Expert: Claes-Gustaf Nordquist, M.D. - 8/17/2009

Question
QUESTION: I am 45 and have had regular mammogram's for 5 years. This year I decided to go digital. When doing the mammogram the technician showed me I had a cyst. She said she thought it was because of the round edges. She showed the radiologist the views and they did a few more. She came back and said not to worry as they looked on my old mammograms and this cyst has been there since 2006. Is it harder for the regular mammogram to pick up cyst than digital? I do have very dense breasts. I just receive a letter from the Radiation dept. To return in 6 months for a breast diagnostic mammogram. The results of my test was sent to my health care provider and they will be in touch. What is with the magic number of 6 months? How much does cysts change in that short of time? What is the difference of a digital mammogram and a diagnostic mammogram? Sorry for all the questions. Thank you so much for your time.

ANSWER: If you have very dense breasts that will make mammographies - especially regular ones - less certain. Digital ones are better but not so good that they can be used alone. You SHOULD therefore always complement your mammographies with ultrasound scans AND MRI scans! DEMAND that! AND if still something unclear is seen with at least (stereotactically guided or ultrasound or MRI guided) needle biopsies. That way unpleasant surprises can be avoided. The 6 months return check up is just routine, but if you insist on a needle biopsy now (ultrasound guidance should work for a cyst) that should be possible to avoid. Why wait? The difference is that regular ones use old fashioned photography (film) technique and are less certain while digital ones use electronic (like a TV camera) digital recording and computer storage & processing. Good luck!



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

QUESTION: I just received the x-ray report:
 Persistent nodule in the right lower midline 6 o'clock position is again seen. This was spot compressed appearing well circumscribed measuring about 1.6 x 1.3 in size. Medial margin is again a bit indistinct, but no architectural distortion or skin thickening is seen and abnormal microcalcification is observed.
Several benign appearing nodule in the right breast lower midline measuring 1.5 x 1.3 cm in greatest dimension is seen. There appears to be another smaller nodule just lateral to the midline lesion measuring about 1.3 by 1.1 cm appearing well circumscribed.
Ok, does this report warrant more tests? How do you tell on a mammogram what is benign or not? Thank you for your time. Deb

ANSWER: Well I can hardly give you a crash course of mammography diagnostics here (besides I'm NOT a diagnostic radiologist but a medical oncologist & radiation therapist) and it IS a difficult subject. But what is described all seems to be benign lesions. If they can be seen in ultrasound scans that can easily be confirmed by ultrasound guided needle biopsies. Personally I think they should be, if possible, on principle.



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

QUESTION: Thank you so much for all your great information! I had a ultrasound done and this is the report: Impression
1. Left breast shows no significant lesion. The right breast shows at least 4 solid lesions. One in the upper inner quadrant, and 3 in the lower outer quadrant. They are echogenic and have characteristics similar to fibroadenomas. The lesion at 1 o'clock, however does show considerable posterior shadowing more so than the other lesions, and it is a suspicious lesion. I do not believe it was seen on x-Gras as I have reviewed these studies although it could represent a small lesion marked by cad view on the medial lateral study.
2. Bi-rads category 0-incomplete.
What does shadowing? Besides having a MRI and a biopsy is there anything else you would suggest? Should I be concerned or is this just cautionary steps that we are taking. Thank you so much for your time.

Answer
Shadowing here is the same as shadowing of light where light is absorbed or reflected so that a shadow arises. Here though it is the sound waves that are blocked in the same way so that a sound shadow arises. That makes the lesion appear somewhat differently than expected. However an ultrasound guided needle biopsy should clear that up. I'm not suggesting anything else.