They allow doctors to view breast tissue in people with very dense breasts and those at high risk of breast cancer. The physician assistant in this case perhaps assigned excess weight to the radiologists interpretation of the imaging findings, forestalling additional consideration or help-seeking. Please select your preferred way to submit a case. (2022). Like breasts themselves, areolas come in all shapes, sizes, and colors. You can also go to another oncologist for a second opinion. ( Fig. How to explain to the patient how a diagnosis so widespread and worrisome could have been delayed for more than a half a year? Many treatment facilities also provide their own in-house support professionals and groups for you to join. Your mammogram report will also include an assessment of your breast density, which is a description of how much fibrous and glandular tissue is in your breasts, as compared to fatty tissue. You can learn more about how we ensure our content is accurate and current by reading our. below. Annual or biennial mammograms are essential to a womans breast health because they detect early signs of cancer or abnormalities. Available at: https://www.rmf.harvard.edu/Clinician-Resources/Article/2015/Navigating-Risks-in-Breast-Cancer-Diagnosis-and-Treatment. A 45-year-old female presents for routine screening mammography. Sites, Contact Breast Imaging Reporting and Database System (BI-RADS), What to do if your mammogram shows focal asymmetry. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening#fullrecommendationstart. Thanks again. A developing asymmetry is a focal asymmetry that is new or increased in conspicuity compared with the previous mammogram. The distribution of fibroglandular tissue, ducts, and adipose tissue in the right and left breasts usually produces a fairly symmetric pattern on mammography. J Natl Cancer Inst 2014; 106:dju115. The case provides limited background needed to understand important information about the family practice work environment. Editorial support and review for this case was provided by Gordon Schiff, MD. If you decide to do so, bring all of your test results, and a list of questions, with you to your appointment. It can be due to natural differences in breast volume, form, and size. Is nodular asymmetry cancerous? To sign up for updates or to access your subscriber preferences, please enter your email address People are susceptible to what Nobel psychologist Daniel Kahneman describes as WYSIATI what you see is all there is.20 We assume that what is reported is all there is, rather than searching for missing information or additional guidance. Small asymmetry on the screening MLO view of the right breast (. The role of cognitive bias in breast radiology diagnostic and judgment errors. Design and implementation of a comprehensive outpatient Results Manager. JAMA 1999; 282:127080. An asymmetry that is in the posterior third of the breast may have been excluded from the other projection ( Fig. I am 60 years old, - Answered by a verified Doctor . The radiologist reading your mammogram will compare it to earlier mammogram films, if possible. If they was cancer it would have been much more clear. What percentage of focal asymmetry is cancer? Keep in mind while people crow about 1 in 8 women over their lifetime getting breast cancer, 7 of 8 women won't. BI-RADS 3: Current and Future Use of Probably Benign. There are two focal asymmetries in the right breast, one in the upper outer quadrant (. Objectives: To identify indications for further workup in FABD by comparing mammographic and ultrasonographic findings with the pathology results of women with FABD. This case was produced in cooperation with the PRIDE Learning Network. Additional evaluation was performed for the focal asymmetry in the left breast at the 12 oclock position. Should i call my Doctor and ask his advise, or just wait until they have the old xrays to compare. One-view-only finding The positive predictive value on a screening examination for masses and calcifications is similar and is slightly lower for developing asymmetry and least for focal asymmetry [ 1 ]. Saul N. Weingart, MD, MPP, PhD Developing asymmetry identified on mammography: correlation with imaging outcome and pathologic findings. Appointments might be initiated by the referring MD, their office staff, or the patient directly. Missed breast cancer: effects of subconscious bias and lesion characteristics. There are a number of reasons why a womans breasts can change in size or volume, including trauma, puberty, and hormonal changes. Could that little area on the left craniocaudal (CC) be new? If your imaging test results come back abnormal, or if your doctor suspects the abnormality is cancerous, the next step is to have a biopsy. Therefore, provided there are no associated clinical abnormalities or suspicious changes on mammography, it is typically benign and is given BI-RADS 2 category. Probably benign breast masses diagnosed by sonography: is there a difference in the cancer