explanantion of terms in mammogram

[lkatz]

Mammogram results:  BIRADS IV suspicious eval left breast.  1 cm nodule in upper/inner quadrant 10:00 position.  Has micro lobulations and a slight indistinct contour and is not visible by ultrasound.  Biopsy recommended to exclude underlying malignancy.  Lesion amenable to stereotactic biopsy.

Right breast, palpable lump upper/outer quadrant.  No mammographic abnormality seen.  Ultrasound performed no abnormality seen.  Given BIRADS II.

Patient has been evaluated since December 1996 for FUO and elevated white cell count (including bone marrow biopsy), with no specific cause determined.  

Are lobulations the same as calcifications?  Does slight indistinct contour mean no clear margins?  What type of doctor does stereotactic biopsy?  Once biopsy done, how long before receive test results?  Will results be given by phone or in office consult?

If biopsy shows cancer, could it be the possible cause of fuo and elevated white cell count?

[CCF-RN,MSN-rf]

Dear 1katz:  Lobulations are not calcifications.  Lobulations describes the appearance of being rounded - like a small cluster of grapes.  Indistinct contour refers to the appearance of the nodule not having as clear an edge on the film.  In other words, the edge may appear fuzzy or difficult to see.  Margins usually refer to the edges of a surgical/pathology sample.  Stereotactic biopsies are usually done within the radiology department.  Depending on the type of stereotactic biopsy, a surgeon may be involved as well.  The length of time for results and the method of delivery will depend upon the institution that performs the biopsy.  Most results will take about a week.  Method of delivery will vary.  If the biopsy shows cancer, it is an unlikely explanation for the fuo and elevated white count.

[surgeon]

lobulations are not calcifications: they are shapes that are rounded and repeated, like the contour of cauliflower. Slightly indistinct would not necessarily mean "no" clear margins (first of all, "clear margins" most often refers to the pathological exam of removed tissue; it indicates whether the edges of the tissues removed do or do not have cancer cells in them). "Distinct margins" or some similar term is used to describe xray shadows: shadows which have very sharp, like a pencil drew them, edges are less likely to be cancer than ones that have fuzzy margins. "Slightly indistinct" sounds fairly equivocal, and not definitive information. Most stereotactic biopsies are done by a radiologist: it's a technique where you lie on your belly, the breast is xrayed and by xray guidance a needle is inserted into the area. The report timing varies a lot from community to community: it could be within 24 hours or a few days. The report would usually go to the doctor who ordered the test (your doctor) and it would be up to that doctor, not the radiologist, to tell you the results. Whether by phone or in person would depend on the practice of that particular doctor; you could tell him/her what you'd prefer. Unless you had a large tumor which had dead tissue in the center, it' highly unlikely breast cancer would cause FUO or elevated white count.