0:00

Okay next case.

0:04

a 48 year old woman with a recent benign

0:07

biopsy

0:09

she presented for Signal opinion.

0:14

She had a screening mammogram before just

0:17

diagnostic mammogram. So

0:20

that's her mammogram. What's your assessment?

0:26

Rate you're going to write. Let's look at the also

0:29

together.

0:31

So this patient has a architect

0:34

registration in the right breast of all

0:37

the quartering posterior depths over here.

0:42

And outside of radiology causes a

0:45

patient back and then they report

0:48

abnormality of the right upper Auto rest

0:51

safety disappeared with the

0:54

spot compression. That's the Imaging. They have Diagnostic

0:57

Imaging of the patient back and then

1:00

they did their whole breast so sound which

1:03

was a negative and that they recommend the

1:06

patient go back to screening.

1:09

My question for you, just based on the diagnosis you begin.

1:12

What do you do?

1:14

With your recommendation to go back to screening

1:17

like the outside Radiology is recommended

1:20

or you disagree and why

1:23

you disagree?

1:24

if you were reviewing this case and what

1:27

I'm going to do

1:30

most this question and look at

1:33

the answer together.

1:35

the correct the answer

1:37

I think is the Audi disagree.

1:41

And I'll repeat the evening. I'll show

1:44

you why I want to repeat the diagnostic

1:47

and mammogram instead of a geometry MRI. I

1:50

just point because you can see that

1:53

that's how the identity a spot compression that's the

1:56

envelope view of the spot compression and you

1:59

can see that the position vote over

2:02

here. There's lots of all it's not the

2:05

right male view over here and the

2:08

patients and rest was really crushed.

2:11

And also you cannot see the architecture

2:14

destroy him.

2:16

In this Auto compression, but you can

2:19

use so another landmark over here. There's a calcification

2:22

over here, you know, that is approximately three

2:25

centimeter above that if

2:28

Just the calcification over here on this photo compression even

2:31

three or four centimeter buffer that it should be somewhere here

2:34

right indeed. If you look

2:37

at the more carefully, that's the

2:39

architectural distortion

2:42

Overlapped by this had a

2:45

margin over here, right? That's the envelope View

2:48

and then look like they look at the CC's father compression

2:51

view. You can see that the architecture disposium

2:54

is also at the peripheral.

2:58

Regional for this as part of

3:01

paddle over here. So that's the why you know

3:04

the miss this Vision on

3:07

the yes final compression and then they just

3:10

get lost and did the whole breast.

3:13

So ultrasound.

3:15

So that's why I think the patients should get repeated

3:18

spot compression at

3:21

least.

3:26

So patient follows the outside radiologist recommendations,

3:29

she went back to screening and

3:32

then one year later. She was a call back

3:35

again for the same concern.

3:38

At this time ultrasound clearly who was was

3:41

about to described as Elysian and

3:44

the right address. Thank you, 11 o'clock area.

3:48

okay, and in that

3:51

that sound guided biopsy which

3:54

shows

3:56

denying having eyes a fibrous tissue over

3:59

there.

4:01

And based on the results the outside their Radiologists

4:04

recommendations. She'll return

4:07

to screening again. Do you agree and what's your

4:10

women?

4:13

Some of you'll read some of you recommend to

4:16

repeat a biopsy or breast MRI, so

4:19

miss.

4:22

Look at the yeah answering the Imaging together. I think we

4:25

should repeat the policy either

4:28

by ultrasound or and a

4:31

mammogram. So let's look at the Imaging together. That's the

4:34

spot compression this time this part of

4:37

the right part of the breast over here.

4:40

You can see that the architectural Distortion

4:43

just a persist on both CC and

4:46

the Emerald View over here and that's just

4:49

before the biopsy here is a target over there

4:52

of the ultrasonic added biopsy. You can see that

4:55

the clip is over here is the

4:58

approximately five centimeter away from

5:01

the nipple, but to this architectural Distortion

5:04

definitely support posterior to

5:07

this biopsy clip over here.

5:10

So he said that the biopsy the

5:13

wrong spot or they ultrasound findings just

5:17

did not correlate with the

5:20

mammographic foundings.

5:23

So this

5:24

edit you.

5:28

reject and then YouTube repeated biopsy

5:33

So what did a video offer to be reviewed

5:36

all this Imaging we decided to represent mammogram

5:39

with Thomas synthesis because he's architecture destroysing

5:42

promotions is can detectively are

5:45

architectural discourage disappointed motivators in

5:48

the convincibility. So this

5:51

is the architectural disposition organ

5:54

show up on the envelope view of the enormous synthesis

5:57

in slides over here as you can see that is again

6:01

is away from the nine biopsy

6:05

clip over here. So we be the a

6:08

yeah ultrasound.

6:10

we found a

6:12

regular mass divided breast

6:15

ten o'clock eight centimeter from the nipple.

6:18

Okay, and there is an increase of flow

6:21

over here to give the paradise of

6:24

four.

6:25

Will be over here and then a video.orgisana

6:28

guided biopsy because we feel

6:31

very confident that the ultrasound will correlate

6:34

the wages in your mammographic founding over here based on

6:37

the morphology and also the

6:40

location over there. Okay. It's up outer

6:43

is 80 centimeter from the nipple.

6:46

Okay, so we did today autosana gabapsee and

6:49

place that you clear over here which indeed indeed

6:52

match the yeah mammography found

6:55

in before the biopsy.

6:58

So the repeat of biopsy turned out

7:01

a tree being invasive or doctor carcinoma and the

7:04

patient and when to lumpectomy

7:07

and the epoxy clip and the

7:10

cancer activity Distortion over there.

7:13

will removed

7:17

So what if we can learn from this second

7:20

case number one,

7:23

when we do the spot of compression.

7:26

We need to be very very careful. Make sure

7:29

that

7:31

Spotted the right area right reason

7:34

over there if you don't.

7:37

Spotted the right area. Of course, you're missing

7:40

cancer you missed solution, right?

7:43

That's number one, since you need to check when

7:46

you review these article compression. Sometimes it's

7:49

kind of confusing but always use the

7:52

landmark like in this case we can use decalsification as

7:56

our landmark.

7:59

That's number one. Number two when you

8:02

found something on the ultrasound to

8:06

make sure that it requires home to the

8:09

young mammographic funding like in this case outside.

8:12

The report is just to say that hey

8:15

this vision is at 11:00

8:18

no clock.

8:20

It didn't tell us to how far away from

8:23

begin nipple, right? So we really

8:26

described a yeah, ultrasound foundings.

8:29

You will need to make sure

8:32

that they collect the clock position and

8:35

also give them.

8:38

the report of the distance from

8:41

the nipple

8:45

Another scenes, I would like to point out is that when

8:48

this results come back as will be nine.

8:51

We normally review.

8:53

the pathology results and the Radiology

8:56

Imaging

8:58

In this case, this would be nine results cannot

9:01

explain the Imaging planning

9:04

because on the your mammogram

9:07

clearly. This is the architectural Distortion

9:10

benign sounding cannotic is

9:13

playing this architectural destroying

9:16

on the yamamagram. So in

9:19

this case, we'll be right past these coding.