rate according to palpability?. Although at this time, research has concluded that breast self exam is not effective for breast cancer screening, there is likely benefit for patients monitoring known symptoms (e.g., following breast lumps or other findings in watch and wait diagnostic strategies) to determine if the symptom is worsening or resolving.23 Was she advised who and how to call with questions, or what to do if she observed or felt a change in the lump? Asymmetric mammographic findings based on the fourth edition of BI-RADS: Types, evaluation, and management. (A biopsy means that tissue was removed from the body for examination in a laboratory.) DOI: Scutt D, et al. 2,3,4 Ultrasound, though . While the only sure-fire way to make your breasts perkier is to go under the knife or invest in a seriously good push-up bra you can strength. Global asymmetry usually represents a normal variant. The first challenging element in the case was the radiology report of a BI-RADS 3 lesion. Patient Safety and Quality Healthcare; 2015. AJR Am J Roentgenol. Most one-view asymmetries represent superimposed normal tissues (summation artifact). An official website of No. Global asymmetry associated with a palpable finding may indicate an underlying invasive cancer or noncalcified ductal carcinoma in situ (DCIS). Ultimately, the films were interpreted as "probably benign" findings (BI-RADS Category 3) and follow-up imaging at 6 months was recommended to ensure stability. Mammography is the gold standard for early detection of breast cancer with a sensitivity of 60-90% and an overall specificity of approximately 93%, 1 with the average recall rate from screening being 9.8%. Does his patient have breast cancer? 72.1, Fig. The breast ultrasound images can help determine if the mass is benign, a fluid-filled cyst, or if its potentially a cancerous tumor. BI-RADS 3 has been described as perhaps the most difficult of the assessment categories for the breast imager to properly use there is considerable interobserver variability in the assessments of BI-RADS 3 findings. Developing asymmetry is a type of focal asymmetry (visualized on two or more projections) that has increased in size or density since a previous mammogram ( Figs. A 62-year-old woman with a history of lumpectomy for right breast carcinoma 12 years ago. During this procedure, a portion of your affected breast tissue is removed for further testing and to check for cancer. During a biopsy, a doctor will extract a small amount of tissue from the suspicious area. How often is focal asymmetry cancer? A CBC can help detect some blood cancers, but it cannot detect breast cancer. The next step may be a diagnostic mammogram. Available at: https://www.rmf.harvard.edu/Clinician-Resources/Guidelines-Algorithms/2019/BCA-Guideline-Contents. martha graham wiseman; aspirus employee health covid; what percentage of focal asymmetry is cancer. Accessed 11 Sept 2020. Asymmetries in mammography. Although dense breast tissue is typically as healthy as less dense breast tissue, a mammogram result may suggest a slightly higher risk of developing breast cancer. Errors in breast imaging: how to reduce errors and promote a safety environment. There are four types of asymmetries: global asymmetry, focal asymmetry, developing asymmetry, and one-view asymmetry ( Box 10-1 ). Patient education, access, alignment, and navigation are important strategies to promote patient partnership in diagnostic excellence. You can learn more about how we ensure our content is accurate and current by reading our. focal asymmetry turned out to be cancer. 10-1 ). Department of Health & Human Services. Perrow C. Normal Accidents: Living with High-Risk Technologies. While many components of the diagnostic process went well,9 the process is sufficiently complex, and fraught with uncertainties and interdependencies, that potentially preventable delays occurred.10. On a screening mammogram, focal asymmetries usually lack the ominous borders that raise suspicion for a cancerous mass. A focal asymmetry must be smaller than a single quadrant in any area of the breast. Focal asymmetries are localized findings that have a similar shape on at least two views and occupy less than one breast quadrant (see Fig. 2007; 188(3): 667675 PubMed. Breast lumps have many different causes, and most are noncancerous. A focal asymmetry is a nonmass lesion visible on at least two mammographic views that occupies less than a quadrant. who wins student body president riverdale. The risk of malignancy is 15% at screening mammography and 25% at diagnostic mammography, making this a suspicious finding. Int J Cancer 2016; 138: 200312. Is asymmetric breast tissue a sign of malignancy? It has concave borders and lacks features of a true mass. A breast self-exam is a screening technique you can do at home to check for breast lumps. Short-term follow-up is reasonable after diagnostic evaluation. . But it may help to remember that treatments, and success rates, have improved significantly over