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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.0:00
This is a 66-year-old female who's presenting
0:02
with a palpable abnormality in the right breast.
0:06
In first pass, we can see that image quality is good.
0:09
Good ALs muscles, IMF, good CC views right away.
0:14
Corresponding to this palpable BB
0:16
marker, we see an underlying mass.
0:19
We can call it a mass 'cause we see in two
0:20
views, and it's in the right breast, probably
0:23
in the sort of four to five o'clock position.
0:27
Since this is...
0:29
exam for a palpable finding, and we
0:30
haven't seen this patient for some time,
0:33
we got our standard CC and MLO views first, and
0:36
as we scroll through these, we can see there's
0:39
an, uh, oval, circumscribed, indistinct, um, mass,
0:47
which directly underlies the palpable marker.
0:50
There's some additional asymmetry, more posterior
0:52
to the mass, and perhaps that's making it a
0:54
little more irregular, uh, in appearance, and
0:57
maybe some radiating lines from that spot.
1:01
One thing we also notice is that if we scroll
1:03
down to the, uh, inferior-most DBT slices,
1:07
we can see that, um, there's not a real...
1:10
large amount of, uh, tissue or any tissue
1:13
plane between, um, the skin where the palpable
1:16
BB marker is, and this mass. This suggests
1:19
that it's very close to the skin surface.
1:22
On the MLO view, we can confirm that finding again,
1:25
seeing our mass in the inferior part of the breast.
1:28
And we can see that the, uh, the mass either
1:31
directly abuts or potentially invades the skin
1:34
surface. Here, we get a much better sense of that
1:36
more posterior asymmetry, making the overall shape
1:39
of this more likely to be irregular, um, with
1:42
some potential associated distortion, and maybe
1:46
angular margins that we would see on ultrasound.
1:50
We did get, um, spot compression views
1:52
as well to confirm these findings.
1:55
And again, demonstrate the same, uh, imaging
1:57
findings as we see on the full field views.
2:01
Um, this patient did go on, so we had
2:03
an ultrasound sonographer take some
2:05
images at the right breast, five o'clock
2:07
position, five centimeters from the nipple.
2:09
We see this irregular hypoechoic
2:10
mass with angular margins.
2:12
A little bit of that hyperechoic halo,
2:14
which is another marker of, um, malignancy.
2:18
And we see that this mass is
2:19
directly invading into the skin.
2:21
Here's the line of the dermis here.
2:23
We see this mass is right basically with this very,
2:26
very thin plane between the mass and the skin surface.
2:29
Um, this is, uh, would be considered a
2:32
locally advanced breast cancer, with
2:34
direct invasion into the superficial skin.
Skin Thickening, Mass - Locally Advanced Breast Carcinoma
HIDEInteractive Transcript
0:00
This is a 66-year-old female who's presenting
0:02
with a palpable abnormality in the right breast.
0:06
In first pass, we can see that image quality is good.
0:09
Good ALs muscles, IMF, good CC views right away.
0:14
Corresponding to this palpable BB
0:16
marker, we see an underlying mass.
0:19
We can call it a mass 'cause we see in two
0:20
views, and it's in the right breast, probably
0:23
in the sort of four to five o'clock position.
0:27
Since this is...
0:29
exam for a palpable finding, and we
0:30
haven't seen this patient for some time,
0:33
we got our standard CC and MLO views first, and
0:36
as we scroll through these, we can see there's
0:39
an, uh, oval, circumscribed, indistinct, um, mass,
0:47
which directly underlies the palpable marker.
0:50
There's some additional asymmetry, more posterior
0:52
to the mass, and perhaps that's making it a
0:54
little more irregular, uh, in appearance, and
0:57
maybe some radiating lines from that spot.
1:01
One thing we also notice is that if we scroll
1:03
down to the, uh, inferior-most DBT slices,
1:07
we can see that, um, there's not a real...
1:10
large amount of, uh, tissue or any tissue
1:13
plane between, um, the skin where the palpable
1:16
BB marker is, and this mass. This suggests
1:19
that it's very close to the skin surface.
1:22
On the MLO view, we can confirm that finding again,
1:25
seeing our mass in the inferior part of the breast.
1:28
And we can see that the, uh, the mass either
1:31
directly abuts or potentially invades the skin
1:34
surface. Here, we get a much better sense of that
1:36
more posterior asymmetry, making the overall shape
1:39
of this more likely to be irregular, um, with
1:42
some potential associated distortion, and maybe
1:46
angular margins that we would see on ultrasound.
1:50
We did get, um, spot compression views
1:52
as well to confirm these findings.
1:55
And again, demonstrate the same, uh, imaging
1:57
findings as we see on the full field views.
2:01
Um, this patient did go on, so we had
2:03
an ultrasound sonographer take some
2:05
images at the right breast, five o'clock
2:07
position, five centimeters from the nipple.
2:09
We see this irregular hypoechoic
2:10
mass with angular margins.
2:12
A little bit of that hyperechoic halo,
2:14
which is another marker of, um, malignancy.
2:18
And we see that this mass is
2:19
directly invading into the skin.
2:21
Here's the line of the dermis here.
2:23
We see this mass is right basically with this very,
2:26
very thin plane between the mass and the skin surface.
2:29
Um, this is, uh, would be considered a
2:32
locally advanced breast cancer, with
2:34
direct invasion into the superficial skin.
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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