Breast lump in a 59 year old

I found a lump in my breast in October that did not show up in my Feb 2007 mammogram.  Immediately saw my GYN and was referred to a breast specialist.  She did ultrasound and found a small solid mass.  Core needle biopsy of that mass showed no evidence of malignancy.  Specialist, however, was concerned that the palpable mass "did not match" what she saw on ultrasound.  She indicated that she thought the mass viewed on ultrasound, the one biopsied, was "smaller and deeper" than the palpable mass.  Recommended an excisional biopsy, which was done this past week.  Excisional biopsy actually produced two masses - the palpable one (about the size of a nickel) and another smaller one.  Is it possible for a malignant mass to NOT show up on an ultrasound?  

[DennisMD]

Hi.
A breast ultrasound will only differentiate between a solid or cystic breast mass.  It will not diagnose a malignancy.  It depends on the expertise of the sonologist.  It also has limited sensitivity.
I agree with excision biopsy in order to find out if the mass is benign or not.
Please do give updates.
Good luck.

[gam59]

I was under the impression that all malignant masses were solid.  What would cause a solid mass to not be picked up on the ultrasound test?

[Dennis MD]

Hi.
Not all solid breast masses are malignant.  An example of this is fibroadenoma which is a benign breast mass.
When the mass is deep seated, or when the breast is large, there is a possibility that the ultrasound will not be able to pick up small breast mass.

[gam59]

I was aware that a solid mass is often benign.  I am still a bit confused, however.  This mass was easily palpable just below the nipple and I am a thin and very small breasted woman.  How is it possible that the ultrasound would not "see" it?  

[BhumikaMD]

Hi,
Ultrasound can pick up only those lesions which are different in density from the surrounding breast tissue. That is , any lesion will only be picked up if it is hypodense or less dense and hyperdense or more dense than surrounding tissue.
Any lesion that is isodense, or the same density as breast tissue will not be picked up. So any lump or mass or scar tissue will not be picked up if it has similar density tissue or if it itself is made up of breast tissue.
Also, calcifications are not picked up on ultrasound.
One of this could have bben the reason that ultrasound did not pick up the mass in your case.
Do discuss this with your radiologist if you still have any doubts.
Hope this helps.
Good luck.

[gam59]

Thanks for the explanation.  I think I understand the issue now.  The biopsy report will be in next week.  I will just have to cross my fingers and pray a lot until then.  Thanks again to you and to Dennis for your help

[BhumikaMD]

Hi,
Good luck to you for the biopsy report.
Do ask a copy of the report for yourself.
Glad to be of help.
Do let us know about the progress in your case.
Regards.

[gam59]

I got my biopsy report today and the mass was benign - very good news!!  Diagnosis reads "Proliferative fibrocystic change including florid duct epithelial hyperplasia,  evidence of previous biopsy, microcalcifications present, no epithelial atypia present".  What the presence of microcalcifications mean?  

[BhumikaMD]

Hi,
This is in fact great news!! Congratulations!!
Microcalcifications are tiny deposits of calcium in the breast tissue which need to be biopsied to get a confirmed diagnosis and to rule out malignancy.
The results in your case rule out a cancerous lesion.
You need to carry out regular breast examinations now and report any abnormal features to your doctor.
Have you been called for a follow up clinical examination  or mammogram and ultrasound?
Good luck!

[gam59]

Yes, I have an appointment to see the surgeon for a post-op check next week and will have a mammogram and ultrasound in March.  Thanks for your advice and answers to my many questions.  You and the others posting on this forum have really helped a lot during this entire process.  God bless all of you!  Thanks again.

[BhumikaMD]

Hi,
You are most welcome.
Do let us know how did your appointment with your doctor go and were you prescribed any medication.
Also try to keep us posted about your health.
Carry on regular breast self exams and report any abnormal features like nipple discharge, skin changes, and lump etc to your doctor.
Good luck.