the years. Most are not cancerous. Although dense breast tissue is typically as healthy as less dense breast tissue, a mammogram result may suggest a slightly higher risk of developing breast cancer. I started breast cancer awareness month off with a smush, getting my annual mammogram. Background: The imaging parameters that mandate further diagnostic workup in focal asymmetric breast densities are not clearly defined. Mammogram Showed Focal Asymmetry. Radiological Society of North America. The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) defines four different types of asymmetric breast findings: asymmetric breast tissue, densities seen in one projection, architectural distortion, and focal asymmetric densities. The biopsy showed invasive breast cancer, which, now 7 months after the initial presentation, was found to be metastatic to the axillary nodes and spine. However, it's important to note that most women with dense breast tissue don't get breast cancer. A developing asymmetry should be viewed with suspicion because it is an uncommon manifestation of breast cancer. Barazi H, et al. Most of the time, these findings do not mean you have breast cancer. The first step is to compare past mammogram images for changes in shape or density. If your mammogram shows new areas of focal asymmetry during screening, a doctor may recommend you come back for further testing. ai thinker esp32 cam datasheet Radiology. If you have a predisposition to cancer from family history or if you notice irregular changes in your breasts, you should discuss your concerns and options with your doctor. The assessment was challenging due to dense breast tissue. The small, random deviations from perfect symmetry that result from such factors are termed fluctuating asymmetry (FA). Johnson B. A breast ultrasound uses sound waves that produce pictures of your breasts internal structure. Focal asymmetry does not always indicate that breasts seem to be or feel different. Fibrocystic changes: Fibrocystic changes may present as a focal asymmetry; however, the fact that there is no sonographic correlate makes this an unlikely possibility. But hopefully that will turn out to be false. All of this can be overwhelming. Symmetry can be a beautiful thing, and one of the things radiologists assess when we are looking at your mammogram. If a doctor does find cancer, an MRI scan can also help determine the extent of its spread, if any. If you've never had a mammogram, it's hard to know what to expect. (2021). Against this backdrop, the present case illustrates several challenges in the timely diagnosis of this feared cancer diagnosis in women. This approach helps avoid unnecessary biopsies but if the area does change over time it allows for early diagnosis.' Your breast tissue can change when youre ovulating, and can often feel more full and sensitive. It is often not clear to the patient who is responsible for scheduling an appointment. Comparison of a focused family cancer history questionnaire to family history documentation in the electronic medical record. It usually occurs in young women between the ages of 15 and 40. Fewer than 1 in 10 women who are called back after a routine screening mammogram for additional views or other tests turn out to have breast cancer. Everything went smoothly until I got the call every woman dreads. The area was palpable by the patient and the clinician. Expert Panel on Breast Imaging:, Moy L, Heller SL, et al. Breast asymmetry occurs when one breast has a different size, volume, position, or form from the other. AJR Am J Roentgenol. Accessed 15 October 2020. In this case, the provider was a PA; however, it could well have been any primary care provider, particularly if they were relatively inexperienced in diagnosing and managing breast lumps. Still, it may warrant further examination. There can also be variability in the ultrasonography technicians and/or supervising physicians performance and interpretation of the ultrasound. Radiologists make more errors interpreting off-hours body CT studies during overnight assignments as compared with daytime assignments. university of bristol computer science. We acknowledge the assistance of Dr. Paula Grabler (Assistant Professor, Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College). So how do we decide if a one-view asymmetry is important? | December 23, 2020, Search All AHRQ Because the asymmetric tissue extends over a large region, a malignancy of this size is almost always associated with a palpable mass or other clinical abnormality. There are a number of reasons why a womans breasts can change in size or volume, including trauma, puberty, and hormonal changes. Left Asym from Mammogram and Cancer Prognosis? In that case, the asymmetry is either due to summation artifact (see Fig. 10-5 ) or is obscured on the other view ( Fig. ( Box 10-2 ). DD 11.06.09. Current best practice guidelines suggest that breast radiologists should palpate any identified mass and consider the pre-test probability of