Hi I’m Brca2+ And Had Ultrasound Yesterday On Left Breast

Posted on Thu, 11 Oct 2018

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 11 Oct 2018 Answered on

Last reviewed on

Question : Hi I’m brca2+ and had ultrasound yesterday on left breast which turned up multiple abnormal areas. Underwent immediate biopsy BIRADS IV. I have report just looking for insight from oncologist or radiologist. My dr said it was prob nothing but everything in report in highly indicative of cancer so I’m confused and unsure if he was just trying to comfort me until they know what kind? They said a week on path report when it’s usually next day. I’m confused. Also not on the report but all three masses they talk about at 4:00, 5:00 and 6:00 appeared to have a tail coming off them connecting to duct and all had vascular flow. The surgeon noticed the connection and tail during biopsy and called in someone from radiology and subsequently biopsied all three areas via vacuum.

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer:
Breast ultrasound findings need to be complemented by contrast MRI scan

Detailed Answer:
Hi,
Thanks for writing into us.

First, the pathology report is most important in your case to know any results of cell sampling on biopsy.

Your ultrasound breast scan shows BIRADS IV lesions and is highly suspicious for cancers. This needs to be complemented by a more detailed investigation and to confirm the vascular flow.

If you were under my care then I would request for a contrast MRI breast scan. There is dynamic contrast enhancement curve on contrast breast MRI scans which shows the lesions which are most likely at risk for being malignant.

Please do write back with your doubts,
Regards,

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Vivek Chail (5 hours later)

Yeah I have had mri in past bc I have the brca gene and it’s part of screening. Since it’s been removed via vacuum biopsy there wouldn’t be anything to mri right? Is it highly suspicious of cancer just bc it says birads IV or in your opinion are those specific feature of my report that make it highly suspicious? Do you know of any benign explanation?

Answered by Dr. Vivek Chail (13 hours later)

Brief Answer:
NIRADS IV has a wide range of benign vs malignant lesions

Detailed Answer:
Hi,
Thanks for writing back.

BIRADS IV is sub categorised in to IVa, IVb and IVc based on the ultrasound imaging features and depending on the probability of malignancy.

In BIRADS IVa the change of malignancy is 2 to 10 percent.

In BIRADS IVb malignancy can be seen in 10 to 50 percent of lesions.

In BIRADS IVc we have 50 to 95 percent malignancy rates.

So if your report says BIRADS IV only then malignancy rates can be from 2 to 95 percent and this is a wide range.

Biopsy is always done in BIRADS IV lesions.

Speaking about MRI, I was only stating the higher accuracy of MRI scan compared to an ultrasound scan in picking up malignant features in a lesion. Right now if biopsy is done then a MRI may or may not be needed depending on the pathological findings and this will be decided by your doctors.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar