One appears to be located at approx. 3 o''clock. It also says the exam demonstrates an area of slight increased echogenicity in the medial aspect of the breast with mild posterior acoustic shadowing present. The shadowing does not appear as prominent as on prior study and no pathological calcifications are seen. Please explain this to me. Thank you.
		A:	hard to say without a lot more information including the ability to actually look at the images themselves. that said, given there is a change with more density and prominence they might want to pursue a biopsy. ask what the bi-rad score is. this will tell you how concerned or not they are.
Question:  #11 8/29/2009		Q:	I am 45 yrs old and reeived findings from ultrasound and mamogram films. Solid mass 17 mil wide x 6 mil long x 5 mil high with circumscribed margins parrallel to the skin line, no posterior acoustic pattern and oval shape with vascularity present adjacent to the lesion. Can the vascularity flow to the lesion if it adjacent? Does that signify that there may be a chance of possible malignancy even though the other markers seem to point to benign mass? Will MRI be able to show cancer cells and is it possible the vascularity is signigying some cancer activity elsewhere on the breast?
		A:	benign masses can be vascular too. by deion this sounds like a benign fibroadenoma. oval. smooth, wider than it is tall. don't sweat over this. the radiologist can tell you if he/she is concerned or not.
Question:  #12 8/29/2009		Q:	I just turned 40 and I am still breastfeeding my 2 year old. I have never had a mammogram before. I did have a breast ultrasound 1.5 years ago to confirm a breast infection caused by a clogged milk gland due to breastfeeding. Other than that I have had no breast issues and do monthly self exams. My grandmother was diagnosed with breast cancer in her late 70''s. I know mammograms while breastfeeding are hard to read and not so great for a baseline. Should I push for a mammogram at my next Ob/Gyn appointment or ask for a sonogram or ultrasound or just wait until another year? Thanks for your insight
		A:	mammograms during lactation are of little to no value. they show us virtually nothing. your grandmother's breast cancer was late in life and is 2 generations removed from you so this doesn't have much impact on increasing your risk. about 4 months after your finish breast feeding, get the mammo then. breast feeding by the way reduces your risk of getting this disease.
Question:  #13 8/8/2009		Q:	Lillie - Thank you for your quick response. My OB/GYN did the genetic testing last year and my tests came back negative for the BC gene. They never did it on my sister since she was so far advanced with her OVC. It''s just a puzzlement that the radiologist who has been doing the diagnostic mammo all these years never ever suggested a biopsy. But, in all fairness, neither did my OB/GYN last year. don''t know why this year was different since the genetic testing came back negative last year. My thanks, again.
		A:	they would only need to have pursued a biopsy before if they saw it growing or it had some other distinctive appearance that was concerning. hope you get good news dear. if not, i'm just a click away. L
Question:  #14 8/8/2009		Q:	Lillie, I am 61 with a family history of BC. My sister was a sixteen year BC survivor who died of Ovarian Cancer six weeks after diagnosis. As a result of her BC, I have been undergoing diagnostic mammograms for several years. They have been following an area in my right breast since at least 2004. Last year''s mammo read, "...1.8cm mass which is unchanged since prior ultrasounds...stable benign right breast mass since 2004." This year''s read, "Comparison is made with prior mammography of July 2008 and earlier...a stable lobular nodule inferiorly on the right. Three are no overt developing mass densities, clustered microcalcifications or other suspicious findings..."Ultrasound again identifies a multilobular solid lesion in the inferior 6 to 7:00 periphery on the right, again measuring about 18mm in greatest dimension, as it did last year. There are cysts or solid lesions elsewhere in either breast...(Benign Findings), with a stable solid lesion inferiorly on the right , but no suspicious developments on either side." Last year my OB/GYN did not suggest anything. This year she suggested a second opinion. The female surgeon I saw who did an ultrasound suggested a biopsy because of the irregular shape. Is this a normal procedure? Of course, given the recent death of my husband from EC and the miserable past two years with the economy, I am stressed beyond reason. And, of course, the biopsy is a week away. Why would the rad not have suggested a needle biopsy over the last five or six years? Thank you so very much for an enlightenment.