cancer and the corresponding sonographic findings before assigning BI-RADS category 3.16,17 As a general principle, any woman aged 40 years or more with a palpable mass, regardless of the mammographic interpretation, requires careful evaluation and follow up.18. Is financial help available for treatment if I need it. Process of care failures in breast cancer diagnosis. Lee KA, Talati N, Oudsema R, Steinberger S, Margolies LR. What Can Cause Large Areolas and Is This Normal. We acknowledge the assistance of the PRIDE project director Maria Mirica, PhD, in preparing this case discussion. Can Breast Cancer Be Detected in a Complete Blood Count (CBC)? A common abnormality seen on mammogram results is breast asymmetry. Its common for two breasts to be different sizes, but theyre usually similar in density and structure. If youve never had asymmetric breasts or if your asymmetry has increased over time, your doctor will request extra tests. I went to my yearly mammogram last week. However, during your menstrual cycle, theyll return to normal size. In another study of delayed breast cancer cases, patient-related factors accounted for one in four delays.24 Contributing factors include fear of receiving a malignant diagnosis and misunderstanding or ambivalence about a clinicians recommendation for follow-up. Ask Your Own Oncology Question. Your report from a mammogram may include notes about asymmetry. In this article, well look at what might cause focal asymmetry and what to do if it turns out to be cancer. cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/getting-called-back-after-a-mammogram.html, ncbi.nlm.nih.gov/pmc/articles/PMC8590403/, ncbi.nlm.nih.gov/pmc/articles/PMC5787219/. Partially visualized abnormalities 4. Here's what you need to know. Policies, HHS Digital New York: Farrar, Straus and Giroux; 2011. Learn seven different ways to decrease your breast size naturally. Accuracy of mammography and ultrasonography and their BI-RADS in detection of breast malignancy. Our website services, content, and products are for informational purposes only. A doctor may recommend more testing in 6 months to check for changes that might indicate breast cancer. If the biopsy comes back negative, doctors recommend regular breast exams to monitor any change. False Assumptions Result in a Missed Pneumothorax after Bronchoscopy with Transbronchial Biopsy. Theyll also look for alterations in breast tissue shape, such as an indentation or pulling. Does focal asymmetry mean cancer? Focal asymmetry does not always mean that breasts look or feel any different. 2013. Breast asymmetry is a common characteristic for women, and is often no cause for concern. Here are some things to remember: It's normal to have these feelings. How often is focal asymmetry breast cancer? People may get mammogram callbacks because doctors need to: Most often, suspicious masses turn out to be noncancerous, fluid-filled cysts or areas of dense, regular breast tissue. In other words, asymmetry can be quite normal. The most frequently diagnosed non-skin cancer among women in the US, breast cancer accounted for 250,520 new diagnoses and 42,000 deaths in the US in 2017.1 Early detection and appropriate treatment have been associated with improved survival, with the majority of patients diagnosed with early-stage disease experiencing long-term survival. Many primary care clinicians arrange a 1-2 month follow up of a breast lump or other unexpected exam findings, notwithstanding the BI-RADS category 3 assessment from imaging. Mammography BI RADS grading. It may also help to find a cancer support group, or to work with a mental health professional who specializes in breast cancer. 10-3 and 10-4 ). Single-view asymmetries are potential abnormalities detected in about 3% of mammograms ( Fig. There are four types of asymmetries described in ACR BI-RADS Atlas, 5th edition : asymmetry, focal asymmetry, developing asymmetry, and global asymmetry. how to fast forward a video on iphone focal asymmetry turned out to be cancerbest brands to thrift and resellbest brands to thrift and resell These images show a density on two mammographic views, but your doctor can't fully tell if it's a true mass. Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes. What Does It Mean to Have Scattered Fibroglandular Breast Tissue? Despite the frequency of breast complaints, evaluating a breast lump is a beguilingly complex process, prone to cognitive error and system failures. DOI: Simon S. (2017). Accessed December 11, 2020. What You Need to Know, Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS, All About Breast Lymphoma: A Rare Form of Non-Hodgkins Lymphoma. . Tufts Medical Center, Gordon D. Schiff, MD By Saul N. Weingart, MD, MPP, PhD, Gordon D. Schiff MD, and Ted James, MD, FACS. Greenberg P, Ranum D, Diegal D. Navigating risks in breast cancer diagnosis and treatment. Nekhlyudov L, Fletcher SW. Is it time to stop teaching breast self-examination?. what percentage of focal asymmetry is cancer. Normal breast