0:01

All right, so that was case. Number one. So case

0:04

number two 54 year old female presenting

0:07

with a painful new lump in her left breast negative mammogram

0:10

two months prior.

0:12

So, you know if it was a negative mammogram two

0:15

months prior you could you could consider going straight to

0:18

ultrasound at that point. For some reason. We did

0:21

a mammogram. You'll see this triangular marker

0:24

right where she's having the lump.

0:26

You can see that she's got this prefectural saline

0:29

implant the peck goes the

0:32

saline implant is in front of the pack. So it means a prepectoral

0:35

we know it's saline because you can see through it and

0:38

you can see the nozzle for the saline infusion.

0:41

So again, she's got this

0:44

area of palpable concern indicated by the Triangular marker.

0:48

again, nothing really two

0:51

months prior

0:53

on the implant displays you there's maybe a

0:56

little skin retraction there.

0:58

So what is the next step for the

1:01

area of palpable concern on this diagnostic mammogram?

1:05

So we want to reassure her send her

1:08

for a surgical console do an ultrasound or

1:11

do a biasy?

1:13

Good, so everyone got that right great. So

1:16

yes, you always want to do an ultrasound if something

1:19

is palpable. So if that's why they have to be a diagnostic so

1:22

you can do that ultrasound, even though the mammogram looks normal

1:25

definitely want to get an ultrasound.

1:30

So right ultrasounds correct and

1:33

at 11 o'clock three centimeters. So nipple we

1:36

see an irregular hypochoic mass and abnormal

1:39

lymph node as well. Like I

1:42

said, we always look in the in the

1:45

axilla to see if there's any abnormal nodes. So what

1:48

would be your appropriate virus for this, Mass?

1:52

Notice I left Pirates five out.

1:55

So there's no confusion.

1:57

Good, so everyone's gotten that right. So you guys are

2:00

doing good here. All right, so let's keep going.

2:03

Yeah, so that's a byrid for obviously you're gonna want to do a

2:06

biopsy if if you

2:10

see it on ultrasound and Starry and

2:13

mammogram. It's better to do it under ultrasound because

2:16

what we're really going for is you want to

2:19

know if it's invasive cancer and if you do a stereo

2:22

and Target the calcification you might get dcis but

2:25

no Invasion and you may be falsely reassured so

2:28

they won't do nodes. They won't do a sentinel node

2:31

biopsy or anything like that. So that's why it's important if you see it

2:34

on mammogram or ultrasound and have the choice you want to do it under ultrasound.

2:37

So, of course this came back as invasive grade

2:40

three, you know, it always tells us that estrogen

2:43

progesterone receptors and the herd who

2:46

knew and that lymph node

2:49

with but it was positive as well.

2:52

This is what it looks like on the MRI. You can see it's sitting

2:55

right on top of her breast implant and she's

2:58

got that abnormal node.