Expert: Claes-Gustaf Nordquist, M.D. - 2/24/2010

Question
One week ago I had a routine mammogram.  I was asked to return for a spot compression due to a focal asymmetric dense area.  Today I had the spot compression, it was read by a radiologist and I was then sent to get an ultrasound.  I appeared to have a cyst right below or under my right nipple.    As she looked for it and found it, she said that it looked like a cyst and then kept looking in that area.  She found nearby what she described as a dark area of thickening.  She commented that "it does not shadow which is good"    The ultrasound took about 30 minutes.   She then took the report to the radiologist again and returned saying he wanted me to have a core biopsy for an irregular nodule.  My question concerns what the irregular nodule means, the dark area of thickening and the comment about the shadowing.  I am 50 years old,  showing signs of menopause as in no period for several months but still have the hormonal feelings like painful breasts.   I am actually in that period now.

Answer
An irregular nodule is a denser area with irregular borders to its surroundings. Such are always suspect. Smooth rounded borders are not. The dark area of thickening is also an area that lets the soundwaves through so no shadowing. Remember that the ultrasound scan works like radar but with sound waves. It registers the sound echoes coming back. If the sound waves pass through there will be no shadows (behind an echoe producing barrier) since there is no such barrier and no echoes from it. I agree that a biopsy should be done in this situation.



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