Expert: Claes-Gustaf Nordquist, M.D. - 11/18/2010

Question
QUESTION: I'm 31 and my doc found a small lump and told me to watch it. So i waited a month and contacted an agency that would do tests for free because i have no insurance if suspicious.  My diagnostic mammo said this-moderate fibroglandular tissue is seen throughout each breast.  There is some benign appearing parenchymal asymmetry in the upper right breast which disapates to normal parenchymal pattern on additional spot compression and true lateral film.  No significant dominant mass or distortion is otherwise seen.  There are a few punctate calcifications in each breast without suspicious clustering.  No significant radiographic abnormality seen in the BB lump marker on the right.  2-benign finding.  So that means they don't see the lump at all and the asymmetry was there, not summation as far as i can tell and it appears what they see is benign. How can they say it's benign without further testing.  Ii have looked at my mammo pics and i can see the benign area on there, even spot and wonder why they don't call it a lesion or measure it-is it just because it doesn't light up? I've done some researching and i think it should have been rated a birads-3 not 2 and i also read about ILC and how tricky it is and can show up like this.  It often has the same opacity if not less than of normal tissue.  Which is what worries me.  So why would they be satisfied with that and not want further testing.  I am pursuing and hopefully will be approved a surgical consult for the lump now and should i ask if they can biopsy the asymmetry as well.  Thank you for answering all my questions-i appreciate any info i can get.

ANSWER: What is possible to say based on mammography is that it LOOKS like a benign lesion (which is not quite the same thing as saying that it IS benign). To be more sure I suggest at least a needle biopsy of it. That way we would at least have a microscopic test of the lesion itself! However I have no idea of what is available to you.



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

QUESTION: I don't know if i made clear they did not see the original lump at all. But they did see asymmetry-do you know why they don't say anything about a lesion?  Is it because it looks normal on spot compression-even though i can see it there on the pics. When they say normal pattern on spot do they mean they see something there it just doesn't look suspicious-And why don't they call it focal asymmetry? I can see it on two different ml views and on spot.  They can biopsy the lump by feel alone is that correct? And can they biopsy the asymmetry?  If i can see something on there it seems like it should be called a lesion.  Sorry for all the questions-thanx for the help!

Answer
Yes, they mean that it does not have a suspect look. Yes a fine/thin needle aspiration biopsy can be done by feeling/touch alone. A stereotactic wide core needle biopsy can also be done probably. It (a fin/thin needle one) can also be guided by ultrasound or by MRI. Also an assymetrical area can be checked by biopsy (surgical or a stereotactic wide core needle biopsy based on mammography). If it is called a lesion or not depends on what it looks like.



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