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Great. Thank you so much for the introduction and

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I'm happy to be lecturing today to MRI online.

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This lecture is called diagnostic workup

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and it's going to focus on some basic but important topics

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that I really want to emphasize and

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I think their board relevant and also practical

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clinically relevant. So I hope you find

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it helpful. And please feel free to ask me any questions a diagnostic.

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I focus on breasts and abdominal Imaging. I'm

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at MD Anderson Cooper in South Jersey, right

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outside of Philadelphia.

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And all right, so the goals are the lecture to highlight

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the diagnostic worker for masses asymmetries calcifications

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and palpable lesions. We're going to

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discuss the different types of diagnostic views and emphasize appropriate

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management.

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So before we get started, I'm going to ask some pre-test questions

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just to kind of test your own knowledge before you even start this

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lecture and hopefully you'll know the answer by the

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end of the test if you do it, but by the end of the lecture if you

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don't know it already. So what do you should you get

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if you see a lesion on mlo but not the CC

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view if you're trying to triangulate in the breath.

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a role views be true

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lateral c-spot compression or

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de-exaggerated CC lateral

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So a cold is came up post

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and panel vote.

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Okay.

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Now the a great time to vote I'll give you the answer at the end.

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All right next case.

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Our next question what view should

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you get if you see a lesion on the CC view but not the mllo. So

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kind of the opposite of what I just asked you want to get roll to

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use true lateral spot compression or exaggerated lateral

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views.

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All right, we're going to keep moving on so next.

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Slide this is a pre-test question. I'm going to go over all this during

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the lecture.

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and lastly

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If you roll the superior breath medially and

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the lesion in question rolled medially

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it is located in.

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Actually, I feel like I'm missing a piece of information. I have to tell you

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if it's in the Superior or I'm sorry, if it's

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in the medial or lateral breath, but we're

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going to get to that more. So don't answer this question because

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I don't actually think this is a correct way to ask it but so the

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diagnostic examination is different from

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the screening exam. So the indications for a diagnostic exam

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is if a patient comes into focal breast complaint lump

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pain or discharge most commonly, it could

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be a callback from screening. So patient came in for a screening mammogram had

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an abnormalities that got a by Red zero or

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you need more information and they're there to

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work it up further and the third type of

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indication would be a follow-up of a probably

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benign finding so a patient is on every six

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month protocol. They're gonna come in every six months or two years to

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kind of document stability and then after that

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two years and they can go back to the screening exam and

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most places the diagnostic exam

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the patient comes.

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To the clinic the workup is done that day. We get

3:11

additional mammographic views and ultrasound

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if needed off a diagnostic exam. You

3:17

can give a buyer ads one through actually six if you

3:20

know they have cancer and they're getting newadjamin chemo and

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you want to assess response to chemotherapy than they would be a

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birad six.

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And so before we go any further, I'm just going to

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you know, Define byrad's categories

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by Reds, of course answer breast Imaging reporting

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and data system. These are the categories that you

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are going to give at the end of your final diagnostic of

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your final workup a zero needs more imaging. There's

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really minimal rule

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for a zero off a diagnostic exam. You

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should have a conclusive.

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Buy rides at the end of it usually rarely give a

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zero and there's a few circumstances where it would be appropriate. Other

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than that, you're pretty much going to do them a one through a six

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one is negative. There's essentially

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you're saying it's a normal test. The two is benign. Both

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of those are the likelihood of that being cancer should be about zero.

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Probably benign means that it's you're gonna

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follow it every six months for two years and there's specific

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criteria that fall into the probably benign or

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by red three category the likelihood of

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cancer should be less than two percent. Um,

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and just to kind of this is an important point that

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I always try to tell my residents. So there's three real good situations

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where you can give a buy red

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three, it's usually a focal asymmetry without

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a correlate on ultrasound off of Baseline mammogram a

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fiber adenoma

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appearing lesion, that's non palpable off a

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Baseline and also a cluster

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of I'm sorry a group of calcifications on

4:55

a baseline if any of those lesions were

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new then they wouldn't be a birads three but

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those are the three kind of classic scenarios for

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a birads three thyroids for

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suspicious, you know, you could subcategorize it into

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four a b and c

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Depending on your level of Suspicion, but it's anywhere from two

5:16

to ninety five percent of risk of

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it being cancer a bired side is a highly suspicious

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lesion. The rate of cancer is usually is greater than

5:25

95% So even if you get something benign, you're probably going

5:28

to recommend excision to get that area taken out

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if it comes back benign because that would be discordant and a bi

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red six is known by FC proven malignancy. Like I

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said, if you're you know assessing a spot response

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to chemotherapy, that would be a good by Red six.