Expert: Claes-Gustaf Nordquist, M.D. - 10/7/2008

Question
I am a 38y/o woman on HRT for 16 years arter TAH. The following is my U/S and Mammo report. I am scheduled to go in for a mammotone biopsy this week and am hoping you can inform me on what percent chance that this is a benign finding vs. possible malignancy.
U/S: 5mm hypoechoic lesion at 1o'clock position and showing posterior wall shadowing. There is a slight lobulation of the margins in some images. Malignancy cannot be ruled out and biopsy reccomended for further evaluation.
MAMMO:
Breast tissues are heterogeneously dense and there is a palpable in the left upper outer quadrant which corresponds to ill defined density. No suspicious or calcifications appreciated bilaterally. No skin thickening or nipple retraction appreciated.
BI RADS 0 Needs additional imaging, reccomend L breast U/S.

Can you give me your impression of what my BI RAD rating would be also.

Thank you very much.

Answer
Dear Elizabeth, I'm a Swede living in Sweden and English is NOT my first language. So when writing to me PLEASE abstain from using acronyms/abbreviations that will just increase the risk of misunderstandings and mistakes! What is HRT & TAH?
Based on your mammography results and your ultrasound scan report I can only conclude that 1. You have dense breast tissues that make mammography difficult. 2. There is a density seen that can not be better defined corresponding to a mass that can be felt. Due to this an ultrasound scan was done. 3. In that scan a lesion of 5mm (1/5 inch) was seen in your left breast corresponding to the mass above. Malignancy can not be ruled out (which makes it more likely that it is benign but certainly no guarantee). So 4. An ultrasound guided needle biopsy of your lesion there is recommended - which I do support! That will most likely tell us what it is. 5. With such dense breasts I would also recommend MRI breast scans - at least in any future check ups! 6. The available information does not allow any reliable BI RAD estimate at present. Good luck! Please keep me posted!