0:00

So case number four is a 40 50

0:03

year old with new calcification seen

0:06

on the screening mammogram.

0:09

So magnification View.

0:14

is provided here and

0:20

the question is what is the Best Buy rights assessment

0:23

and descriptor for these calcifications?

0:30

great, so

0:34

The answer to this question is course heterogeneous

0:37

calcification in grouped.

0:43

distribution

0:48

so when we talk about the distributions, I

0:51

know we talked about Regional segmental and grouped in

0:54

terms of the linear distribution. It means

0:57

that it's a straight line

1:00

calcifications within a straight line. So it

1:03

is linear distribution.

1:07

Why is it not a regional distribution? It's

1:10

because Regional is more than

1:13

two centimeters in.

1:17

do more than two centimeters and here you could see I maged

1:20

it up, but it's less than

1:23

You know, it's definitely less than a centimeter. So

1:26

it is actually in a grouped distribution and it's

1:29

you could see more coarser calcification

1:32

here rather than more punctate calcifications.

1:40

So the pathology yielded a

1:43

typical ductal hyperplasia with Associated calcification is

1:46

this concordant? And what is the next

1:49

best? It is concordant and

1:52

the best Next Step will be the surgical consult. There

1:55

are many they're controversy regarding the

1:58

management of hybrist lesions on core biopsy

2:01

first. I would say that you need to

2:04

do a careful rat path review if it

2:07

is concordant.

2:09

And if you don't have any high risk

2:12

conferences that your institution I recommend all

2:15

of the high risk lesions that we

2:18

that we diagnosed on coordinatal biopsy to

2:21

go and see a breast surgeon.

2:23

So why surgical Council for atypical ductal

2:26

hyperplasia?

2:28

So the upgrade rate from ADH on

2:31

the core biopsy to either dcis or

2:34

invasive cancer on the surgical excision is reported

2:37

to be anywhere from 15 to 30 percent.

2:42

Also ADH is a precursor lesion, which

2:45

means that women with ADH are

2:48

four to five times more likely to develop

2:51

breast cancer than those without and therefore some

2:54

of these women are offered chemo prevention

2:57

such as tamoxifen to reduce the

3:00

risk of future breast cancer.

3:06

Here is a companion case where a 60

3:09

year old with bilateral calcification screen

3:12

on seen on screening mammogram here. You

3:15

could see multiple bilateral groups of course heterogeneous

3:18

calcifications. And obviously that

3:21

is by rats too here. You could see course heterogeneous

3:24

calcification and its Pirates too. So

3:27

the teaching point of the course heterogeneous calcifications are

3:31

it is more conspicuous like you could see those calcification, but

3:34

you can be regular in shape.

3:38

And it's usually more finer than the

3:41

dcis. Sorry more Corsa than the dcis calcifications Which

3:44

is less than 0.5 millimeters.

3:48

The distribution is important. So if

3:51

it is diffuse and bilateral then it becomes a

3:54

virus too. But if it is grouped segmental or

3:57

linear, then it becomes Barracks for so

4:00

the positive predictive value for malignancy is

4:03

about 13% for the course heterogeneous. Calcifications.