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Architectural Distortion - Radiating Lines, Asymmetry / Invasive Ductal Carcinoma (IDC)

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This is a 59-year-old female presenting for a routine

0:03

screening mammogram. We're showing, uh, both

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the CC and MLO views. Uh, image quality looks

0:10

appropriate, good pectoralis muscles and IMF.

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Looks good one.

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Profile, at least one view.

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Direct your attention to the right breast.

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If we first look at the CC view SM, we see a

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few scattered, typically benign calcifications

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and some scattered fibroglandular density breast tissue.

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There are no findings that stand

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out for the, uh, CC SM view.

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If we look at the SM right from the MLO view,

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we again see our scattered, uh, densities,

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typically benign calcifications, and then

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this asymmetry here, which sort of stands out.

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If we investigate that a little bit further

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with our tomosynthesis, we'll start in

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the lateral aspect and scroll medially.

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As we get to that point, we see, um, this

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asymmetry that does stand out amongst the,

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uh, remainder of the background tissue.

1:00

Now, at this point, we're gonna call it an

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asymmetry 'cause we only see it on one view, but

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you might wonder if there's some radiating lines,

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uh, coming out from the CI that look like a little

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bit more straightened than you might expect.

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So we'd want to investigate that further.

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This patient was called back for this finding,

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and she subsequently had a diagnostic exam.

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We got an XCCL spot view,

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see if we could find that.

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Lo and behold, could you see the same,

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uh, similar appearing finding on the XCCL

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view, making this at least focal asymmetry,

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if not a mass. We see corresponding

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uh,

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asymmetry here on the upper right

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breast. Switch over to the DBT images,

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have a look at those, scrolling

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from the inferior aspect first.

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Um, and going superiorly, you would

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stop here, uh, at this finding here.

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And we at least look at this and

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think there might be a mass here.

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And I think you do see some radiating

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lines here, which, uh, are consistent with

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some associated architectural distortion.

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If we look at, uh, the MLO view again,

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we see something similar, right?

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Our mass is there again.

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We see some straightening lines,

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certainly a suspicious seizure, which warrants

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further evaluation with diagnostic ultrasound.

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This patient underwent a diagnostic

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ultrasound directed to the right breast.

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At 10 o'clock, we see a corresponding

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hypoechoic, irregular mass with some

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angular margins, some indistinct margins.

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Clearly corresponds to the imaging finding

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we see, uh, on the mammogram views.

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Uh, this was subsequently — it's

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compatible with ductal carcinoma.

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The patient went on for further treatment.

Report

Faculty

Ryan W. Woods, MD, MPH

Assistant Professor of Radiology

University of Wisconsin School of Medicine and Public Health

Tags

Women's Health

Ultrasound

Tomosynthesis

Oncologic Imaging

Mammography

Breast

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