0:00

This is a 63-year-old female presenting for a

0:04

screening mammogram. Looking at image quality,

0:07

the images, uh, look good.

0:11

Looking sort of globally, we can see

0:13

that there's some subtle differences

0:15

between the right and left breast.

0:17

On the left, the, um, parenchymal density is

0:21

a little bit higher as compared to the right.

0:24

Less interspersed fat, or it doesn't appear there's,

0:26

there's less interspersed fat also on the left.

0:30

In terms of skin, we see that there's some skin

0:32

thickening, mostly centered around the periareolar

0:35

region, and we can see that same imaging finding

0:38

in the MLO view, seeing the skin thickening, the

0:40

periareolar region, extending a little bit inferiorly.

0:47

On...

0:48

We also see this...

0:51

axillary node, um, which stands out a little bit

0:54

in comparison to the other side as well.

0:59

If we focus on that left breast a little more closely,

1:02

knowing that we see some asymmetric findings there

1:05

and some potential skin thickening, we're, um,

1:08

already starting to think about is maybe this is

1:10

an advanced cancer that I need to be worried about.

1:15

On the SM views, we don't see anything, uh, else

1:18

that really stands out as maybe a potential focal

1:20

finding. My eye's a little bit drawn to this area.

1:23

Um, so we want to make certain we evaluate

1:25

that when we look at the DBT slices.

1:30

Starting with this, uh, CC view and, uh, scrolling

1:32

from the inferior towards the superior,

1:36

we again see some of that skin

1:37

thickening right around the nipple. No changes

1:40

from the SM view that we saw before.

1:43

As we look into this area here, we do get

1:45

the sense that there is something that

1:46

stands out amongst the background tissue.

1:49

Uh, it's a little bit denser here.

1:51

We describe this as an asymmetry,

1:53

or a focal asymmetry, essentially.

1:55

Um, but we do see some possible

1:57

architectural distortion.

1:58

There's some very subtle, uh, lines kind

2:00

of radiating from this central point.

2:02

Some straightening of these other, um...

2:05

parenchymal lines here, which are suggesting

2:08

that there's a mass here with some

2:10

possible architectural distortion.

2:13

Of course, we'd want to look, um, on the MLO

2:15

view to verify that and see if we can figure

2:18

out where it is on the, um, scroll bar.

2:22

We can see that this projects

2:23

as being slightly, uh, superior.

2:26

Um, so we'll look in the upper, uh, left

2:28

breast here, try and find the correlate.

2:31

We're scrolling from lateral to medial.

2:33

This looks like it's gonna be a little bit

2:34

more on the medial side, so we'll expect

2:36

to find that more in the second half image.

2:39

If I stop about right here, you can get the

2:41

sense that there's a little bit of that same,

2:43

um, asymmetry with, um, some kind of radiating

2:47

lines, maybe a few very fine calcifications in there.

2:50

Um, something that sort of stands out

2:52

a little bit in the rest of the tissue.

2:54

We would certainly recommend this patient to

2:56

have an ultrasound evaluating this, uh, finding.

2:59

We also want to evaluate this axillary

3:01

node or, or potentially axillary tail node.

3:05

And then also wanna look at the skin thickening to

3:07

see if we can, uh, verify that that's truly the case.

3:10

We also want to, um, at least lay our

3:12

eyes on the patient in terms of figuring

3:14

out whether this skin looks red or not.

3:16

Of course, this is all leading us to think

3:18

this is potentially inflammatory carcinoma.

3:21

Lo and behold, in this case, we

3:22

did find this, uh, mass here.

3:26

Um, and it was subsequently biopsied

3:27

as an invasive ductal carcinoma.

3:29

She did have, um, definite skin thickening, and

3:33

the appearance of the breast was a little bit red.

3:35

Now, of course, inflammatory carcinoma is a

3:37

clinical diagnosis, not really made by imaging per

3:40

se, but, um, these imaging features are the ones

3:42

that we classically see in inflammatory carcinoma.

3:44

Hold on.

3:45

Um...

3:46

In some cases of inflammatory carcinoma, we don't

3:49

see an underlying mass, but in, uh, many cases we do.

3:52

So it's really important to try to look for an underlying

3:54

mass to see if you can find something that would

3:56

be a good target, uh, for a subsequent biopsy.