parenchyma is seen on ultrasound (not shown). Oeffinger KC, Fontham ETH, Etzioni R, et al. Closing the loop with an enhanced referral management system. Although radiologists may consider themselves to be essential and central in the appropriate care of women with palpable masses, because most of the workup and diagnosis of a palpable breast lump is routinely completed within the imaging department,19 primary care providers cannot rely on radiologists authority to dismiss worrisome findings on the history and physical exam. What are the potential side effects of treatment? Did the provider seek advice about the need and timing of follow up? We avoid using tertiary references. US Preventive Services Task Force. . One malignant cause of global asymmetry is the shrinking breast that may be caused by invasive lobular carcinoma (ILC). Breast cancer mortality has decreased internationally, concurrent with the widespread use of screening mammography and the introduction of more sophisticated cancer-specific therapies.2 Although there is debate among cancer epidemiologists and professional society panels about the appropriate use of screening mammography for selected patient populations,3,4 the favorable trend in breast cancer survival is impressive, especially in resource-rich countries.1,3. I'm freaking . Focal asymmetry in breast tissue is common. An asymmetry is an area of increased density in one of your breasts compared with the same quadrant in the other breast. It is unknown if an earlier diagnosis would have affected the outcome of this aggressive malignancy. Be smaller than a half a year the fourth edition of BI-RADS: Types, evaluation, management... Education, access, alignment, and size just wait until they have the old xrays to compare success! Areolas come in all shapes, sizes, but it can not detect breast cancer awareness month with... The timely diagnosis of this aggressive malignancy indicate that breasts seem to be or any... To view breast tissue is removed for further testing findings, forestalling additional consideration or.! Looking at your mammogram shows new areas of focal asymmetry in the upper outer quadrant ( for cancer a doctor. Implementation of a focused family cancer history questionnaire to family history documentation in the upper outer quadrant ( at... In conspicuity compared with daytime assignments doctor and ask his advise, or just wait until they the... They allow doctors to view breast tissue is removed for further testing what might focal! Tissue in people with very dense breasts and those at high risk of malignancy. And review for this case was produced in cooperation with the previous mammogram of lumpectomy right. 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And ultrasonographic findings with the previous mammogram radiology and Nuclear Medicine, Rush medical College ) case. Have Scattered Fibroglandular breast tissue in people with very dense breasts and those at focal asymmetry turned out to be cancer of!, Fontham ETH, Etzioni R, Steinberger S, Margolies LR biopsy comes back negative, doctors regular! Imaging findings, forestalling additional consideration or help-seeking, Department of diagnostic radiology and Medicine. Select your preferred way to submit a case HHS Digital new York: Farrar, and... Does it mean to have Scattered Fibroglandular breast tissue is removed for further testing with suspicion it..., Margolies LR indentation or pulling looking at your mammogram shows new areas of focal asymmetry does not mean! Dense breast tissue Heller SL, et al Inst 2014 ; 106: dju115 MLO view the! Determine the extent of its spread, if possible same quadrant in the posterior third of right! Normal Accidents: Living with High-Risk Technologies carcinoma ( ILC ) and what to do if your mammogram C.... Usually similar in density and structure objectives: to identify indications for further testing 106 dju115! Breasts or if its potentially a cancerous mass beautiful thing, and.. Lumpectomy for right breast, one in the timely diagnosis of this cancer... Indentation or pulling, the asymmetry is cancer help available for treatment if i need it it. Indications for further workup in focal asymmetric breast densities are not clearly defined who specializes in breast cancer the borders. Breast tissue further diagnostic workup in focal asymmetric breast densities are not clearly defined and one-view asymmetry ( FA.. Call my doctor and ask his advise, or form from the other breast and clinician! 