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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Lesson
Pre-Course Activities
1 topic, 1 min.
Lesson
Introduction to Tomosynthesis
7 topics, 21 min.
Welcome to Advanced Tomosynthesis Mastery Course
1 m.Introduction to Tomosynthesis (DBT) - Why Learn about Tomosynthesis?
3 m.Image Acquisition Technique, Positioning, and Physics
5 m.Screening & Diagnostic Performance of Tomosynthesis
4 m.CAD/AI in Tomosynthesis
2 m.Image Quality and Common Artifacts
8 m.Motion Artifact Case Example on Tomosynthesis
2 m.Lesson
Approach to Interpretation and Lesion Localization
5 topics, 23 min.
Lesson
Normal Imaging Findings
10 topics, 29 min.
Normal Findings - Palpable Lump Focal Fibroglandular Tissue
4 m.Normal Findings - Palpable Lump Unilateral Axillary
4 m.Normal Findings - Palpable Lump Bilateral Axillary
4 m.Normal Findings - Screening Mammogram - Calcifications
3 m.Normal Findings - Screening Mammogram - Dermal Calcifications
3 m.Normal Findings - Screening Mammogram - Deodorant Artifact Example 1
4 m.Normal Findings - Screening Mammogram - Deodorant Artifact Example 2
3 m.Normal Findings - Screening Mammogram - Deodorant Artifact Example 3
2 m.Normal Findings - History of Lumpectomy
4 m.Normal Findings - Diagnostic Mammogram after Right Breast Masses on Screening
4 m.Lesson
Asymmetries and Masses
8 topics, 24 min.
Mammographic Asymmetries and Masses - Overview
7 m.Asymmetry - Invasive Ductal Carcinoma
3 m.Focal Asymmetry - Focal Fibroglandular Tissue - Benign
4 m.Developing Asymmetry
4 m.Solitary Mass - Fibroadenoma
2 m.Solitary Mass - Malignancy
3 m.Multiple, Bilateral Masses - Case 1
3 m.Multiple, Bilateral Masses - Case 2
2 m.Lesson
Gynecomastia
3 topics, 4 min.
Lesson
Fat-containing Lesions
8 topics, 18 min.
Lesson
Architectural Distortion
5 topics, 17 min.
Architectural Distortion on Tomosynthesis - Imaging & Management - Overview
6 m.Pseudodistortion on Screening Mammogram, Normal on DBT
4 m.Architectural Distortion - Radial Scar / Complex Sclerosing Lesion
4 m.Architectural Distortion - Radiating Lines, Asymmetry / Invasive Ductal Carcinoma (IDC)
3 m.Architectural Distortion - Radiating Lines, Mass / Invasive Lobular Carcinoma (ILC)
3 m.Lesson
Calcifications
8 topics, 22 min.
Calcifications on Tomosynthesis - Overview
5 m.Pseudocalcifications - Case 1
3 m.Pseudocalcifications - Case 2
3 m.Calcifications - Typically Benign - Milk of Calcium - Case 1
3 m.Calcifications - Typically Benign - Milk of Calcium - Case 2
2 m.Calcifications - Suspicious - Amorphous / Malignancy (BI-RADS 4B)
4 m.Calcifications - Suspicious - Coarse Heterogeneous / Benign
2 m.Calcifications - Suspicious - Segmental Fine Linear Branching / Invasive Ductal Carcinoma (BI-RADS 4C)
4 m.Lesson
Associated Findings
7 topics, 18 min.
Associated Nipple Retraction, Palpable Mass / Invasive Ductal Carcinoma
3 m.Axillary Adenopathy - Unilateral / Chronic Lymphocytic Leukemia (CLL)
3 m.Axillary Adenopathy - Bilateral / History of Chronic Lymphocytic Leukemia (CLL)
2 m.Skin Thickening - Prior Lumpectomy, Post Radiation
2 m.Skin Thickening, Asymmetry - Inflammatory Carcinoma / Invasive Ductal Carcinoma
4 m.Skin Thickening, Calcifications - Inflammatory Carcinoma / Invasive Ductal Carcinoma
3 m.Skin Thickening, Mass - Locally Advanced Breast Carcinoma
3 m.Lesson
Postsurgical Findings
9 topics, 19 min.
Post Breast Reduction - Case 1
4 m.Post Breast Reduction - Case 2
2 m.Post Breast Reduction - Case 3
2 m.Post Lumpectomy - Benign Findings - Case 1
3 m.Post Lumpectomy - Benign Findings - Case 2
2 m.Post Lumpectomy - Recurrence
5 m.Post Lumpectomy - Benign Fat Necrosis
3 m.Silicone Injection
3 m.Concluding Remarks
1 m.0:01
Okay.
0:01
This is a 63-year-old female presenting for
0:04
a palpable, uh, abnormality in the right
0:08
breast, uh, with associated nipple retraction.
0:12
Show you first the CC full-field
0:14
CC and MLO views of both breasts.
0:16
On the left, we can see she has a
0:18
history of some kind of surgery.
