Expert: Claes-Gustaf Nordquist, M.D. - 6/23/2011

Question
I am 61 - had yearly mammogram - results listed below:
Tissue left breast heterogeneously dense.  1.2 cm round density with a circumscribed margin in left breast at one oclock.  No other significant masses or calcifications are seen.  The 1.2 cm round density in the left breast has a diffferential diagnosis of a cyst, solid mass or lymph node and appears indeterminate.

Ultrasound read 1.2 cm x 0.9 cm round cyst in left breast at 2 oclock middle dept.  This round cyst is anechoic with posterior acoustic enhancement.  Correlates with mammography findings.  Color flow imaging demonstrated that there is no increase in vascularity.  There are numerous associated dilated ducts in the same region extending towards nipple.  The round cyst resembles a simple cyst and appears to have low suspicion for maligancy.  MRI suggested for further evaluation.

I talked to the radiologist who read the mammogram and ultrasound and asked why the MRI.  She acted like I was crazy and didn't understand why I was saying an MRI.  Told me that dilated breast ducts was normal with my age and it was a simple cyst - followup in 4 - 6 months.  Then my doctor called and wanted me to have the MRI because that is what the report said.  My insurance would not pay authorize it and said it was not medically necessary.  My doctor said okay lets have another mammogram.  I went to the hospital to have the mammogram and the technician said you were just here 2 weeks ago - why again.  Told her the entire story.  She went and personally talked to the radiologist on duty who read both my mammogram and previous ultrasound.  He said simple cyst and dilated ducts are normal but call the originally reading radiologist.  She was then called - pulled my information up and looked at it again and said the same thing.  Cyst and dilated ducts that come with age.  Followup in 4 - 6 months with another mammogram.  Technician advised that MRI should not have been on the results previously and it was a mistake.  My doctor is now saying 4 - 6 months  followup mammogram.

I was put through so much with this entire situation that it has scared me to no end.  Does it sound reasonable to you and I just followup with another mammogram in 4 - 6 months - is this normal?

Answer
This is probably a simple cyst and nothing else! If you want to be absolutely sure I do suggest an ultrasound guided needle biopsy. Then you will KNOW what it is with certainty and a new mammography will not be necessary in some months' time. The only good reason for an MRI breast scan here is the fact that in spite of your age you have dense breast tissues. That may make mammography diagnosis more difficult. But your findings seem to be quite clear cut. Good luck!





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