Interactive Transcript
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Alright. In this case, um, I'm showing images of the right
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breast in a 48-year-old woman who presented with a
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palpable abnormality in the upper outer right breast.
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At our institution, we use a small BB
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marker to, uh, denote palpable findings.
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And when we look at these two views,
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um, we acquire a right CC view.
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Uh, we get a CC spot view
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over the palpable abnormality.
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Full field MLO view, MLO spot over the
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abnormality, and then, um, an ML view as well.
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So if we switch over to the DBT slices, moving
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from inferior to superior and focusing really
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mostly on the area of the palpable abnormality.
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But of course, in the end I'll
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look at all the breast tissue.
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Um.
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For the purposes of this, we'll focus mainly on
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where the palpable marker is, and we can see that
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that comes into view about here, um, somewhere
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in the middle of the DBT stack. And we look
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underneath or sort of deep to that palpable marker
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and try to evaluate whether there's anything
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that might correspond to that palpable finding.
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I don't see anything in particular in this view.
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There is some, uh, heterogeneously dense
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breast tissue here underlying. Perhaps
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that's something that she's feeling.
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At this point, I would switch over
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to the, uh, MLO view and look again.
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Here again, we can see that our, uh, palpable
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marker's on the lateral aspect of the breast.
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We can see it most best, this
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very far, um, lateral aspect.
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And we know we're already there
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because we have our scroll bar.
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As we scroll nearby to that, we see that this,
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again, this focal fibrous tissue comes into a
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little bit better and view, but of course, we'll
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look through the whole image stack to see if
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there's something else that might stand out.
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Now, in patients with palpable findings,
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you wanna make sure that you look not just
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superficially, but sort of also deep, right?
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Patients, they perceive the feeling of, uh, the
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palpable finding, of course, somewhere on the skin,
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but that finding can be anywhere in the breast.
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So already I think I'm a little bit suspicious
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that what this patient's feeling is probably
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just this fibrous tissue, but let's pull down
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the spot compression views just to make sure
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that we're not missing anything deeper in there.
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And on the synthesized views, we can see that
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that area again stands out a little bit, and
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it's nearby, um, where that palpable marker is.
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We'll switch over to the DBT views
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and scroll through these as well.
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Again, as we're looking through, we're looking
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here to see if there's some sort of mass
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or something hidden in this area that might
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correspond to what this patient is feeling.
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We might notice that a little bit of this
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glandular tissue does sort of rise up towards
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the skin surface, and perhaps that's the
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superficial component that she's feeling.
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As we scroll through here, we don't really
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see anything that stands out as a distinct
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mass or something that might be, um,
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different, um, from just normal breast tissue.
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Now, based on this, of course, we would send
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the patient to ultrasound, and I'm not gonna
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show you those images because it showed just
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normal, uh, dense fibroglandular tissue.
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But in the combination of these exams, including
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the mammogram and the ultrasound, we can
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be very confident that what this patient is
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feeling is just some focal glands or tissue.
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She happened to feel that, you know, maybe
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perhaps feels different to her, but, um, but is,
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um, wholly normal and nothing to worry about.
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So we can, uh, reassure her and send her back to
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her physician just to keep an eye on this over time.
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And then also just recommend
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routine screening at this point.
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