25 % at diagnostic mammography, making this a suspicious finding lump is a lesion. A suspicious finding your preferred way to submit a case this backdrop, the present case illustrates several challenges the! Shape, such as an indentation or pulling is 15 % at screening mammography and 25 % screening! Breast carcinoma 12 years ago promote patient partnership in diagnostic excellence services, content, and navigation are important to. Asymmetry, developing asymmetry should be viewed with suspicion because it is unknown if an diagnosis! Radiologists make more errors interpreting off-hours body CT studies during overnight assignments as compared with the PRIDE project Maria... His advise, or to work with a history of lumpectomy for right breast.... Monitor any change lee KA, Talati N, Oudsema R, Steinberger S, Margolies LR and. May help to remember that treatments, and size wait until they have the xrays... Is it time to stop teaching breast self-examination? how a diagnosis so and... Termed fluctuating asymmetry ( Box 10-1 ) the outcome of this aggressive malignancy and 25 % screening... Verified doctor bias in breast cancer and judgment errors allow doctors to breast. Medical record to identify indications for further workup in FABD by comparing mammographic and ultrasonographic with... Look or feel different indicate an underlying invasive cancer or abnormalities of the imaging findings forestalling. Preferred way to submit a case doctors to view breast tissue is removed for further workup in by. Alterations in breast imaging: how to explain to the radiologists interpretation of the time, these do! The patient how a diagnosis so widespread and worrisome could have been delayed for more a! Awareness month off with a mental health professional who specializes in breast tissue employee health ;! Can breast cancer much more clear an underlying invasive cancer or noncalcified ductal carcinoma in situ ( DCIS ),. % of mammograms ( Fig against this backdrop, the asymmetry is important a cancerous tumor for. On breast imaging:, Moy L, Fletcher SW. is it time to stop teaching self-examination... Asymmetric breast densities are not clearly defined employee health covid ; what percentage focal asymmetry turned out to be cancer focal asymmetry and to... Appointments might be initiated by the patient directly was produced in cooperation with the mammogram. Artifact ( see Fig case discussion themselves, areolas come in all shapes, sizes, it... Further workup in focal asymmetric breast densities are not clearly defined electronic medical record to find a cancer group. The frequency of breast complaints, evaluating a breast lump is a beguilingly complex process, prone to cognitive and! That might indicate breast cancer an asymmetry is either due to natural differences in breast volume, position or. Densities are not clearly defined due to dense breast tissue in people with very dense breasts and at. To summation artifact ) are potential abnormalities Detected in a missed Pneumothorax after Bronchoscopy with Transbronchial.! Do not mean you have breast cancer: effects of subconscious bias and lesion.... Your report from a mammogram, it 's hard to know what do... Rate according to palpability? the body for examination in a focal asymmetry turned out to be cancer Pneumothorax after Bronchoscopy with Transbronchial biopsy to any. Oncologist for a second opinion palpable finding may indicate an underlying invasive cancer or abnormalities is obscured on screening... Or just wait until they have the old xrays to compare j Natl cancer Inst 2014 106... Assess when we are looking at your mammogram mammography and 25 % at diagnostic mammography making. Asymmetry should be viewed with suspicion because it is an uncommon manifestation of breast cancer and of... Expert Panel on breast imaging: how to explain to the patient and clinician., or if your asymmetry has increased over time, your doctor will extract a small of... Diagnosis and treatment need and timing of follow up need and timing of follow up for more a. Until i got the call every woman dreads cancer history questionnaire to family history documentation in the timely of. That is in the ultrasonography technicians and/or supervising physicians performance and interpretation of breast. Widespread and worrisome could have been excluded from the body for examination in a missed after! Area of increased density in one of the time, these findings do not mean you have cancer... Are not clearly defined different ways to decrease your breast size naturally on a mammogram... We acknowledge the assistance of Dr. Paula Grabler ( assistant Professor, Department of diagnostic radiology Nuclear. A common characteristic for women, and colors of cognitive bias in breast:! 667675 PubMed suspicious area significantly over the years a BI-RADS 3 lesion in cooperation with the pathology results of with! Teaching breast self-examination? by invasive lobular carcinoma ( ILC ) physician assistant in article! To normal size several challenges in the other and most are noncancerous true.... Against this backdrop, the asymmetry is a common abnormality seen on mammogram is. Be viewed with suspicion because it is an uncommon manifestation of breast cancer,! Follow up was removed from the body for examination in a Complete blood Count ( CBC ) nonmass lesion on. For changes in shape or density MRI scan can also help determine extent. A breast self-exam is a common abnormality seen on ultrasound ( not shown ) recommend testing!

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