		A:	understandable to be stressed. sorry about your loss too. glad you ar being diligent in getting yourself checked regularly. smart thing to do. its good that it has shown on growth. that implies it is benign. since it doesn't have smooth edges, that meets the criteria for a core biopsy. so proceed. the peace of mind of confirming it is benign will get you something to finally celebrate. also if you haven't considered it, think about genetic testing, unless your sister tested prior to her death and was neg. L
Question:  #15 8/3/2009		Q:	I am 53 years old and for the first time I had to go back for a second mamo on my right breast and they also decided to do a sonogram the same day. Radiologist said that it was basically just dense tissue. I asked him about the difference between sonogram & mri testing for breat cancer as everyone is telling me I should ask for a mri. The radiologists said that the stats. had not proved that the mri was a better tool. My doctor also said she thought the sonogram was sufficient. Both have said that I need a follow up in six months. I talked with a woman that has survived breast cancer and she has said that I need to get retest done before six months and that I should ask for a MRI. What do you think? Thank you, Nancy C. Kent
		A:	I don't know what the radiologist is following. It could be a possible change that will be seen in 6 months that mri would not pick up either. It could be a 6 month check to confirm all is the same. MRI is not necessarily a better test and is used in conjunction with mammogram in specific cases. Friends are well meaning but every case is different. ds
Question:  #16 8/3/2009		Q:	Hello Lillie, I''m 52,dx 9/18/09, Stage 1 (tumor 1.1 cm),Grade 1, 0/3 nodes. Lumpectomy 10/08 with good margins but one close--tumor was lower inner quadrant (6:00 position?) Rads, Tamoxifen since Jan. Just had first post tx mammo and they want an MRI (this Wed.) to better view scar tissue around the site because of dense breast tissue. Is this standard procedure? While I realize that my "stats" are relatively good, my Oncotype score was 19, which was a tad disappointing initially but have been trying not to obsess over that. Does Oncotype score have any bearing on whether or not the MRI will reveal a nasty surprise? Thank you for the intelligence, finesse, and HEART that you put into your responses!! We are indeed lucky to have such a wonderful resource.....Thank you,
		A:	Sounds like your dr is being thorough. MRI is not influenced by oncotype score. Let's hope for the best. ds
Question:  #17 8/3/2009		Q:	I am a 50 year old woman who was diagnosed with a Grade 1, invasive ductal carcinoma (the tumor was less than 1cm in greatest dimension) – all lymph nodes clean. On re-excision additional deposits of .5 mm to 4 mm were found and clear margins to 1 cm have been attained. When the surgery was completed I expected to be sent for radiation but the oncologist recommended that I have a MRI first. The MRI results indicated that there is a single persistent irregular linear area of 2 cm. It is in the same quadrant as the previous cancer. I have since had an ultrasound. The ultrasound is unable to locate this area and a mammogram that I had before the surgery did not pick up anything. After some discussion, I feel they are leaning towards recommending a mastectomy. My last surgery was 50 days prior to the MRI. I take Ramipril, I had already started tamoxifen, and at the time of the MRI I was still experiencing swelling off and on. Can you tell me the likelihood of the MRI showing a false- positive? What does a persistent irregular linear area on a MRI usually indicate?
		A:	That liniear irregularity could be anything including healing normal breast tissue. MRI can have a lot of false positives. I would defer to your doctors however, whether or not more surgery is necessary and/or get a 2nd opinion. Best.
Question:  #18 8/3/2009		Q:	Hi I had a mammogram done and results stated generally symmetrical moderately high density parenchyma occupyng 60% of both breasts. What does this mean? Thanks.
		A:	You have dense breast tissue in both breasts. It is a deion of the breast, not a finding of something to be concerned about. ds
Question:  #19 7/27/2009		Q:	A recent study indicated that some breast cancers are over treated. The study also reported that early detention doesn''t necessarily save lives. What do you think about the study? Thanks.
