Expert: Claes-Gustaf Nordquist, M.D. - 11/27/2010

Question
HI, i had a mammogram and an ultrasound about 3months ago and the results showed a hyperechoic mass lesion highly suggestive of being the result of a hematoma at the 2 oclock position measuring 1.2 x 0.7cm in the left auxillary tail of the left breast.  There is also bilateral moderate duct estasia with fine rim of discharge seem within.  What does this mean?  It becomes swollen and very painful during ovulation up to menstruation.  i also have some numbness in my arm at this time.  I am very worried as they have classified this as BI-RADS 3.  Can you explain this to me and shouls i request a biopsy?  Thank you.  Kerry.  

Answer
It is never wrong to ask for a biopsy! Hyperechoic means that it reflects back ultrasound more than normally (ultrasound works like radar except that it works with sound waves instead of radio waves). It sends out these sound waves and receives echoes which are registered. Knowing the speed of sound in the tissues the depths of the echoes can be determined based on the return times of the echoes. The directions to the echoes are determined by the directions of the outgoing ultrasound. So the echoes can be pinpointed. So what is seen here is believed to be a scar after a hematoma. Have you had any such blunt injury there? If so it is a reasonable interpretation and has nothing to do with breast cancer. The problems you describe prior to menstruation are rather common in menstruating women, especially in those with dense breasts. What did your mammography show? In view of the possiblity of dense breasts and a BIRAD 3 (middle ground risk of a breast cancer) evaluation any mammography should not only be combined with ultrasound scans but also with MRI breast scans and also with at least needle biopsies. The reason for this is that dense breasts are difficult to interpret with mammography alone! The rest that is described only shows widened milk duct with some discharge within. Lactation? Are you breast feeding? Good luck! Please keep me posted!



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