0:20
I.
0:23
On the right side, we can
0:24
see our palpable marker here.
0:26
Uh, noted approximate location of the
0:28
nipple, as well as here on the MLO view.
0:31
If you look at just those views, you
0:34
can see right away that the positioning
0:38
of the breast is a little bit abnormal.
0:40
You see a skin fold or line here.
0:42
And on this MLO view, we see
0:44
some pulling in of the nipple.
0:46
Um, right here, directly
0:47
underlying our palpable BB marker.
0:51
We switch over to the DBT slices,
0:54
scrolling from inferior to superior.
0:58
We can already see that at this point here
1:00
there's some areas of architectural distortion.
1:02
There is an associated mass and even some potentially
1:06
spiculated margins or associated distortion here,
1:09
and we can see that some of this distorted appearance
1:12
starts to pull in the skin directly overlying that
1:15
mass right at the location of our Palp BB marker.
1:20
There are no other findings
1:21
that we see in the, uh, CC view.
1:24
On the MLO view, we see something similar, right?
1:28
We see our nipple retraction here.
1:31
There's an underlying, uh, mass, which causes
1:34
some architectural distortion as a result. Because
1:38
of that nipple retraction, there are potentially
1:41
some associated calcifications here, both within
1:43
the mass and a little bit further posterior.
1:47
Because this was a diagnostic exam, we did end up
1:50
doing those spot compression views, which demonstrate
1:55
similar findings as we saw in the full-field views.
2:01
So based on this mammographic appearance, we
2:03
would certainly recommend diagnostic ultrasound
2:05
for further evaluation, which this patient had.
2:08
I won't show you those images now, but you
2:10
can imagine there would be an irregular
2:11
hypoechoic mass with posterior shadowing
2:14
and directly right under this
2:15
area of nipple retraction.
2:18
We can see this also, um, from, uh, it
2:21
doesn't have to be right at the nipple.
2:22
If we see a large, uh, cancer, like this one, positioned
2:26
differently or at a separate location in the breast,
2:28
then it would not be surprising to see, um, pure
2:31
skin retraction rather than nipple retraction.
2:33
It's just that there's an associated area that
2:35
gets pulled in related to this, uh, growing malignancy.
2:39
This one diagnosed with invasive ductal carcinoma.
Associated Nipple Retraction, Palpable Mass / Invasive Ductal Carcinoma
HIDEInteractive Transcript
0:01
Okay.
0:01
This is a 63-year-old female presenting for
0:04
a palpable, uh, abnormality in the right
0:08
breast, uh, with associated nipple retraction.
0:12
Show you first the CC full-field
0:14
CC and MLO views of both breasts.
0:16
On the left, we can see she has a
0:18
history of some kind of surgery.
0:20
I.
0:23
On the right side, we can
0:24
see our palpable marker here.
0:26
Uh, noted approximate location of the
0:28
nipple, as well as here on the MLO view.
0:31
If you look at just those views, you
0:34
can see right away that the positioning
0:38
of the breast is a little bit abnormal.
0:40
You see a skin fold or line here.
0:42
And on this MLO view, we see
0:44
some pulling in of the nipple.
0:46
Um, right here, directly
0:47
underlying our palpable BB marker.
0:51
We switch over to the DBT slices,
0:54
scrolling from inferior to superior.
0:58
We can already see that at this point here
1:00
there's some areas of architectural distortion.
1:02
There is an associated mass and even some potentially
1:06
spiculated margins or associated distortion here,
1:09
and we can see that some of this distorted appearance
1:12
starts to pull in the skin directly overlying that
1:15
mass right at the location of our Palp BB marker.
1:20
There are no other findings
1:21
that we see in the, uh, CC view.
1:24
On the MLO view, we see something similar, right?
1:28
We see our nipple retraction here.
1:31
There's an underlying, uh, mass, which causes
1:34
some architectural distortion as a result. Because
1:38
of that nipple retraction, there are potentially
1:41
some associated calcifications here, both within
1:43
the mass and a little bit further posterior.
1:47
Because this was a diagnostic exam, we did end up
1:50
doing those spot compression views, which demonstrate
1:55
similar findings as we saw in the full-field views.
2:01
So based on this mammographic appearance, we
2:03
would certainly recommend diagnostic ultrasound
2:05
for further evaluation, which this patient had.
2:08
I won't show you those images now, but you
2:10
can imagine there would be an irregular
2:11
hypoechoic mass with posterior shadowing
2:14
and directly right under this
2:15
area of nipple retraction.
2:18
We can see this also, um, from, uh, it
2:21
doesn't have to be right at the nipple.
2:22
If we see a large, uh, cancer, like this one, positioned
2:26
differently or at a separate location in the breast,
2:28
then it would not be surprising to see, um, pure
2:31
skin retraction rather than nipple retraction.
2:33
It's just that there's an associated area that
2:35
gets pulled in related to this, uh, growing malignancy.
2:39
This one diagnosed with invasive ductal carcinoma.
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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