Assessment 4 on Ultrasound - What is this?

[bradfordvero]

I had a mammogram and ultrasound due to a mass I found in my right breast a few weeks ago.  I am 46 years old.  The ultrasound report stated that I had a possible fibroadenoma and that it was a circumscribed hypoechoic mass.  The ultrasound says that I am an assessment 4 at the bottom of the report.  I will be seeing a surgeon soon because the radiologist recommended I have a biopsy.  From what I read it is very unusual for someone my age to have a fibroadenoma.  I have not had a period in almost 2 years and have NOT taken any hormones.  What is an assessment 4?  Any comments are welcome.  

[bradfordvero]

I just hope that this mass is benign.  I have no history of breast cancer so that helps bring my risk level down.  I do have other factors that bring it up like smoking and my age.  I am 46 and have not had a period in about one and 1/2 years.  Don't know if I am in menopause or not because I am adrenal insufficient and have been on replacement steriod therapy for four years.  Thanks for all your help during this time of need.  I am sure all will do fine.

[bradfordvero]

Thanks for your response.  Yes the assessment 4 is the same as the category 4.  This radiology group prefers to use the word assessment instead of category.  I saw the surgeon today.  He did the exam of my breast from every angle possible.  He said that he would recommend having surgery to remove the entire mass.  He said that it would be very likely that if I had the core biopsy I would also have to have the entire mass removed anyway.  He said that because the mass did not show well with the mammogram, it would be very difficult to follow the mass over time and I would need  mammograms then magnifications followed by ultrasounds.  So his recommendation was to have the mass removed at a local surgery center.  I know I am in good hands and I just hope that this m

[Fernando Roque, MD]

Hi.  I'm not exactly sure what "Assessment 4" refers to.  The standard way of reporting breast ultrasound findings according to the American College of Radiology is through the use of 6 categories as follows:

Category 1 - Negative
Category 2 - Benign Findings
Category 3 - Probably Benign Findings, Short Interval Follow Up Suggested
Category 4 - Suspicious Abnormality, Biopsy Should Be Considered
Category 5 - Highly Suggestive of Malignancy
Category 6 - Known Biopsy Proven Malignancy

If "Assessment 4" means Category 4, it may mean that your doctor is not entirely sure that your breast mass is indeed fibroadenoma, and wants it checked by a biopsy.  My suggestion is for you to have that biopsy done.

[riley180]

The radiologist can only tell if the mass looks malignant or looks benign. The radiologist doesn’t examine you. This is good because it allows him to decide based on what it appears like and won’t be biased by the findings of his physical examination. The surgeon will include the nature of the tumor (how long its been growing, how fast, presence of symptoms, how solid and regular it feels) along with your risk factors and make a recommendation if a biopsy is warranted at this point. The approach to cancer involves a lot of doctors (translating to more people working against cancer, and this has improved care), and while there is concern that too many appointments tend to be needed, this is one of the realities we’ll have to accept.