Breast ...hypoechoic ill-defined nodule ...making well informed decisions.

[Shehawk]

Hi there...I was hoping that you could help me.  About a month ago, I started having itchy nipples. My montgomery glands started filling up and were swollen.  I think that a soap and detergent change were the cause.  I  also noted that above each of my nipples that I had two places that seemed bigger. (They have always been there; I wonder because I was constantly rubbing that area if I caused the breast tissue to change?)  I am in peri-menopause and my hormones are swinging wildly back and forth.

Anyway, I had my doc check my breast , and he suggested a cream, which after 2 weeks helped my nipples to return to normal.  He also sent me for an immediate ultrasound.  He said my breast felt normal and perhaps my breast were a bit Fibrocystic.

I really do not want to do a mammogram.  We have no history of breast cancer or any cancer of any kind in our family for at least 4 past generations.

The ultra sound found:  
BILATERAL BREAST ULTRASOUND:

TECHNIQUE: Ultrasound evaluation of bilateral breasts performed.

COMPARISON: None available.

FINDINGS:
The right breast was evaluated. At the 9:00 position 1 cm from the areola, there is a hypoechoic ill-defined nodule 0.6 x 0.5 x 0.4 cm in size. There is internal blood flow. This does not represent a simple cyst. Posterior shadowing is noted. The remainder of the right breast is unremarkable.

The left breast was evaluated sonographically. Subareolar cyst 0.5 cm in size. There is an adjacent 0.6 cm subareolar cyst. The left breast is otherwise unremarkable.


IMPRESSION:
1. Right breast has an ill-defined 0.6 cm mass at the 9:00 position. This is a palpable finding and has internal blood flow. The characteristics are concerning for neoplasm and further evaluation with mammography and MR breast imaging may provide additional information. The patient is currently considering whether she will have a mammogram and/or MR breast imaging. Ultimately this finding will need biopsy for definitive evaluation.
2. Subareolar cyst retroareolar left breast.

BI-RADS CATEGORY 4: Suspicious abnormality - Biopsy should be considered.

Since the ultra-sound, my nipples are normal, and the twp places that felt a bit hard to me are soft and normal.

I am not worried about breast cancer, but feel like I have opened up a can of worms. I do not want a mammo, nor a needle biop because I feel it is unnecessary, at least at this time.  The place that they are referring to seems to be very small.  My other breast feels the same...only smaller, but my left breast is smaller than my right one.

If I opt for a mammogram, will it provide concrete information? ...or will I still be looking at deciding whether or not to do a needle biop?

I would like to take a conservative approach and want and see if I have any changes.  I do not want to base a decision on fear.  Also, the doctor who talked with me (head of rad. department) was ready for me to do a MRI dye needle biop.  (If I did a biop, it would be ultrasound guided because it is a"safer" option..  She was talking about removing the mass & etc.  I did not trust her at all.  If she had a knife, I am sure she would have used it that day! :)

...and do you know anything about the Breast MRE ...Breat Elsastrogram, which uses non-invasive ultra-sound to detect 98% of breast cancers?

Is this screening available, yet?  

Thanks for you comments,
Shehawk

[fvf147]

You should be able to have another Dr look at that report for you.  Well... let me clarify... have another Dr look at the actual images.  Doesn't do much good for another Dr to read another Dr's report... wouldn't he then just be giving an opinion of another's opinion.  My breast surgeon always looks at the actual images, no matter what the radiologist's report is.  If you have another imaging center in your area then there's no harm in calling them up and saying... "Hey would you take a look at this for me?  I'd like a second opinion."  Or if you know of, or want to meet a good breast surgeon in your area he/she could look at the images for you.

All they can do is say no but I can't imagine why they would.  I hope others with more experience will be on through out the day and can help you with more specifics.  I've had abnormal findings before but not exactly like yours.  Mine turned out to be fibroadenomas.  But I did have additionally images done then, at 6 months and then at 1 yr... all reviewed by my breast surgeon, who made the final call.  I did not have the needle biopsy or anything else.

[Shehawk]

Thanks so much for replying.

I am not totally opposed to mammograms; I think they are a great diagnostic tool, but they do expose you to some radiation.  I don't even like to have routine dental x-rays.  :)  

Believe me, if I really thought that there was a problem, I would want it fixed.
However, I do feel like they are being too aggressive at this point. I hate it when a doc puts you through the mill.

My current doc is awesome, but the one at the imaging was something else!  I have been in sales, and she was working hard to throw some business to her doctor group, which does not have a good reputation.  She'd make a killing selling cars!  Is there someone else that I can get to look at the ultra-sound pictures...other than her "group?"  I have a cd copy of the report & images.


I have also been reading about Breast Elastrograms on the web.  This seems diagnostic tools seems to be better option than a ultra-sound or  mammogram because they are very accurate in diagnosing "suspicious" lumps and bumps.  ...and they avoid needless biopsies.

Quick story...  My little daughter was very ill with a cough & cold symptoms.  I took her to the doc.  He wanted to do an X-ray of her chest.  I asked him what antibiotic that he would put her on if, indeed, she had pneumonia.  He told me that name of it.  I then asked him what antibiotic he would use  if she DID NOT have pneumonia.  It was the same one.
So...I told him that we should skip the x-ray and just put her on the antibiotic. If she did not respond within 2-3 days, I would bring her back.  She responded quickly and got well...and she did not have a x-ray of her little chest.

If ultimately, I am going to have to do a needle bi-op, why in the world would I want to do a mammogram, especially  if the place turned out to be benign?  It it were cancerous, then at that time a mammo would be a good idea in order to detect other places.

If possible, I would rather wait until I can find a center or doctor who does the breast elastrograms, which are non-invasive.  Does anyone know a place?

..and also, are doctors doing breast cryoablation (they do this for liver tumors...freezing them)  for small places?  This seems like a better procedure than removing a lump because it is done outside of a hospital, there is no scar, and you do not have a deformed breast.

(JUST THINKING...)  As of yet, I do not know if doctors are doing cryoablation on breast tumors, but I will try to find out.  I do have some fear or else I would not be posting.

Thanks again,
Shehawk

[fvf147]

May I ask why you are so against the mammogram?  I think the mammogram would show greater detail than the ultrasound but nothing would be concrete except for a biopsy.  It sounds like they are being aggressive towards something they deem to be very suspicious.  It it didn't meet their "suspicious" parameters then I don't think you'd be getting the aggressive approach.  

I've been there and gotten the "ah it's nothing don't worry about it" result and I've gotten the "...this looks suspicious and we are concerned and can't give you a definitive answer until we know more.." result.  I have a strong family history for breast cancer, my Mom died in 2005 from it.  So that may be why I get the more aggressive treatment sometimes... but you have to understand that a huge majority of breast cancer patients do NOT have any family history.  With that being said... I've been told by doctors that most lumps turn out to be benign.  I respect you not wanting to make decisions based on fear, I wish I could be more like that myself.  But sometimes fear isn't such a bad thing... it's built within us for protection.

All the best to you!