Q I am 59 years old, single and have undergone breast ultrasound and mammogram yearly for the last three years. Can you explain to me what the results of my tests mean? How can I know if the hypoechoic nodules in my breasts are benign or malignant?

Result of sonomammography: R. Breast, 11-12:00 position, hypoechoic nodule measures 1.3 cm; 7:00 position, areolar area, hypoechoic nodule measures 0.53 cm. L. Breast, 3-4:00 areolar area, hypoechoic nodule measures 0.7 cm.
 
Thank you for your time and attention.

TL Ferreras, 14 March 2003

A Hypoechoic is just a descriptive term used by sonologists or radiologists in the ultrasound report. You will find answers to a question similar to yours by reading the Q & A on What Does My US report mean posted on 27 March 2002.

Normally, your report will have a conclusion or impression/comments at the end of it. What were the final comments or recommendation by the radiologist? That will help you to find out if you have benign or probably benign lumps in the breasts.

www.radiologymalaysia.org/breasthealth/TalkBack/BreastNu.htm#Topic2
(please scroll down to read the 2nd Q & A on this page)

You may find answers in the other sections of the Q & A on Breast Health.

Editor
 

Q Saya baru berumur 19 tahun. Pada masa ini saya berasa sangat keliru samada saya menghidapi masalah kanser payudara ini atau tidak. Sudah 2 bulan saya mendapati ada ketulan di payudara saya. Pada mulanya saya ingat itu adalah bisul memandangkan ianya semakin membesar dan kemudian ianya pecah mengeluarkan nanah. Tetapi 2 minggu kemudian ianya membengkak lagi. Saya sangat takut. Apatah lagi saya mendapati terdapat 2 ketulan dibawah ketiak saya. tetapi saya tidak tahu samada ini adalah salah satu simptomnya. Saya tidak berani ke hospital saya ingin mengkajinya terlebih dahulu.

Saya merasa sangat sakit pada bawah ketiak jika saya tekan pada biji tersebut dan bila kedatangan haid, payudara terasa sangat sakit.

Saya tidak tahu apa yang harus saya katakan nanti bila saya berjumpa dengan doktor klinik nanti?? Adakah saya harus menyatakan tentang masalah
yang saya hadapi secara terperinci ataupun secara ringkas sahaja?? dan
adakah ini boleh dirawat? Terima Kasih

RD, 12 April 2002
 

A Adalah lebih baik, kalau saudari pergi ke klinik biasa (klinik kerajaan atau swasta) dahulu untuk diperiksa oleh doktor dan berkemungkinan, anda memerlukan ubat serta rawatan yang seterusnya. Jangan takut buat masa ini. Kanser kurang sekali menjangkiti mereka yang sangat muda. 

Daripada huraian saudari, berkemungkinan besar, saudari menghidapi bisul di payudara. Tidak hairanlah, kalau nodus limfa membesar dan terasa sakit di bahagian bawah ketiak. Tetapi ini tidak boleh ditentukan kalau saudari tidak terus pergi menjumpa doktor. 

Selalunya soalan adakahnya boleh dirawat tergantung kepada diagnosa keadaan payudara saudari. Secara amnya, lebih awal sesuatu penyakit (walaupun bukan kanser) dikesan, lebih senang ianya boleh dirawat dan rawatannya lebih berkesan serta lebih simple. 

Apakah yang saudari patut katakan bila berhadapan dengan doktor?
Saudari tidak harus berasa malu kerana terdapatnya kod etika di mana semua yang diberitahu kepada doktor merupakan komunikasi di antara saudari dan doktor saudari sahaja, kecuali saudari memberi kebenaran untuk doktor anda memberitahu orang berkenaan yang lain.

Lebih baik, saudari tidak merahsiakan apa-apa dan menjawab soalan doktor anda dengan terus-terang. Kadangkala, saudari mungkin tidak tahu apakah sepatutnya yang perlu diberitahu. Jangan risau, doktor akan tahu menyoal saudari mengenai simptom saudari. Adalah merupakan praktis yang baik untuk memberitahu segala yang telah berlaku kepada ketulan di payudara saudari.

