Mammo & US report results worry me

[Zuno]

Hi, I am 39 years old and have been categorized on my radiology exam report from 5/2010 as left breast BIRADS 4 and right breast BIRADS 3.  This US exam was performed after a CBE with my OB and my first bilateral mammo.  

The report states in part that there is a "solid hypoechoic microlobulated heterogenous lesion in the area of asymmetric lesions seen in the left breast.  The mass measures 2.5 x 1.4 x 1.8 cm and is located at the 11:00 position.  There is mild posterior shadowing."  

The final impression reads as follows:  "Solid microlobulated mass with poorly circumscribed borders in the central left breast at the 11:00 position.  A sonographically guided core needle biopsy is suggested.  Focal area of mild heterogeneity in the right breast at the 10:00 position 4.0 cm from the nipple may represent mild ductal ectasia.  Recommend a short-term ultrasonographic follow-up in three to four months."

Within the report it is noted also that for my left breast "There is no clear evidence of architectural distortion.  No suspicious microcalcification groupings are seen.  There is no skin thickening or nipple retraction."

For my right breast it states: "No discrete mass is seen in this area.  There is no abnormal vascularity."

My physician is referring me to a general surgeon for evaluation, biopsy and/or surgical extraction.  This whole situation worries me.

I wish to understand the meaning of:  "microlobulated" , "heterogenous" , "hypoechoic" , "heterogenity".  Also what is "architectural distortion" and "microcalcification" ?

My physician mentioned that 2.5 cm is a rather large lesion.  Are the lesion mesurements given in my report length x width x depth?   Also, is lesion size an indicator of malignancy?

Thanks for any information.

[katarina777]

So glad for you, Zuno! Best, Katrin

[Zuno]

Just to follow up:

I had a core needle biopsy on both tissues; much to my relief the results were benign.  The Birad 4 suspicious abnormality turns out to be a fibroadenoma.  The Birad 3 are fibrocystic changes within that breast.
I agree with Katarina as she said the waiting and uncertainty are most difficult.  
My best wishes to all who have experienced screening exams that require follow up and thank you for the reply to my post.

[Zuno]

I am waiting now for the appointment with the surgeon, many thanks for your observations.

[katarina777]

PS: The right breast with the BIRAD 3 is nothing to worry about, and whatever is going on there is benign.

[katarina777]

The final conclusion is the most important sentence of the report, and it states the number one concern/abnormality which to the radiologist makes your case suspicious, and therby a BIRAD 4. ....."Solid microlobulated mass with poorly circumscribed borders in the central left breast at the 11:00 position'.

On the other hand, what makes it a little less suspicious, or 'clear', or 'surely bad', of the fact that the following elements are missing,(not present) and which are often a further lead towards more suspicion.

'There is no clear evidence of architectural distortion.  No suspicious microcalcification groupings are seen.  There is no skin thickening or nipple retraction.'

So, if this was me, I think you have good reason to worry, and we all would, but there is nothing really alarming either? i think the report is very good and very clear, and you definitely need the biopsy.

I wish you the best, but also want to say that the waiting and uncertainty is the worst part.

KAT     PS: Let us know what happens?