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Has anyone had MRI suspicious for malignancy but negative Mammo + US?
Breast Cancer | Last Active: Dec 22, 2023 | Replies (53)Comment receiving replies
Thank you so much! With my last MRI very concerning, I am hoping to do a MRI guided biopsy if the next one is concerning, as well. A biopsy was done on one lesion which came back as a necrosis. Lymph nodes were not biopsied even though they were suspicious on MRI. An ultrasound was done a few days later and the lymph nodes were just “fluffy” and didn’t “look” concerning according to the other radiologist.
I just don’t know who to believe because no one can come to an agreement! I would think if the MRI has characteristics of cancer (hypoechoic, washout, rapidly lighting up, etc…) then more would’ve been done.
Replies to "Thank you so much! With my last MRI very concerning, I am hoping to do a..."
First, you have to do what is right for you to give you peace of mind. You also have to look at your risk factors and family history. You have to be your own advocate and listen to your body. Our daughter had cancer, she chose the double mastecomy at 25 years of age. she is no over 40 and has had no reoccurrence. She had triple negative, very aggressive.
In my case, they took all the lymph nodes (which I did not find out until after the surgery). They figured I had this for 5 to 6 years. At this point, I want to eliminate all possibility of the cancer spreading or returning. Also, I am opting for a double mastectomy.
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What was the BiRADS on your initial MRI? That would help guide a decision on biopsy or not. It is well known in breast radiology research that malignancy and fat necrosis can mimic each other on MRI. I had washout and clustered-ring enhancement, both of which characterize malignancy AND fat necrosis. So, enhancement rate, distribution pattern and morphology can be similar in both, such as your hypoechoic, washout and rapid enhancement. My Nov '23 MRI was BiRads-4 and my report did say suspicious of malignancy but could consider other etiologies such as fat necrosis. Biopsy was recommended and the biopsy last week did in fact turn out to be fat necrosis, but could have gone the other way, too. There are specific criteria for evaluation of lymph nodes on MRI such as 3-D measurement, border characteristics etc. I guess I would wonder what "fluffy" means. I had some concerning lymph characteristics on MRI last December, this year normal. There are a lot of physical and environmental variables that effect lymph nodes at any given time, such as immune responses, timing of COVID vax to MRI, and myriad of others. My own experience with the lymph nodes is that they wouldn't biopsy nodes unless high correlation with breast lesion, and more generally done during a lumpectomy. Sometimes these varying medical opinions have necessitated my getting into the weeds, educating myself on the research, and asking specific questions of the medical team so I'm more comfortable with their evaluations. In the lead-up to my biopsy, I did a ton of reading and this website was particularly helpful for the plain language they use. Disclaimer: I'm an ex-RN. This article is about fat necrosis and I hope it's helpful to you. In addition to Advocate, Advocate, Advocate...I would also add Question, Question, Question (who, what, where, when and WHY... on everything!) https://ajronline.org/doi/10.2214/AJR.07.4051