Ultrasound Addendum Question

My breast ultrasound has been modified to say the following:  Re-review of the mammographic images with doctor suggests a subtle ring shaped finding in the medial left breast.  This raises the question that the finding noted sonographically at the 9:00 radian may reflect focal area of fat necrosis.  Does anyone know what this means?

[zouzi]

Hi there,
Fat necrosis is a benign condition in which damaged and disintegrating fatty tissues form round, firm lumps in the breast tissue. The lumps are usually painless but in some women may be tender.
.
These lumps are not malignant and they don't increase a woman's risk of cancer, in some cases, physicians will keep a watch on the lump through several menstrual cycles, and may perform a mammogram or ultrasound before deciding whether to perform a biopsy to remove it surgically. Usually, though, an area of fat necrosis will not require any treatment and will clear up on its own within a few weeks.Best wishes

[Sarajane0422]

I know what fat necrosis is.  What I really want to know is, what is the subtle ring shaped finding?  I can not find any on that type of describiton involving the breast.

[zouzi]

The subtle ring (round) shaped finding, I believe is the lump that the report says raises the question that it reflects fat necrosis.

[Sarajane0422]

Thank you.  This is all so confusing because the same thing can be described a million different ways.  Now if I could just figure out what it is about the lump that makes the radiologist think it is fat necrosis when the ultrasound report says it is nonspecific in appearance.  I have an appointment with a breast surgeron this Wednesday.  Thanks again for your help!

[zouzi]

Yes I agree with you that the report is not very clear for us to understand it better,because the ring shaped finding could also mean calcification and not necessarily a lump.I am sure that your surgeon will clarify everything for you.Did the report mention what was your BIRADS score?.

[Sarajane0422]

Can you tell me where I can read about the ring shape meaning may be calcifcations?  My BIRADS score is 3, but in the ultrasound report the radiologist said that in light of the nonspecific apperance it is amenable to percutaneous sampling for histologic evaluation.  It would help for me to read more about the ring shape description before I go to see a surgeon.  Thank you so very much for you insight.

[zouzi]

I tried to send you the site where I found this information from a radiologist expert,but unfortunately I wasn't able to do it.( I hate computers! LOL)

The main thing is that the information includes the" word" we are looking for.Some shapes being concerning and some being normal.I have underlined the word "Spherical" and I copied it for you.
                           -----------------------------------------------
                                           QUOTE
                                            
When should you worry? First, don't panic if you have microcalcifications because most women DO have them at some point. The doctor will take a look to see if they warrant further investigation.

When the microcalcifications are of concern, they appear clustered tightly

together, or have irregular shapes, rather than "spherical",(Which is what you might
                                                                    ~~~~~~~
have when your doctor suggested a subtle" ring shape")                          
                                                                                          
Microcalcifications cannot be felt on clinical exam or your own breast self-exam. They do not hurt. This is the value of mammography - it finds them long before they can progress into an actual lump.
                                     -------------------------------------------
Your BIRADS score being a 3 means that it's probably benign, but because it's nonspecific in appearance,the radiologist would prefer to do a biopsy for better evaluation.Either way,you having a lump or calcification with a BIRADS 3 is really not that worrisome.Best wishes and God Bless.

                                        

[Sarajane0422]

I just want to say thank you again.  What you have provided is very helpful.  I'm lucky in that I live close to center city philadephia so I have access to the best doctors.  I am seeing the top surgeon at the University of Pennsylvania.  I know I am in good hands and my OB seems to be taking more of an interest because he called the surgeon asking him to call him after I see the surgeon on Wednesday.  I will  let you know how I make out.  Sarajane

[zouzi]

Hi there,
I just wanted to add a little advice.
Before you go to see your surgeon,write down all the questions you will be asking,so you don't forget them when talking to your Surgeon.(We all do when we are stressed) Also it's a good idea to take someone with you so you don't miss anything that is said to you.Wishing you all the best....and good luck.

[Sarajane0422]

Just wondering how does the radiologist know if something is fat necrosis?

