Breast Density with multiple cyst. Recent Birads 4

Posted by casa @casa, Dec 3, 2021

ill -defined heterogeneous region/lesion with posterior acoustic shadowing was found in addition to my other issues. Should I be concerned? Does anyone rely on thermography (sp?) testing in replace of Mammogram and MRI?

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Are you having a biopsy?

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There is no thermography breast imaging available in my area. You mentioned other issues, understanding a little more of your story could help in supporting you. Can you expand your issues and questions a bit more?

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@auntieoakley

There is no thermography breast imaging available in my area. You mentioned other issues, understanding a little more of your story could help in supporting you. Can you expand your issues and questions a bit more?

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I have the highest level of density. Also, numerous simple and complex cysts. The ultrasound was order as a stepping stone to an MRI. The US showed heterogenous focal region/lesion with posterior acoustic shadowing. A biopsy was ordered. Just this morning I got my results back via mychart, have not talked to my doctor. The finding Ultrasound-guided core needle biopsy of a 0.7 cm heterogeneous lesion with shadowing at 9:00, 10 cm from the nipple in the right breast,
marked with a bowtie clip. Pathology demonstrates intraductal papilloma,
which is high risk and concordant with the imaging assessment. Surgical
management is recommended.

Final Diagnosis
1. Breast, Right, 9 o'clock, 10 cm from Nipple: Benign breast tissue
with
A. Florid ductal hyperplasia of the usual type.
B. Mild chronic inflammation.
C. Microcalcifications in non-neoplastic tissue.
D. Apocrine metaplasia.
E. Focal pseudoangiomatous stromal hyperplasia in the mammary stroma.
F. Area consistent with intraductal papilloma with the usual
hyperplasia.
G. Simple cyst

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Wow, you have a whole lot of, thankfully, benign things going on there. That being said some of the changes like the micro calcifications can be concerning for cancer later. If these things are causing you problems then the surgical consult is a great idea. I haven’t one single clue what they might or might not recommend. How do you feel about talking to a surgeon? Also given the density of your breast I would assume you are pretty young, is that correct?

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@auntieoakley

Wow, you have a whole lot of, thankfully, benign things going on there. That being said some of the changes like the micro calcifications can be concerning for cancer later. If these things are causing you problems then the surgical consult is a great idea. I haven’t one single clue what they might or might not recommend. How do you feel about talking to a surgeon? Also given the density of your breast I would assume you are pretty young, is that correct?

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I am 57. My primary care read my mammogram to say that I needed follow in 6 months. Yes, with the birads 0. I did see a surgeon. Somewhat disappointed that she did not call me prior to this all hitting my chart. I didn’t catch the Microcalcifications in non-neoplastic tissue. What does that mean?

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@casa

I am 57. My primary care read my mammogram to say that I needed follow in 6 months. Yes, with the birads 0. I did see a surgeon. Somewhat disappointed that she did not call me prior to this all hitting my chart. I didn’t catch the Microcalcifications in non-neoplastic tissue. What does that mean?

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Micro calcifications can (not always) be concerning and require a closer follow up. Since your doctor is already recommending 6 month follow up, you are already there. In certain patterns where there are many clustered together, they need to be monitored in case they start to show precancerous cells. It doesn’t always happen but it can. I am glad you are in contact with your doctor, but honestly she might have thought you would be relieved to know it wasn’t cancer. I always tell my friends who are anxiously awaiting breast biopsy results that there are two kinds of women. Those living with breast cancer and those afraid of getting it. Is there something you can do to refocus your attention somewhere else while you wait for consults?

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My biggest concern is this Area consistent with intraductal papilloma with the usual
hyperplasia and the recommendations of surgery. Yes, this issue has been going on since the beginning of Sept, I don’t usually worry, but just thought I would see what I could find out. I am an information seeker!