Kalaulah saudari merasa malu ataupun takut, bawalah bersama seorang kawan yang dipercayai ataupun ibu saudari apabila ke klinik nanti.

Sebagai ingatan, seksyen Maklumbalas/Soalan dan Jawapan di Pusat Sumber Kanser Payudara hanya merupakan nasihat dan panduan secara am sahaja. Saudari dinasihati untuk menjumpa doktor untuk nasihat dan rawatan khusus.

Pengarang

Q Below is the ultrasound report done in September 2001. The doctor didn't tell me in detail what the report meant. She just said it's a small nodule. She did not mention whether it is cancerous or non-cancerous. She told me it is up to me whether I want to do an operation or not. She advised me to wait for a few months. The report for the ultrasound is as follows:
 
”There is a small nodule in the right breast. It is located at 8 to 9 o’clock position and measures 6.9 X 7.8 X 4.5mm. It is hypoechoic, well defined and shows some posterior enhancement. No other focal breast lesions seen. The rest of the breast show normal stromal and glandular components. Impression: Small right breast nodule, most likely a fibroadenoma.”  

May I know in detail about the report? Thanks a lot.
 

ALCW, 27 March 2002

A Explanation of the report

The report describes the position of a small lump in the right breast. As mentioned in www.radiologymalaysia.org\breasthealth\SBE\sbe2.htm think of your breast like a clock face. Imagine yourself looking at your right breast. In the diagram (not drawn to scale) shown, the nipple is the centre where the imaginary long and short hands of the clock are normally “fixed” while the oval red spot is the lump that was seen on ultrasound. The position is about 8-9 o’clock on the clock face (right breast in this case). The triangular bit of the diagram is where the breast tail extends into the right armpit/axilla area. 

The dimensions are in millimeters (mm) and from the measurements, the lump is probably almost oval in shape. Hypoechoic is a term used in ultrasound and relates to the “brightness” seen on the ultrasound monitor. In this case, it means it is less bright as compared to the normal fat or glandular structures seen in the breast.  The rest of the description just serves to characterize the lesion in question. The terms used in your report describe a non-cancerous type of lump (benign).

What is a fibroadenoma?
The radiologist has described the lesion in your breast (the lump you discovered) to be a benign lump, most likely a fibroadenoma. A fibroadenoma is a benign (non cancerous) tumour of the breast which is made up of connective tissue stroma and glandular elements (ducts and acini) of the breast. However, these have multiplied or proliferated in an atypical manner, resulting in a lump formation.

There is high probability that the radiologist (doing your ultrasound) and your clinician (the doctor examining you) being correct in their opinion (more than 90%). The descriptions all fit the bill of a non cancerous condition. It is a common type of benign breast lump and at your age, cancer is not common at all. There is the rare situation (5-10%) of a well defined type of breast cancer that on ultrasound and palpation by your doctor will simulate a benign lesion.

Because this is a rare possibility, normally, you would be recommended to go for follow up examinations with your doctor and also follow up ultrasound examinations at least initially, until there is certainty or a biopsy (needle or open surgery) confirms this lump is 99-100% benign. Generally speaking a lump that is unchanged for years and continues to have benign features on examination would be benign.

Please see www.radiologymalaysia.org\breasthealth\BreastImaging\howoften.htm

In all cases, it is important to discuss your fears with your doctor and seek clarification. Sometimes, for peace of mind, a second opinion may be a good idea especially if you find that you cannot establish a rapport with your current doctor.

Please note this is a general answer to your question. Every person may have a slightly different approach to their breast problem because there may be findings unique to you. Family history, physical, social, psychological as well as emotional factors all play a role.

