Asymmetry - Invasive Ductal Carcinoma
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In this case, we have a 65 year old female presenting for a
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screening mammogram. As usual, we look at image quality, and we see the
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pectoralis muscle looks okay, a little bit less on this left MLO. CC views
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look appropriate. I'll pull down the CC views to look at first.
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We see scattered fibroglandular densities, normal breast tissue on both
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sides, no particular lining seen on the SM views in either breast. We pull
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down the MLO views. On the right side, it looks normal,
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and nothing to see there. On the left side, there is some sort
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of a little bit of tissue here, which might catch your eye.
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You might also think it looks pretty normal on this SM view. As
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we pull up the DBT stack though, however, we'll start on the lateral
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side here and scroll through slowly. Focus your attention on this upper
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part here. And if we stop around right here, we can see that
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this area, the superior part of the breast, looks a little bit
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abnormal, a little bit different compared to the rest. We can see some
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suggestion of some radiating lines here, suggesting maybe there's something
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there that looks a little bit more abnormal.
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We scroll through the rest of the imaging slices. We don't see anything
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else that looks abnormal. If we did decide this looked abnormal enough to
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call back, recall for a diagnostic mammogram, we would have to say that
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this falls into the category of an asymmetry. We see it in only
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a single view. Despite the fact that we might see some potential spiculations
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here, we'd want to call it asymmetry and do some further workup for
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that case. I did want to show you, in this particular case,
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just a prior exam. This prior exam is from 38 months prior.
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And if we look in a similar area in this case,
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we don't see that same asymmetry. Now if I bring over even a
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longer ago prior exam, 73 months prior, we definitely don't see it there
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either. So we would call this an asymmetry. We might wonder about developing
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asymmetry based on the fact that we don't see it on the prior exams.
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Of course, now we don't see it on the CC views. It doesn't
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strictly fall into the category of the developing asymmetry because it's
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not a focal asymmetry. However, you might consider noting in your report
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that it is at least new from the prior exams.
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This patient did subsequently go on to get a diagnostic mammogram at a
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later time. On that diagnostic mammogram, we did eventually were able to
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find this utilizing XCCL view. We scroll through the XCCL. We can see
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there's a small finding here. This could either be considered a focal asymmetry
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or a possible mass. There's some possible associated architectural distortion
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with it. They subsequently went on to ultrasound and biopsy and it was an
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invasive ductal carcinoma.
Ryan W. Woods, MD, MPH
Assistant Professor of Radiology
University of Wisconsin School of Medicine and Public Health
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