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There is quite a bit of info out there on intraductal papilloma and most of it not behind a paywall.
Here is a snapshot of it from web md.
https://www.webmd.com/women/what-is-intraductal-papilloma

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@casa

I have the highest level of density. Also, numerous simple and complex cysts. The ultrasound was order as a stepping stone to an MRI. The US showed heterogenous focal region/lesion with posterior acoustic shadowing. A biopsy was ordered. Just this morning I got my results back via mychart, have not talked to my doctor. The finding Ultrasound-guided core needle biopsy of a 0.7 cm heterogeneous lesion with shadowing at 9:00, 10 cm from the nipple in the right breast,
marked with a bowtie clip. Pathology demonstrates intraductal papilloma,
which is high risk and concordant with the imaging assessment. Surgical
management is recommended.

Final Diagnosis
1. Breast, Right, 9 o'clock, 10 cm from Nipple: Benign breast tissue
with
A. Florid ductal hyperplasia of the usual type.
B. Mild chronic inflammation.
C. Microcalcifications in non-neoplastic tissue.
D. Apocrine metaplasia.
E. Focal pseudoangiomatous stromal hyperplasia in the mammary stroma.
F. Area consistent with intraductal papilloma with the usual
hyperplasia.
G. Simple cyst

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@casa
If you are that concerned, may I suggest you insist on an MRI? My original biopsy was positive for cancer and after that I was so nervous about the other breast that I insisted on an MRI……guess what…there was another very small tumor in the same breast that did not show up on mammogram that was a neuroendocrine lesion which is highly aggressive and rarely shows up in the breast. So a second surgery was performed to remove that as well. My oncologist poo-pooed me, the first surgeon did not think an MRI was necessary, but the second surgeon I saw felt it reasonable. Sending you best wishes in your journey.

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@trixie1313 that is just what happened to me. I had 3D mammo. It showed nothing. I went to a surgeon and due to my dense tissue ordered up a MRI. Bingo they found tumor. Then my journey began. I felt blessed that my doctor was proactive and said ‘let’s do a MRI & see what in there’ , due to the dense tissue. I think women should get MRIs done every so often depending on circumstances. As we are seeing MRIs show more than mammograms do.

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This was my experience. In the 90's I had surgery in both breasts to remove many papiloma's. I found out that you have an increased chance of breast cancer when you have papillomatosis so I have always been diligent about getting yearly mammograms. I had a 3D mammogram in 2019 and was told it was clear and 2 months later I insisted on getting an ultrasound because I had read that when you have breasts that are dense tumors are sometimes difficult to spot on a mammogram. The doctor who read the ultrasound walked in the room and informed me that I had a 2 cm tumor and I was to see a breast surgeon right away. I had a rare adeno squamous metaplastic carcinoma. I had a lumpectomy Jan, 2020 and 4 weeks of radiation and so far (knock on wood) I am cancer free.

Anyone with dense breasts please, please ask for more imaging than a 3D mammogram. In my opinion women are not warned enough about how difficult it is to spot cancer when you have very dense breasts.

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@katrina123

This was my experience. In the 90's I had surgery in both breasts to remove many papiloma's. I found out that you have an increased chance of breast cancer when you have papillomatosis so I have always been diligent about getting yearly mammograms. I had a 3D mammogram in 2019 and was told it was clear and 2 months later I insisted on getting an ultrasound because I had read that when you have breasts that are dense tumors are sometimes difficult to spot on a mammogram. The doctor who read the ultrasound walked in the room and informed me that I had a 2 cm tumor and I was to see a breast surgeon right away. I had a rare adeno squamous metaplastic carcinoma. I had a lumpectomy Jan, 2020 and 4 weeks of radiation and so far (knock on wood) I am cancer free.

Anyone with dense breasts please, please ask for more imaging than a 3D mammogram. In my opinion women are not warned enough about how difficult it is to spot cancer when you have very dense breasts.

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I agree. As well, primary physicians don't seem to act on the heterogenous dense breast warnings we get with mammogram results. It would seem that these should be customarily followed up with an ultrasound and/or MRI. It is a little late when we learn what it all means once we have been diagnosed with breast cancer at a later date!

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