		A:	Every cancer is assessed for risks and benefits of local and sytemic treatment like chemotherapy and there are standards for treatment. And yet some breast cancers are likely overtreated. We have come a long way from the radical mastectomy that was done for all and any size or stage cancer. This is a topic that is continually being assessed as with this study and in other settings. Early detection is important. There are some cancers that grow slowly and can sit in the breast without traveling to other organs. There are other breast cancers that grow more aggressively and even small size have ability to metastasize. We aren't always able to determine nature of cancer until biopsied or with surgery. Either way, I would want an earlier detection to deal with the cancer at an earlier stage of the disease when it is possibly easier to treat. ds
Question:  #20 7/27/2009		Q:	Hello, just received the results of my digital diagnostic mammo and it reads, "ABNORMAL, PROBABLY BENIGN", but the results of my sonogram read, "NEGATIVE". (Had to have this done due to "shadows" and "uneven density" showing up on my screening mammo-- right breast only.) Anyway, I find these two new results to be confusing-- can you help? Thanks!
		A:	The radiologist described an area that looked different but did not feel was concerning for cancer. The ultrasound is a good tool for following up on mammogram. It helps detect masses, solid like cancer or liquid like cyst. The ultrasound helped determine that there was not a finding. As suspected it is benign. ds
Question:  #21 7/27/2009		Q:	Hi Lillie,my question is in regards to Breast MRI''s. How accurate are MRI''s at differentiating between cysts and tumors. Also, could fibrocystic changes cause false positves.
		A:	MRI is often sensitive (sees the abnormal findings) without being specific to what they are. Depending on the uptake, some of the benign findings can be read differently from a tumor. For unknown abnormal findings, a follow up ultrasound or biopsy can be recommended. ds
Question:  #22 7/27/2009		Q:	Hi Lillie Had a mod. rad. mast. to the right breast in Jan 06 both ductal and lobular car. T3 N0 Er+ Pr+ Her 2 -. Had accelerated AC Tax and rad completed July 06. 2 years of tam then one year of Femara. Yearly mamogram always showed calcific foci in the left breast among other things BIRADS2. this year a new phrase "well rounded calcific foci" still BIRADS 2 . Should I be worried about LC?? Thanks
		A:	It did not change the birads, level of suspicion for cancer. These calcifications are being monitored and this is radiology term for how they appear. I would not worry at this time. ds
Question:  #23 7/26/2009		Q:	I''m a survivor, 2006, IDC Stage One. I''ve heard of a product called "BreastLight" on several news clips lately- it''s an intense light that can be shined on your breast and apparently see shadows in your breast that could be suspicious. Have you heard of it? Is there any merit to it? Of course I wouldn''t advocate it as a replacement for mammograms, I''m just looking for any additional tools that could help me during self breast exams. But at over $100, I''m skeptical... Also, what about thermography? Lots of alternative health clinics offer this as a diagnostic tool. Again, I''m skeptical... I''d love a medical opinion on these two diagnostic tools.
		A:	I'm glad you are skeptical and especially glad you value mammography, the gold standard for detection of breast cancer. There is no evidence that such a product works. Thermography was tested and proved not to be effective. Glad you asked too. ds
Question:  #24 7/19/2009		Q:	45 yr old, getting annual mammos, all birads 1(density 3...). Found a more discrete palpable lump so went for dx mamo and ultraound. Complex cyst, birads 3. Gyn sent me for BSGI rather than do short term f/u and because he found multiple cyts in both breats with ultrasound. BSGI reads no focal uptake, uptake pattern consistent with firbroglandular tissue. Rad says I still need to do short term f/u with ultrasound, doc says return to normal screening. Lump is still there...who do I trust? Docs are in a different city and I won''t be back there for months so f/u now means starting from scratch locally.
		A:	radiologist is correct.
Question:  #25 7/18/2009		Q:	Is DCIS that is found in many locations in one breast, and picked up by an MRI - but not detected on a mammogram - treated differently than DCIS found by a mammogram? Is non-mammogramic DCIS less serious than mammographic?
		A:	they are treated the same. doesn't matter how it was found or diagnosed. if there are multiple spots of the dcis and they occupy multiple quadrants of the breast, then the standard of care is a mastectomy (usually followed immediately by reconstruction).
