Asymmetry - Invasive Ductal Carcinoma
HIDEInteractive Transcript
0:00
In this case, we have a 65 year old female presenting for a
0:04
screening mammogram. As usual, we look at image quality, and we see the
0:10
pectoralis muscle looks okay, a little bit less on this left MLO. CC views
0:15
look appropriate. I'll pull down the CC views to look at first.
0:21
We see scattered fibroglandular densities, normal breast tissue on both
0:26
sides, no particular lining seen on the SM views in either breast. We pull
0:34
down the MLO views. On the right side, it looks normal,
0:39
and nothing to see there. On the left side, there is some sort
0:42
of a little bit of tissue here, which might catch your eye.
0:44
You might also think it looks pretty normal on this SM view. As
0:49
we pull up the DBT stack though, however, we'll start on the lateral
0:53
side here and scroll through slowly. Focus your attention on this upper
0:58
part here. And if we stop around right here, we can see that
1:02
this area, the superior part of the breast, looks a little bit
1:06
abnormal, a little bit different compared to the rest. We can see some
1:10
suggestion of some radiating lines here, suggesting maybe there's something
1:14
there that looks a little bit more abnormal.
1:19
We scroll through the rest of the imaging slices. We don't see anything
1:22
else that looks abnormal. If we did decide this looked abnormal enough to
1:26
call back, recall for a diagnostic mammogram, we would have to say that
1:30
this falls into the category of an asymmetry. We see it in only
1:34
a single view. Despite the fact that we might see some potential spiculations
1:38
here, we'd want to call it asymmetry and do some further workup for
1:42
that case. I did want to show you, in this particular case,
1:46
just a prior exam. This prior exam is from 38 months prior.
1:52
And if we look in a similar area in this case,
1:55
we don't see that same asymmetry. Now if I bring over even a
2:00
longer ago prior exam, 73 months prior, we definitely don't see it there
2:05
either. So we would call this an asymmetry. We might wonder about developing
2:10
asymmetry based on the fact that we don't see it on the prior exams.
2:13
Of course, now we don't see it on the CC views. It doesn't
2:15
strictly fall into the category of the developing asymmetry because it's
2:18
not a focal asymmetry. However, you might consider noting in your report
2:22
that it is at least new from the prior exams.
2:26
This patient did subsequently go on to get a diagnostic mammogram at a
2:29
later time. On that diagnostic mammogram, we did eventually were able to
2:34
find this utilizing XCCL view. We scroll through the XCCL. We can see
2:43
there's a small finding here. This could either be considered a focal asymmetry
2:47
or a possible mass. There's some possible associated architectural distortion
2:50
with it. They subsequently went on to ultrasound and biopsy and it was an
2:52
invasive ductal carcinoma.
Ryan W. Woods, MD, MPH
Assistant Professor of Radiology
University of Wisconsin School of Medicine and Public Health
© 2025 Medality. All Rights Reserved.
