New Malignancy vs. Fat Necrosis on MRI. Anyone have this conflict?

I had this exact thing n happen about 2 years after a 1.8cm mass on my kidney was ablated. Eventually the area showed some changes that were felt to be a fat necrosis until about 6 months later signs of enhancement were found on scan. Now monitoring continues in the 1.2 cm mass and surgical removal will likely happen. But mine is on a kidney. As long as no sign of enhancement is found probability of malignancy is lower. Continued monitoring with scans every 3-6 months may be recommended.

That happened to me too. The surgeon that did my bilateral mastectomy told me I would have to keep coming back to her for mammograms and MRIs. At the time I couldn’t figure out why. I was on my third oncologist and mentioned it to him, so he must’ve thought that I wanted to go that way, so he ordered an MRI for me. What a nightmare! Same thing as yours! Needless to say, I was a real pain in the butt. I called the oncologist and he reassured me that everything was fine. I spoke with the plastic surgeon and he told me not to go for anymore scans. He said I did not need them. The oncologist said the same thing . The MRI was read at a big hospital in my state. This is the same hospital where I had my bilateral mastectomy and deep flap reconstruction. They were very insistent that I came in for more whatever’s that they wanted to do to me. They compared my MRI to the one I had before I had the surgery for my second cancer. In fact, they told me they did not have a copy of the MRI that the mammogram surgeon had done in March before my big surgery in July 2020. What! I was all over them. They said they had no record of that MRI. They compared it to the one I had in April 2018 which was misread by a radiologist. He said I did not have cancer when I actually had invasive ductal cancer. The thing is that the person that read the MRI that wanted to do more testing was a radiologist from the hospital that worked with the mastectomy surgeon. They could not find my MRI desk, nor could the place that did it. You just can’t make this stuff up! They gave me a huge runaround. Needless to say, I sure will not be giving that breast cancer center any positive comments. So as it stands right now, my oncologist and the plastic surgeon have both told me that there is no need for me to get those test done anymore. I think it’s all about the $$$$$$! In any event someone that has gone through what we have gone through should not have to be put under that sort of stress for someone else’s job security.

So sorry for what you had to go through. I’m a retired nurse and while I want to think the best about the medical system, I’m also not naive to the potential of one hand feeding the other. I know there are ways to produce more definitive MRI readings in cases where it might be fat necrosis and not malignancy. They know how to compare the morphology of a lesion with the surrounding fat tissue to better determine if it is more likely fat necrosis or malignancy. With that, I’ve been very disappointed with the lack of detail in my breast MRI reports for a couple years, since I started reading more research papers. The radiologist was NOT very happy getting asked a lot of questions right before he did my last MRI-guided biopsy last December. They are definitely not used to it! It takes a lot of work being one’s own best advocate.

Thank you for sharing your experience. I’m not really sure why the radiologist equivocated by adding the suggestion of benign etiologies, like fat necrosis, after the statement of “suspicious of malignancy “. At least could provide some rationale in his report. So frustrating.

@gardenfairy, when will you meet with your doctor to discuss the results of the MRI and get some answers to your good questions?

Hi Colleen,
Unfortunately, the picture became even murkier today with the ultrasound and mammogram. There were no findings that corroborated the MRI findings. The mammogram did find pleomorphic linear calcifications in the opposite breast (not seen on MRI) so I might be facing two biopsies. A discussion came up today with the radiologist about consideration of a double mastectomy in light of the multiple excisional, MRI guided, and steriotactic biopsies I've had. I meet on Wednesday with my long-standing surgeon. Thank you so much for connecting with me and for your concern. I greatly appreciate this forum.

Followup to my post on 11/28: met with my surgeon and he is concerned that I could have lobular cancer, which he says often doesn't show up on mammo and ultrasound. I added a separate post about positive MRI and negative mammo/US for anyone with similar experience.