0:00

next case a 66 year old female presents

0:03

for Baseline mammogram

0:07

This is her mlo.

0:10

This is her CC.

0:13

I'm gonna give you a minute to just look at this. This is

0:16

like her ml.

0:18

and her CC

0:21

So based on the screening examination, what

0:24

is the appropriate by Reds?

0:28

Okay good. So the finding

0:31

here is really unilateral acts are

0:34

lymphatinopathy.

0:37

so that is never a normal finding this is

0:40

really breast cancer until proven otherwise

0:43

So really, you know, and then she also has these

0:46

two masses that you can see that are asymmetric to

0:49

the left.

0:51

So you certainly would want to give her a buy red zero we

0:54

need more information for sure.

0:56

Okay, I answered

0:59

this already. So I'm not gonna open the poll but the most likely causes this

1:02

finding is in fun is um, sorry metastatic breast cancer when

1:05

you have unilateral ax sorry lymphatinum the you want

1:08

to make sure that it's not you need to

1:11

exclude breast cancer.

1:13

what is this Imaging modality many

1:16

of you may not have seen this before my residents

1:19

definitely have

1:22

so is it digital breast homosynthesis MRI contrast

1:25

enhancy or none of the above? I'm

1:28

sorry. I'm freezing.

1:36

Good. So this is a contrast enhance me immigrant. If you've never seen

1:39

it, these are actually the subtraction images from a contrast

1:42

enhance me and room. I don't know how much they ask you on the boards, but

1:45

it's definitely fair game. So if you never seen it, this is what

1:48

it looks like. So findings are suspicious for

1:51

now read this carefully. Let's say

1:54

that these are both cancer. Is it multi-focal multi-centric

1:57

contralateral or

2:00

inflammatory breast cancer?

2:04

Sorry, I'm going to move this box. So we're not just curing

2:08

the findings.

2:11

Okay.

2:12

Good. So this is multicentric breast

2:15

cancer. They're in different quadrants multifocals when

2:19

they're in the same quadrant and multicentric is when they're in

2:22

different quadrants. So this would definitely be multicentric so

2:25

you can see she's got in a regular speculated mass

2:28

at 3 o'clock. She has another ill-defined mass

2:31

in the right breast at 10 o'clock. So another quadrant and she

2:34

also has what looks to be an abnormal lymph node.

2:37

What is your bi Reds for this?

2:40

I answered that quickly but this is going to be a four or

2:43

five, you know, you're certainly suspicious you would at least want to buy it

2:46

see one of the masses and the lymph node, but ideally

2:49

you'd like to biopsy all three. We typically

2:52

don't do more than two in the same day, but not for any other reason

2:55

that insurance isn't pay for it and patients can't often

2:58

tolerate three biopsies, but certainly that's in this appropriate thing to

3:01

do.

3:02

This is suspicious for multi-centric metastatic breast

3:05

cancer. We ended up by seeing on the same

3:08

day. We did that this the regular mass and the

3:11

right acts are node. But the one in ten o'clock was also breast cancer.

3:16

So you definitely want to give it a screening and you know,

3:19

it's really important to know are they screening are they diagnostic? Because

3:22

if this was a diagnostic you can give it a four but

3:25

if this is screening you want to give it a zero, you need more information

3:28

unilateral axillary lymphatin up

3:31

these metastatic breast cancer until proven. Otherwise, if you

3:34

don't see I had a case recently where she had unilateral excellentopathy

3:37

nothing that I could see on me Mo, but we

3:40

brought her back for a survey breast ultrasound and of course, we found a

3:43

little cancer hiding and it ended up being metastatic

3:46

breast cancer. So you got to find that you've got

3:49

to find that cancer.

3:50

If you don't see it on Old survey ultrasound then

3:53

you want to do an MRI and you'd also biopsy the lymph node,

3:56

make sure that it's not something else because other things from the task size to the excellent

3:59

as well.

4:00

Most likely cause is metastatic

4:03

breast cancer. This is a contrast mammogram. These

4:06

are the low dose subtraction images from contrast.

4:09

This is suspicious for multicentric breast

4:12

cancer as we talked about.

4:15

So multicentric involves more than one quadrant.

4:18

multifocal involves two masses in one quadrant

4:22

synchronous means two tumors diagnosed within

4:25

six months of each other

4:28

antagonist means two tumors diagnose greater

4:31

than six months apart from each other.