The words in your report, translated, so you do not spend two years with the wrong diagnosis

Twenty four months ago, one of these words happened to me

Two years ago a report about me contained the word suspicious.

It means exactly what the list further down says it means. Somebody raising their hand. Look again. It is a request, and it is one of the most useful words in medicine, because it is a professional saying out loud that they are not finished.

It was not read that way. It was read to me as the answer. From that afternoon it stopped being a question anybody was asking, and became the thing my care was built on. I did not check it. I had no idea that a word could be promoted like that, and nobody in the room told me it had been. The oncologist who came afterwards followed the same line, because by then the line was already drawn on the page.

Nobody ever went back to the word.

I am writing this with one hand. My left hand is my dominant one and it does not work any more, and the road to that runs back through two years of being treated for something that had never actually been established. A request to look again had been turned into a finding, and by the time anybody questioned it, the cost had already been taken out of a part of my body I am not getting back.

“Suspicious is a request. It is not a diagnosis. Two years and one hand is what it cost me to learn the difference between those two things.”

So this page is not here so that you can argue with a radiologist. Radiologists are usually the most careful writers in the whole building. It is here so that you can tell the difference between a word that means look again and a word that means this is what you have, because the people in the room may never make that distinction out loud, and you are the only one who has to live in the body afterwards.

Why this exists

A report is not written for you. It is written by one specialist for another specialist, and you are given a copy of it because it is legally yours, not because anybody expected you to read it.

So you take it home and you read it anyway, because of course you do, and the words in it are doing two jobs at once. To the person who wrote them they are precise. To you they are weather. Some of them sound terrible and mean almost nothing. One or two of them sound mild and are the ones to ask about.

Here they are, sorted by that, rather than by the alphabet.

Start at the bottom

Before the words, the shape. Almost every report has four or five parts, in the same order.

• Indication. Why the scan was done. One line, usually somebody else's words.
• Technique. Which machine, which protocol, whether contrast was used. Mostly for other radiologists.
• Comparison. Which earlier scans this one was held up against. If this line is empty, nobody compared anything, and that is worth knowing.
• Findings. Everything seen, in detail, including a great deal that is completely normal.
• Impression. What the radiologist concluded.

Read the Impression first

It is at the bottom, it is the shortest part, and it is the only part where somebody has decided what all of it adds up to. Then go back up to Findings for the detail.

Reading a report from the top is how people spend an hour frightened by a sentence that the last paragraph already answered.

The words that sound worse than they are

• Unremarkable. Nothing abnormal was seen in what was looked at. It is the best word in the whole report and it reads like an insult.
• No acute abnormality. Nothing new and nothing urgent. It is not the same as nothing at all, because long standing things are not acute, but as a sentence about today it is good news.
• No evidence of disease. Nothing detectable with the tests that were used. Not the same word as cured, and that is deliberate rather than evasive. It is the most honest phrase in oncology, and it is where this site gets its name.
• Incidental finding. Something was seen that nobody was looking for. Most are harmless and always were. This is why they found something is not the same sentence as something is wrong.
• Lesion. An area of tissue that is not like the tissue around it. A completely neutral word. A bruise is a lesion.
• Mass. A lump. Also neutral. It does not mean tumour and it does not mean cancer. It means something is there that has a shape.
• Nodule. A small lump. The same word as above, wearing smaller shoes.
• Hypoechoic. On an ultrasound, darker than the tissue around it, because it sent back less sound. Darker is one of several features that get counted up. On its own it decides nothing.
• Hyperechoic. Brighter than the tissue around it, because it sent back more sound.
• Anechoic. Completely black, which almost always means fluid. Often the most reassuring word an ultrasound report can contain.
• Well defined, or well circumscribed. You can see exactly where it ends. A clear edge generally counts in your favour.
• Status post. After. Status post right mastectomy means this person has had a right mastectomy. It is your history being written down, not a finding about today.
• Scarring, or fibrosis. Tissue that healed into something tougher than it was. Surgery leaves it and radiation leaves it. It is permanent, it is not disease, and it will appear on every scan you ever have again, which is why it is worth knowing it is there.
• Stable. Compared with last time, no meaningful change. On a report about something that is being watched, stable is the word you were hoping for.

The words that are a request, not a verdict

“Clinical correlation recommended is not a warning. It is a handover. The question is whether anybody caught it.”

• Suspicious. The radiologist thinks this needs a closer look. It is not a diagnosis and it is not a probability. It is somebody raising their hand. This is the one that cost me two years and my hand, because it was repeated to me as a conclusion and I did not know I was allowed to ask whether it had ever become one. If this word is in your report, the only correct next question is: what was done to settle it, and when.
• Ill defined, or irregular margins. The edge is unclear or ragged. This one does count against rather than for, and it is a reason to ask a question, not a reason to decide anything at home.
• Follow up recommended. Look at this again, after a stated amount of time. It is a plan. Make sure the plan has a date on it before you leave, because a plan without a date is a hope.
• Clinical correlation recommended. The picture on its own cannot answer this. Somebody now has to put it next to you, your symptoms and your history. It is the radiologist saying, plainly, I have done my half of this.

The one that is not about you

Comparison: none available. If that line is on your report, nobody held this scan up against your last one.

Sometimes that is correct, because there is no last one. Sometimes it is because nobody went and found it. On anything that is being watched over time, a scan with nothing to compare it to is half a scan, and you are allowed to say so.

Three things to do with the paper

• Ask for the report itself, not the summary of it. The words are yours and so is the document. A verbal version of a report is somebody's memory of it.
• Read the Impression, then one word at a time. Mark the ones you do not know. There will be fewer than you think, and after this page there will be fewer still.
• Take your marked copy to the appointment. Not as a challenge. As an agenda. A person holding a report with four words circled gets a different conversation from a person holding nothing.

You are not being difficult

You are not being difficult by reading your own report. You are the only person in the whole process who has to live in the body it describes.

Nothing here is medical advice, including the parts that sound like it. These are the plain meanings of words used in imaging reports, written down so that you are not meeting them for the first time on your own kitchen table. What any of them means in your body is a conversation with somebody who has seen your scan.