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Breast Cancer

Vague area of regional shadowing

06/02/2008

Question:

Hello, I was reading a previous thread about shadowing on ultrasound imaging which was very helpful to me. I am 49, 9 months into menopause (consecutively without a period.) I take 50 mg of natural progesterone transdermally 21 days of the month for the last 5 years. My doctor and I plan to stop when I reach the one year mark without periods. My breast ultrasound report indicates "a vague area of regional shadowing 7mm @ 1 o`clock. I have never even had so much cyst on my left breast (I have on the right, but all small and never recommended for aspiration). However, at the time of the screening, I had a pinched nerve in my left shoulder and a lot of pain, radiating into the pectoral muscle above my left breast which was hard as sinew. It was in fact painful to lift my arm long enough for the exam. The tech asked if I had a scar or had had surgery, I guess because the tissue was so dense, I said no, but didn`t think about the muscle tension. So, I guess I have two questions. Is there a difference between regional shadowing and posterior shadowing? And, can soft tissue damage to the muscle affect the surrounding breast tissue? Could this possibly cause shadowing or dark areas on the ultrasound? Plus, my breasts are probably denser than ever as I lost 25 pounds in the last year and half, on purpose. I am doing my best dealing with the tissue with deep tissue massage and I will have a second opinion ultrasound next week, before going through with the core biopsy with clip that I thought was a bit prematurely recommended. There is no breast cancer in my family, and I do not feel any lump out of the ordinary in my normally dense breasts, nor did my gyno find one at my last annual. I would like to avoid the biopsy. I have flexural psoriasis which could well be activated by the Koebner response, making me ill for months, so the procedure carries that risk. My doctor says have the second opinion, possibly an MRI, (which I can have in Holland because I have Dutch health insurance) and then have the biopsy if needed. What is your opinion? Thank you so much,

Answer:

There may be a difference between regional and posterior shadowing, but neither are specific findings that definitely indicate cancer.

I do not believe that soft tissue damage to the muscle can affect the ultrasound or the surrounding breast tissue.

MRI can help detect breast cancer. Mammograms should be updated as well, if not already done.

If the ultrasound findings are felt to be suspicious, you should not avoid a biopsy. If the radiologist is not suspicious, sometimes a follow-up after a short interval can be helpful in deciding if something needs to be biopsied.

For more information:

Go to the Breast Cancer health topic, where you can:

Response by:

Paula  Silverman, MD Paula Silverman, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University