Expert: Claes-Gustaf Nordquist, M.D. - 4/19/2008

Question
In September I had a mammogram and Ultrasound done. My report from my mammogram and ultrasound said it was a hypoechoic focus.  Has dense posterior shadowing. I had a biopsy done. The biopsy came back benign.  I went for my 6 month follow-up as recommended after the biopsy.  I had a mammogram and ultrasound.   My ultrasound says it is hypoechoic focus.  Has dense posterior shadowing and it also says that the lesion cannot be assessed due to the posterior shadowing. When I spoke to the radiologist who reviewed my mammogram and US she said that the US and the previous pathology results are not condordant. That what she was looking at on my new mammo and US tests did not look like benign breast tissue.  She showed me where they had done the biopsy and said it wasn't in the spot where she saw the tissue that was suspicious and that they should have taken a biopsy of this area also.  Her report states that given the possibility that the asymmetry seen in the left breast does not represent the same abnormality visualized on ultrasound and given the pathology results are not concordant with the sonographic abnormality, additional workup is warranted.   After speaking with the radiologist I was extremely upset.  Her stating that it didn't look benign to her scared me.  I went for a MRI per her request.  After the MRI,  I had a BIRADS rating of 4 with a recommendation for another biopsy. The report says in conclusion that two patchy areas with ill defined postcontrast enhancement.  One which corresponds to the area of prior biopsy. A similar focus within the lower anterior breast shows similar signal characteristics with similar differential diagnosis.  With regard to the lesion that was previously biopsied the clip is located just lateral to the enhancement.  Therefore additional ultrasound biopsy should be considered given the discordance of prior biopsy and image findings. My Questions are:  Should I be scared?  Could the radiologist be right that the tissue is malignant just by looking at the results of my tests (mammogram and US)?   What are the odds that with a BIRADS rating of 4 that the lesion they are looking at is cancer? What percentage of woman with BIRADS 4 rating end up with cancer?  How accurate are MRI's at determining if something is cancer? I have my biopsy scheduled for next week. Thank you for your time.

Answer
Well, if your rating is correct you are at risk. So quite a number of women with a Birad 4 do end up with cancer, but it is not a sure thing. However biopsies are necessary, either stereotactically or under ultrasound and/or MRI guidance to make sure they are taken from the right spots! For the future I strongly suggest that MRI breast scans always are included in your breast check ups! Good luck!