0:00

In this case, we are showing a screening

0:03

mammogram from a 46-year-old woman.

0:07

We'll pull down our first standardized views to get

0:11

an overall sense of breast positioning and image quality.

0:15

These look like, uh, high-quality images, right?

0:18

Good pectoralis muscles.

0:20

Great view of the IMF here, both MLO views.

0:26

And right away, um, we can see that it

0:28

looks like there's something here in

0:29

the lateral aspect of the left breast.

0:32

Let me pull down just the left breast images.

0:37

Again, we can see what we would

0:38

call an asymmetry at this point.

0:39

So we only see it in one view, lateral aspect

0:42

of the left breast, and we get the sense that

0:44

perhaps it is up here in the superior portion

0:47

of the left breast, making this at least a

0:49

focal asymmetry or potentially a mass.

0:51

So far, based on our view, we would say this

0:54

was perhaps either one o'clock or two o'clock

0:58

in the left breast and approximately middle

0:59

depth. We switch over to the, uh, DBT slices.

1:04

Um, I'll start at the inferior portion of the stack.

1:08

Moving superiorly, our abnormality comes

1:12

into view in more sharp focus, right?

1:15

Um, we can see that it has, um, at

1:18

least partially circumscribed margins,

1:21

maybe some that are obscured.

1:24

And similarly, on the MLO view, we

1:26

see those circumscribed margins.

1:29

Maybe some portion of it is obscured, and

1:32

we would therefore, um, call this a mass.

1:35

And if we went, um, in our reporting,

1:38

we would say there's a mass, two o'clock

1:40

position or one o'clock position.

1:41

Middle depth. Additional imaging is required.

1:44

So this patient, uh, came on to

1:50

get a diagnostic mammogram.

1:53

We did additional spot CC and

1:56

spot MLO tomosynthesis views.

2:01

Switch over to our DBT stack.

2:06

Bigger.

2:07

As I scroll through, moving from inferior to

2:09

superior, this again comes into view with similar

2:12

imaging characteristics—partly obscured, partly

2:16

circumscribed margins,

2:20

and same kind of thing on the left

2:22

breast as well—partly circumscribed,

2:25

partly obscured margins and shape.

2:28

So if we're telling our, uh, grapher

2:29

where we wanna look, we would say

2:31

left breast, maybe one or two o'clock.

2:33

And it's always a little bit difficult to measure,

2:36

um, figure out how to distance from nipple,

2:38

but I tend to do it in one view, um, sort of.

2:41

Trying to think about it as if

2:43

I were holding the transducer.

2:44

So I would expect this would be somewhere in the

2:47

range of, you know, five centimeters from the nipple.

2:50

Maybe a little bit less, depending on, uh, this one

2:53

looks like more four centimeters from the nipple.

2:55

So we might say, look at two o'clock,

2:57

four centimeters from the nipple.

2:59

And I'm expecting to see a mass that

3:01

is approximately 16 millimeters.

3:06

So this patient subsequently went on to ultrasound.

3:10

I'll show you those images here.

3:12

So the sonographer looked at

3:13

left breast, two o'clock position.

3:15

They found something three

3:16

centimeters from the nipple.

3:18

It sits in the trans orientation.

3:20

We see this, uh, mass sort of in

3:22

the more deeper part of the breast.

3:24

Always, depth is a little bit more difficult

3:26

to identify on ultrasound, and we see that it

3:28

measures about 20 millimeters on ultrasound.

3:31

Um, which approximately, um, matches

3:34

up with what we see on the mammogram.

3:36

Um, identifying this left mass.

3:38

So our excellent skills at localization helped

3:41

us identify this mass, helped our sonographer

3:43

find it more efficiently, uh, and helps us

3:46

evaluate whether this matches up, uh, entirely.

3:49

This was subsequently biopsied and was a fibroadenoma.