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What do these ultrasound and mammogram reports indicate?

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Posted on Tue, 15 Dec 2015
Question: Dear Doctor,

Facts:
I has been on close ultrasound imaging surveillance since late 2012 due to fibrocystic changes. It has been quite stable, but in May 2015 ultrasound, it was found that one of the lesions has increased in size to 18mm x 8mm x 15mm (as compared to 10 mm x 5mm x 12mm in September 2014) but it still showed benign sonographic appearance. The nurse called me at that time and just said no big problem. I just collected the ultrasound report and noticed the growth in size only last week when I had a routine follow up consultation with the doctor. During the consultation, doctor examined my breasts and said he could not feel any lump. He has arranged an ultrasound examination in this week. He said if ultrasound finds further increase in size of the lesion, surgery is suggested. If the size remains more or less the same, fine needle aspiration can be performed to ease my mind ( in response to my concern on the increased size within 6 months from Nov 2014 to May 2015)

The ultrasound and mammogram reports in these few years will be uploaded here. My biggest concern now is the lesion 18mm x 8mm x 15mm on right breast at one o'clock.
My questions are –

1. Is the increased size from 10 mm x 5mm x 12mm to 18mm x 8mm x 15mm in six months’ time worrisome (from Nov 2014 to May 2015)? It appeared to me a rapid growth but doctor said the growth is not significant?

2. If the lesion is fibroadenosis, is it normal that it grows to that size within just six months? Can it be atypical ductal or lobular hyperplasia (ADH/ALH)? Can hormonal changes (I am now peri-menopausal) trigger ADH/ALH and breast cancer? Does menopause increase the breast cancer risk?

3. Can mammogram detect fibroadenosis and ADH/ALH? Can doctor tell from ultrasound whether a lesion is likely or unlikely ADH and ALH?

4.. With a stable size of the lesion being about 10 mm x 5mm x 12mm from Sep 2012 to Nov 2014, if it was malignant, is it possible that it was undetected by mammogram? (my mammogram findings in Sep 2012 and Sep 2014 are both negative)

5. How fast does breast cancer progress and how long it usually takes from onset to late stage? I am worried that the lesion was actually malignant when it first appeared on the ultrasound in Sep 2012. If it was malignant, what is the probable cancer stage with a lesion size of 18mm x 8mm x 15mm in May 2015? With six month lapsed up till now, will it have progressed to a late stage?

6. In your opinion, what is the lesion likely be? What is the chance of being malignant?

7. For the ultrasound of May 2015, Category 3 (probably benign) is stated. What is meant by “probably”? more than 50%? I also note a sentence “They are likely areas of fibroadenoses” for some lesions detected. Any difference in denoting probability between the wordings “likely” and “probably” in this medical reporting context?

8.     What are your suggested way forward and actions to be taken? What other advice do you have for me? I am worried.

Best regards,
doctor
Answered by Dr. Indu Kumar (30 minutes later)
Brief Answer:
I suggest for FNAC even if size remain the same.

Detailed Answer:
Hello

Size of mass is definitely increased in short period and benign masses are not expected to grow in such short duration.
You are rightly advised for follow up and FNAC if size increases further.
I suggest for FNAC even if size remain the same because we can't take risk.
Your ultrasound appearance is otherwise normal and not indicative of malignancy but FNAC is conclusive in such cases.

It is difficult to comment on type of mass without FNAC report.

Menopause itself is not associated with an increased risk of developing breast cancer.However age is an important risk factor for breast cancer.

Ultrasound or mammography can't comment on whether a lesion is likely or unlikely ADH and ALH.

Only mammography may miss small lesions.Sensitivity increases with combined mammography and sonography.

I expect you may have benign lesion as there are characteristic findings in sono-mammography and it would had been detected in tests.

You don't worry much.Go for follow up and FNAC.

Get well soon.
Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indu Kumar (7 hours later)
Hi, I have provided some attachments. Please review them.
Dear Dr XXXXXXX

Thanks for your prompt reply. Have you received my ultrasound and mammogram reports? I am not sure whether they have been successfully uploaded.

I have further queries –

1.     I had negative mammogram findings in Sep 2014, and then in Nov 2014 ultrasound (2 months after mammogram), the concerned lesion (10 x 5 x 12mm) I am talking about remained more or less the same size compared to previous ultrasound findings.
If the lesion was malignant, should it had been detected from the Sep 2014 mammogram given its size (10 x 5 x 12mm)?

2.     Is it possible that the increase in size of the lesion within a short period is due to inflammation?

3.     My doctor deliberately arranged my coming ultrasound to be performed by the doctor responsible for my Nov 2014 ultrasound scan, who is different from the one responsible for my May 2015 ultrasound scan. Is it possible that the increase in size of the lesion within six months was variation due to operator difference?

4.     With the size of the lesion being 18 x 8 x15 mm detected in May 2015 ultrasound, is it considered large? Should it be palpable? With this size, should an experienced doctor be able to feel the lump?

5.     If the lesion was malignant, what was the likely cancer stage given the size (18 x 8 x15 mm) found from May 2015 ultrasound? Does breast cancer progress rapidly from early to late stage within a few months?

I am really worried.


Best regards
doctor
Answered by Dr. Indu Kumar (1 hour later)
Brief Answer:
Only size increase doesn't indicate malignancy.

Detailed Answer:
Hello
Sorry for replying late

Your uploaded reports are available to me.
I can understand your concern.
There are different many findings like size,margin,contour,calcification,necrosis,skin appearance,associated lymph node enlargement etc in both ultrasound and mammography which may indicate malignancy.
No findings are indicative of malignancy.
Size measurement is a subjective thing and there may be some variation,your report also indicated about this possibility.

In dense breast tissue,small lesions like in your case may be missed if it is not carefully observed or not corroborated with ultrasound.

Expert surgeon should feel this mass but there may be limitation in heavy,dense breast.

Only size increase doesn't indicate malignancy,please wait for follow up and biopsy.

Get well soon.
Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Indu Kumar

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What do these ultrasound and mammogram reports indicate?

Brief Answer: I suggest for FNAC even if size remain the same. Detailed Answer: Hello Size of mass is definitely increased in short period and benign masses are not expected to grow in such short duration. You are rightly advised for follow up and FNAC if size increases further. I suggest for FNAC even if size remain the same because we can't take risk. Your ultrasound appearance is otherwise normal and not indicative of malignancy but FNAC is conclusive in such cases. It is difficult to comment on type of mass without FNAC report. Menopause itself is not associated with an increased risk of developing breast cancer.However age is an important risk factor for breast cancer. Ultrasound or mammography can't comment on whether a lesion is likely or unlikely ADH and ALH. Only mammography may miss small lesions.Sensitivity increases with combined mammography and sonography. I expect you may have benign lesion as there are characteristic findings in sono-mammography and it would had been detected in tests. You don't worry much.Go for follow up and FNAC. Get well soon. Hope I have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX