0:01

Alright. In this case, um, I'm showing images of the right

0:04

breast in a 48-year-old woman who presented with a

0:09

palpable abnormality in the upper outer right breast.

0:12

At our institution, we use a small BB

0:15

marker to, uh, denote palpable findings.

0:21

And when we look at these two views,

0:22

um, we acquire a right CC view.

0:25

Uh, we get a CC spot view

0:27

over the palpable abnormality.

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Full field MLO view, MLO spot over the

0:32

abnormality, and then, um, an ML view as well.

0:38

So if we switch over to the DBT slices, moving

0:43

from inferior to superior and focusing really

0:47

mostly on the area of the palpable abnormality.

0:50

But of course, in the end I'll

0:51

look at all the breast tissue.

0:52

Um.

0:53

For the purposes of this, we'll focus mainly on

0:56

where the palpable marker is, and we can see that

0:57

that comes into view about here, um, somewhere

1:01

in the middle of the DBT stack. And we look

1:03

underneath or sort of deep to that palpable marker

1:05

and try to evaluate whether there's anything

1:07

that might correspond to that palpable finding.

1:11

I don't see anything in particular in this view.

1:12

There is some, uh, heterogeneously dense

1:15

breast tissue here underlying. Perhaps

1:18

that's something that she's feeling.

1:20

At this point, I would switch over

1:21

to the, uh, MLO view and look again.

1:25

Here again, we can see that our, uh, palpable

1:27

marker's on the lateral aspect of the breast.

1:30

We can see it most best, this

1:32

very far, um, lateral aspect.

1:35

And we know we're already there

1:36

because we have our scroll bar.

1:38

As we scroll nearby to that, we see that this,

1:41

again, this focal fibrous tissue comes into a

1:44

little bit better and view, but of course, we'll

1:46

look through the whole image stack to see if

1:47

there's something else that might stand out.

1:49

Now, in patients with palpable findings,

1:51

you wanna make sure that you look not just

1:53

superficially, but sort of also deep, right?

1:55

Patients, they perceive the feeling of, uh, the

1:58

palpable finding, of course, somewhere on the skin,

2:00

but that finding can be anywhere in the breast.

2:04

So already I think I'm a little bit suspicious

2:06

that what this patient's feeling is probably

2:08

just this fibrous tissue, but let's pull down

2:11

the spot compression views just to make sure

2:13

that we're not missing anything deeper in there.

2:15

And on the synthesized views, we can see that

2:17

that area again stands out a little bit, and

2:19

it's nearby, um, where that palpable marker is.

2:23

We'll switch over to the DBT views

2:25

and scroll through these as well.

2:28

Again, as we're looking through, we're looking

2:30

here to see if there's some sort of mass

2:31

or something hidden in this area that might

2:33

correspond to what this patient is feeling.

2:36

We might notice that a little bit of this

2:37

glandular tissue does sort of rise up towards

2:39

the skin surface, and perhaps that's the

2:41

superficial component that she's feeling.

2:44

As we scroll through here, we don't really

2:45

see anything that stands out as a distinct

2:47

mass or something that might be, um,

2:49

different, um, from just normal breast tissue.

2:53

Now, based on this, of course, we would send

2:54

the patient to ultrasound, and I'm not gonna

2:56

show you those images because it showed just

2:57

normal, uh, dense fibroglandular tissue.

3:00

But in the combination of these exams, including

3:02

the mammogram and the ultrasound, we can

3:04

be very confident that what this patient is

3:06

feeling is just some focal glands or tissue.

3:09

She happened to feel that, you know, maybe

3:11

perhaps feels different to her, but, um, but is,

3:14

um, wholly normal and nothing to worry about.

3:17

So we can, uh, reassure her and send her back to

3:20

her physician just to keep an eye on this over time.

3:22

And then also just recommend

3:23

routine screening at this point.