Expert: Claes-Gustaf Nordquist, M.D. - 1/9/2008

Question
QUESTION: I had a breast MRI in June that showed an enhancing lesion.  An open biopsy pathology report stated it was atypical ductal hyperplasia.  In December I had a follow up mammogram and ultra sound that showed an abnormality in the same area as the biopsy.  The ultrasound report reads the following:  "demonstrates a 2.6 x 1.1 x 3.2 cm hypoechoic region This has internal echoes and does not meet the criteria for simple cyst.  Impression: A 2.6 x 1.1 x 3.2 cm hypoechoic region with a central component measuring 6 x 5 mm.  Recurrent neoplasm cannot be ruled out."  
My question is ~ what is a typical response to this finding?  Is it best to watch and wait or another biopsy?

ANSWER: First of all an experienced radiologist should compare ALL these radiology results (MRI, ultrasound & mammogram) and have access to the biopsy result. If this radiologist can not confidently state that these findings are connected and of no importance now a new biopsy should be done.
Ok?


---------- FOLLOW-UP ----------

QUESTION: Thank you for the information.  That is helpful.  I do have a couple additional questions.
What does hypoechoic mean?  Does it refer to depth of the area in question or fluid as opposed to solid mass/tissue?
Am I correct that atypical ductal hyperplasia is precancerous not cancer?  That is the wording on the pathology report from June.  The surgeon compared it to ductal carcinoma in situ, but that is not specifically what the pathology report said.  
The follow up plan is to repeat the ultrasound in three months.  Is that a reasonable course of action?
The radiologist is from the same hospital where the MRI & Biopsy were performed so I assume he has access to compare the films and pathology, however, he referenced only the mammogram that was performed the day of the biopsy and the mammogram performed just prior to this ultrasound in December.
Again, thank you for your opinion.  I appreciate it.


Answer
Hypoechoic means that the lesions does not reflect (echo) back much ultrasound to the scanner as it is scanned - so the lesion appears more like an empty hole. It may in fact be a fluid filled space OR an area of tissue with much less density OR different acoustical properties.
Yes, that means PRECANCEROUS! Cancer in situ IS a cancer but so extremely local that it has in no way invaded its surroundings! It is the next step in malignancy from precancerous towards more dangerous lesions but still rather harmless.
Well that makes me wonder if anyone really has compared ALL the pictures and included what is known in the pathology report in the interpretation! I think you should ask for a second opinion! Good luck! Please do keep me posted!