[zouzi]

I don't think your radiologist knows for sure if the lump( or whatever he saw), is in fact fat necrosis or other,he can only suspects that it is.Only a pathologist, after examining the tissue taken,can definitely report it as such.I guess that you will have to have a biopsy done to find out what the radiologist saw in the imagery of both your mammogram and U/S.Take care...

[Sarajane0422]

I went to see a surgeon and he says I have oil cysts/fat necrosis and I don't need a biopsy.  He says I need a repeat mammogram and ultrasound in 6 months.  I am confused about not getting a biopsy because the radiologist who did the ultrasound and recommended I see a surgeon said I should have a biopsy.  Should I go with what the surgeon says or get one more opinion?

[zouzi]

In my opinion I would follow the radiologist suggestion to have a biopsy.A surgeon even though he is experienced in his field as a surgeon would not know for sure what this lump really represents.A radiologist would certainly know more because this is his job,and if he/she recommends a biopsy, I would for sure follow his/her advice.You could also have your films read by another radiologist for a second opinion, and if a biopsy is also recommended, then it's clear what your choice should be.A biopsy is a simple procedure that will give you peace of mind and not let you wonder and worry about this lump for the next six months!.Of course this is a choice that only you can make.Take care.

[skeetelmore65]

I had a Mammogram in '06 and yes do to my back and neck issues put it off. I know that is a bad thing, but in excruciating pain that makes it so hard to focus on anything else. Anyway, I got another Mam. to compare. Now, they are requesting that I come in to have an ultrasound...Is there any reason for concern. My breast after Mam. became 2-3 times their normal size and sore. I felt like I was preg. I breastfed both my boys but had to stop @ 7 wks. due to duct clog. Do you think maybe something is up? It has been @ 3 wks. since Mam and breast are still sore but not as swollen. That part has gone down. It feels like where I breastfed is really sensitive. Oh well, If anyone knows what in the world I am talking @. I am prob. just over worrying @ it ...I hope...Yall take care and always...GOD BLESS...K

[zouzi]

Hi there,please allow me to suggest to you that if you state your question in your own new post you'll be more likely to get a quick reply.When you add a question on an old thread,members would most likely overlook it,assuming that your comment is another reply to the first poster.To post a question anew,just go to the top of the page where there is a green rectangle saying " Post a question"click on it and you will find it.

[Sarajane0422]

Via fedex my films and report from the surgeon were returned and the report impression says most likely fat necrosis.  Should I be concerned about the most likely?

[zouzi]

Hi there,
The report you received was the result of a biopsy you just had or your surgeon's opinion after reading the films?I really wouldn't be satisfied with about the "Most likely fat necrosis" This report is just the Surgeon's opinion,no matter how good he/she is,but only a pathologist report stating that without any doubt the lump is fat Necrosis would put my mind at ease.Your BIRADS score 3 is "probably benign" and your Surgeon reports is "Most likely fat Necrosis" but neither are definite answers.If you want to pursue this matter for your own peace of mind you could ask for a biopsy, since the radiologist also advised to do it...,if not then it's your choice and I really don't see what else I can advise you to do.Whatever you decide I wish you all the best.

[Sarajane0422]

Sorry for one more piece of advice.  I did set up an appointment to see another surgeon to get another opinion.  That appoinment is not until 11/23 and is at a cancer only hospital.  When I went to the first surgeon I asked for a biopsy and he refused by saying it was not necessary.  When I go to the second surgeon, do I have an absolute right to ask for a biopsy?  It just seemed with the last surgeon that he was in control not me.

Thank you again for your assistance.

[zouzi]

First of all, don't be sorry for asking questions,you can ask whatever you need to know about your situation and we are always happy to be able to help the best we can.
Now,of course you have the right to ask for a biopsy,many women have asked for this procedure even though they had a BIRADS score 3.No one should be in control of you concerning your own health.I hope you will have better luck with the next Surgeon.Also you could go back to the radiologist who told you from the very start that a biopsy was necessary. Good luck.