Question:  #26 7/12/2009		Q:	I am a 44yo female, currently breastfeeding a 2 year old 3 times a day. I have not had a mammogram as I have been pregnant or breastfeeding since age 40. My sister (54yr) recently was diagnosed with a stage 1 breast cancer tumor. She is my only close relative with a diagnosis. I would like to keep breastfeeding but know a mammogram is not accurate during lactation. Are there alternatives such as ultrasound? How risky is it to postpone the mammogram another 6 months or year? I was told I''d have to wait 6 months after weaning for the mammogram to be accurate.
		A:	if you aren't having any abnormal symptoms presently, you may be able to wait. discuss it with your gyn doctor. if you were having any symptoms, then ultrasound may help. as you know breast feeding makes it very difficult to visualize the structures inside the breast since they are filled with milk. hope your sister does well. stage 1 is the good news.
Question:  #27 6/21/2009		Q:	BIRAD 0. Besides my yearly PAP and breast exams, I have been having mammograms every year since age 40. I am 52 now and after going last week for a yearly one, I received a notice that the mamogram was BIRAD 0 and need to go back. This really scared.
		A:	it would be premature to be scared yet. the bi-rad 0 simply means that they need to do some additional imaging before assigning a bi-rad score. quite common. 80% of the time it is nothing of concern. I have a quote on my wall-- worrying does not empty tomorrow of its troubles; it empties today of its strength. don't sweat over this.
Question:  #28 6/20/2009		Q:	Treated for IDC in 2006. Right mast. Just had diag. mammo and u/s on left breast. Results are BI-RADS 3. Report says there are 3 punctate microcalcs near the scar from a previous biopsy 1 1/2 yrs ago. It also is noted that there is architectural distortion most likely a result of the previous biopsy. I had a BI-RADS 2 mammo a year ago. Is is possible for arch. dist. to appear 1 1/2 years after a b9 excisional biopsy? When I had the diag. mammo the radiologist came out and said all things were fine so the letter I received a week later surprised me when it said there was a "finding that was most likely B9".
		A:	yes, its possible. so this may be from the previous biopsy or it may be signs of recurrence or it may be something totally different, like a benign growth. the "most likely benign" phrase is because they feel that what they are seeing IS benign but cannot state so since they didn't do a tissue sampling to confirm it. this is medical-legal wording.
Question:  #29 6/1/2009		Q:	In March 2008 I found a lump in my left breast below the nipple. I went for a Diagnostic Mammogram and a ductogram which both were negative. I then had a ultrasound and it showed a solid mass. I had surgery in May 2008 and had several milk ducts remove and also the mass removed. Everything turned out fine, no cancer found. I was released from the breast doctor on my post op checkup and told to go for a mammogram in 6 months. In December 2008 I went for mammogram and the facility I went to said they could only take pictures of the left breast where I had surgery. Everything looked fine. In April 2009 I went for my yearly mammogram. I went to the same facility I have gone to for the last ten years. When called and make my appointment they said I did not need a doctor''s order, so I did not contact my gyno. They said it would be a regular mammogram. I waited for my results and everything was fine. They took four pictures, 2 on each breast. They put a little be-be on the place where I had surgery. When I received my bill they billed me for a Diagnostic Mammogram. I called the billing office and they said since I had had surgery that I had to have a Diagnostic Mammogram. Is this true, since I have my follow-up 6 months after surgery. If I would of gotten a form my doctor for a screening would they of done a Diagnostic Mammogram anyway?
		A:	It is likely that a diagnostic was done based on your history. The bebe was placed to help with comparison. You will want to ask radiologist how long you will have diagnostic mammograms. Even bengn findings can lead to this decision. ds
Question:  #30 6/1/2009		Q:	Is mammography adequate in a pre menopausal 47 y.o. with a D4 pattern mammogram? The report states, "no mammographic findings of malignancy", but adds, "extremely dense. this may lower the sensitivity of mammography."
		A:	I am not familiar with D4 pattern mammogram. Dense breasts are a challenge. For women with risk factors and dense breasts, an MRI might be considered. ds