Editor
 

Q Background: RZ is 40 years old and in early 2001, breast lesions were discovered and tested by needle biopsy to be benign (non cancerous) lesions. She had both the mammogram and ultrasound done. Since then, she has not been asked to return for any follow up examination. Her question now is: 

I’m wondering how I can monitor the breast lump because I'm worried that it might turn cancerous later. Should I do the mammogram once every year? My friend told me that there is a private clinic in Damansara that uses the latest method of laser scanning the breast which is much better than doing the mammogram which hurts. Is that method safe? 

As for the process of mammogram causing pain or otherwise, I believe it also depends on the technician who does it, whether she is good at performing the mammogram or not. Also the technician explained to me that if the patient is a small sized person with a small sized breast, several adjustment need to done before each section is completed so as to get a good mammogram result and the patient has to bear the longer time taken to do it. Unfortunately for me, the last experience was bad and does hurt me even though it is momentary.

RZ, 4 Feb 2002

A The principles for how often and what investigation is needed in the follow up examinations were given in the answer to your query previously in October 2001. www.radiologymalaysia.org\breasthealth\TalkBack\2001_11QnA.htm 

It is indeed unfortunate that your first experience of mammography was painful. You are quite right that the skill of the mammographer/technologist performing the mammogram plays a vital role in addition to the psychological state and individual characteristics of the person undergoing the mammogram. However, if you have read the comments by some women on the mammogram, some like you also found it painful but since it is momentary, they all found it tolerable. All the more if it could help detect cancer early!

Go to: www.radiologymalaysia.org\breasthealth\Testimonies\womenonmammo.htm

The recommendation for follow up would normally require either mammogram and/or ultrasound depending on exactly what type of benign lesion was discovered in 2001. If your doctors’ diagnosis was simple breast cysts; that could be the reason why you have not been asked to go back for follow up. We can be up to 99% sure of the diagnosis of simple breast cysts by ultrasound. Simple breast cysts are harmless.

If you have experienced and noted some changes in your breast through your regular monthly self breast examinations, it would be best to see your doctor as soon as possible, especially if the changes are worrying you.

Remember that even if you have non cancerous lumps in your breasts, it does not mean new lumps which may be cancerous will never appear in your breasts. It is therefore important to perform regular SBE and see your doctor the moment you notice worrying changes in your breasts.

Don’t forget you can get detail information on Self Breast Examination (SBE) at www.radiologymalaysia.org\breasthealth\SBE\index.htm and if you feel you need more practical hands on advice, try out the SBE workshops. Their schedules are at: www.radiologymalaysia.org\breasthealth\workshops.htm  

Laser scan for the breasts?
Back to your question on the “laser scan”, I am afraid we are unaware of any scan using laser for the breasts. Perhaps, you may be referring to the Mammaray. This machine uses “light” to “scan” the breast for lumps. It is to be used as an additional tool to add to the findings on your doctors examination but is not recommended as a screening tool for breast cancer. It helps the doctor to differentiate between true lumps and a lumpy breast texture. Mammography is still the best even if not perfect tool for checking for breast cancer. 

The other scan that is not uncomfortable for the lady is the T-Scan. This scan measures low level bioelectric currents to produce real-time images of the electrical impedance properties of the breast. The resulting impedance images of the breast tissue can be used to help determine if the region of interest is normal tissue or a cancerous (malignant) tumor.  

It therefore assists in the diagnosis of breast cancer. It is currently not recommended as a screening tool for breast cancer and is to be used in conjunction (in addition to) with the mammogram. However, it does not cause any pain because there is no need to compress the breast and it also does not use any x-rays. It is also reported to be helpful for women with dense breasts (more glandular tissue in the breasts compared to fat tissue). 

You can find more information on the T-scan at: http://www.imaginis.com/t-scan/why-perform.asp 

Now, both the T-scan and the mammaray cannot replace mammography when screening for breast cancer. However for focussed and directed follow up of certain breast conditions in certain breast types (dense breasts), it may come in useful IN ADDITION to the mammogram and/or ultrasound. This will have to be decided on a case by case basis. This means, it will depend on the patient and the type of breast lesions she has as well as other factors. Both these methods of “scan” are safe thus far.

Editor

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