0:00

This is our 74-year-old who had a recently

0:03

diagnosed stage 0 disease in her right

0:07

breast, which had presented as a mass.

0:09

We think of DCIS as presenting as calcifications

0:12

or as non-mass enhancement, but her DCIS was,

0:16

uh, mass-like on mammogram, ultrasound, and on MR.

0:21

So I'm just going to scroll

0:22

through and remind you of her.

0:24

Let's just start at the bottom.

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I convention.

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I typically start at the top, but we're going

0:28

to start at the bottom because we're closer.

0:30

So, remembering, this is the right breast and,

0:33

and the left breast, we're going to scroll up.

0:36

We're going to look first in the right

0:38

breast where we have a known diagnosis of.

0:43

Um, I, and I've deliberately chosen the, um,

0:46

kinetics as well just to illustrate the, um,

0:51

blue as compared to red nature of a lot of DCIS.

0:54

Um, this is, um, our, uh, our right upper

0:58

outer quadrant, small breast cancer.

1:01

It is morphologically a small,

1:03

irregular enhancing mass.

1:05

Um, and, um.

1:08

Otherwise, there are vessels that are

1:11

evident in the right breast, but there's

1:13

no additional disease in the right breast.

1:15

But oh, by the way, and we just

1:17

scrolled through it in the left breast.

1:19

There is an unsuspected unanticipated,

1:24

her, um, imaging studies on

1:26

mammogram had been normal.

1:28

There's an unanticipated extent of NME,

1:32

uh, which required MR biopsy and was,

1:36

um, uh, DCIS in the left breast as well.

1:39

So I just want to remind you that, um.

1:42

This was, uh, the whole point of doing

1:45

staging disease, particularly in the

1:47

setting of DCIS, has to do with breast

1:49

density and, um, extensive disease,

1:53

unanticipated disease in the ipsilateral

1:55

breast and in the contralateral breast.

1:57

So this would be an example of the

1:59

single-digit but, uh, nonetheless

2:01

possible, um, contralateral disease.

2:04

Remember the buzz phrases, and this

2:06

is really a nice example of that.

2:07

The buzz phrases of suspicious, um,

2:10

uh, NME. Morphologically, the

2:14

morphology is clumped or clustered ring.

2:17

You remember we had a great clustered

2:18

ring case earlier in the course, and,

2:20

but these are, these are, uh, clumped,

2:22

uh, these are clumps of enhancement.

2:24

Then there's also, um, anatomically

2:27

from a, from a, um, from a distribution.

2:31

Um, Perspective, this is linear enhancement.

2:35

So a combination of linear and clumped

2:39

NME in the setting of somebody who

2:42

has newly diagnosed breast cancer.

2:43

We would not want to, despite the fact that

2:45

the kinetics are blue, therefore

2:49

not suspicious or not as suspicious.

2:52

We would certainly not want

2:53

that to go un-evaluated.

2:54

So she went on to and she had.

2:57

So, despite having bilateral breast cancer,

3:00

Her prognosis is excellent 100 percent survival

3:03

at 5 years because both diseases were and

3:08

also by definition that would be bilateral

3:11

breast cancer, which has an incidence of

3:13

between 2% and 6% of the population.