Expert: Claes-Gustaf Nordquist, M.D. - 1/20/2007

Question
what does the results of my mammograms and ultrasound mean?
7/05 mammorgram says There is moderate fibroglandular tissue scattered throughout both breasts. No dominant mass lesion, suspicious cluster of microcalcifications or overlying skin thickening. Birads 2
12/06 mammorgram says compared with 7/05 Moderately dense glandular tissue. Appears somewhat more focal with rounded posterior border in the mid portion of the right breast on the CC view possibly in the upper portion on the MLO view new since the previous study. No suspicious microcalcification. Birads 0 rec:return for CC spot compression.
1/07 CC spot compression views of the right breast demonstrates persistent nodularity in the midportion of the right breast, no suspicious microcalcification
1/07 Right breast ultraound, Demonstrates a hypoechoic, ill-defined nodule at the 8 oclock possition measuring 4x4x7mm. with mixed posterior acoustic enhancement and some posterior shadowing low level internal echoes. a simple cyst athe the 9 oclock 7x3x6mm, simple cyst at the 10 oclock 10x6mm. Small septated cyst versus cluster of cysts medial to the left nipple 9x5x7mm
Reccommendation: ultrasound guided mammotome biopsy at the 8 oclock position Birads 4
question is what does the ultrasound results mean? I'm scheduled with the surgeon on 1/25/07 to find out about doing a sterotactic biopsy. How likely is it to be benign?

Answer
The main reason why a biopsy will be made is the fact that the image of the lesion (at 8 o'clock) is not fully conclusive. However the fact that it on ultrasound is ill defined makes it possible that it may be a cancer. It has been judged as a Birads 4 which means that it is cancer suspicious = around a 20% chance of being a cancer, around 80% of not being one. What it really is can only be determined by a biopsy. That will be done with a stereotactic or an ultrasound guided needle biopsy (both methods are good). A breast MRI scan may have been able to give even more information before the biopsy, but the biopsy is essential! Can not be substituted in any way it is that important!