AboutClaes-Gustaf Nordquist, M.D. Expertise I`m a doctor of medicine and a specialist in radiation therapy and medical oncology. I have long experience in diagnostics and treatment of breast tumours.
Experience I'm a Doctor of Medicine. Licensed/certified physician and surgeon and specialist in Medical Oncology and Radiation therapy in Sweden, Denmark, Finland, Iceland, Norway and the European Union. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps. Now in private practice in Stockholm, Sweden.
Question QUESTION: I am a healthy 39yr old with past Hx of Cysts in R Breast since June 05. Recently noticed larger lump in R breast for about 2 months-slight contour change as well.
Mammo too dense for review. BIRADS CAT 4 U/S report "Oval area of architectural distortion identified in the symptomatic site since the previous exam in 2005 grants tissue Dx. U/S of R breast revealed the presence of a low ill-defined area of abnormal architecture of the parenchyma, with loss of the standard breast lobulations and thin hetrerogenisity throughout. It presents with ill-defined borders.
If you had to separate this to a BIRADS 4, A, B or C?-What would you do?
Also, Would very small AA-A breast affect the "shadowing" of such a mailgnacy since there is not much tissue below the suspected area until the ribs/lungs?
Thank You for your opinion.
ANSWER: You have obviously a history of fibrocystic breast condition which makes your breasts dense and has given you problems with cysts before. Such dense breasts are difficult for good examinations with mammography which is the the main reason for the present difficulties. In your case - as in similar ones - mammography MUST always be complemented with 1. ultrasound breast scans and - even more important - 2. MRI breast scans to get pictures unhindered by your breast density! With these techniques this "abnormal" area can be better studied. Furthermore that area AND the lump you have felt (or are they one and the same?) SHOULD be investigated by needle biopsy so that a specimen for cytology/pathology study can be obtained from each and every lesion seen or felt! As far as I know or understand no malignancy has yet been found. Malignancy (cancer) is a pathology diagnosis and can with certainty only be made with the aid of a biopsy. Signs seen in mammograms, MRI scans etc. are only of a higher or lower probabilty and are NOT a final diagnosis. For that at least a biopsy is needed! Please do keep me posted!
Thanks! While small breasts can make it technically more difficult to take the mammography pictures the real problem associated with mammography in your case is the high density of your breasts and the best way of finding out what it is that is seen & felt - which after all remains the most important matter - is still a biopsy!
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QUESTION: Not so much a question as a comment. I HAD an ultrasound the day of the mamo on my right breast & that is what gave me the BIRADS Category 4. I have read that some Radiology centers differentiate BIRAD 4 into Birads4a, 4b & 4C,--Not a Bx pathology at that point--just a more specific BIRADS.
I have been seen by a Surgeon who did not think a Bx was necessary, but because I want one done it has been scheduled for July 30th. I don't mean size of brests in regard to Mammogram--I thoroughly understand that it is the desity of younger breasts that is the problem. I mean the size on Ultrasound---If you are checking to see if there is a shadow beneath the mass, but little tisse before ribs/lung to see a shadow beneath--Can this be challenging?
Answer Ok. But in this situation an MRI scan is more important than the ultrasound scan. Yes SOME centers do. Personally I think that is pushing category differentiation too far with limited information. Please see my latest reply. Well technically you may be right, but it probably depends on more factors than just size. I do NOT share your surgeon's opinion with regards to a biopsy! A biopsy is the final and ultimate test to find out if there really is a malignancy or not, vastly superior to any radiological method! Of course nothing is 100% certain but this is as close as you can come! I'm glad a biopsy will be done!
