0:00

This is a 73-year-old female, uh, who's

0:03

presenting for screening mammogram.

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We can see already, and we can confirm in

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the clinical history that this patient

0:10

has a history of previous lumpectomy in

0:14

the left breast to treat her prior cancer.

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Quality of this exam is good, although one

0:23

thing to note is that the nipple is not in

0:24

profile, uh, in at least one view on both sides.

0:28

You might consider, uh, calling this

0:31

patient back for a technical recall.

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However, if it's difficult to position this

0:36

patient for some reason, the techs have noted that

0:38

in chart, then, uh, you might just let that go.

0:42

Just look at the left side.

0:44

We can see the stereotypical, uh, post

0:46

lumpectomy findings, uh, multiple surgical

0:49

clips, coarse popcorn-like calcification here.

0:54

My left breast and

0:56

we see those same, uh, imaging

0:57

findings on the MLO view.

1:02

You can see the surgical scar

1:04

marker, which is placed in the skin,

1:07

and we see diffuse, typically benign

1:10

calcifications throughout the left breast.

1:14

We also see a little bit of that, um, parenchymal,

1:18

um, thickening sort of pattern of someone who's had

1:20

radiation in past, and then perhaps a little bit of

1:23

skin thickening related to that radiation as well.

1:27

Now for all these exams, we wanna make sure that we,

1:29

uh, evaluate for any other potential new areas, um,

1:33

that have developed since the prior screening exam.

1:37

In this case, as we scroll from inferior to

1:39

superior on the DBT set, we can see that this area,

1:42

uh, in the left breast stands out a little bit.

1:45

There is some, uh, probable architectural

1:47

distortion, um, with this asymmetry.

1:51

Um, and we'd prove that by seeing

1:54

some radiating lines from that spot.

1:57

Now, of course, we'd wanna compare to

1:58

prior exams to see if something, this,

2:00

this is something that was related to her

2:02

prior surgery, perhaps maybe additional

2:04

biopsy site or something like that,

2:06

that would give the appearance of that

2:07

architectural distortion at that location.

2:10

Now, in this case, the prior exam did not

2:12

show that area-based imagery, and just by that

2:15

fact, uh, it's considered more suspicious. As

2:18

we scroll through on the MLO, uh, tomosynthesis,

2:22

we can see that same area here in the more superior

2:25

part of the breast standing out from the background.

2:28

It doesn't stand out quite as much, uh, in

2:31

the MLO view as it does on the CC view, and

2:34

we, we don't definitely see that associated

2:37

architectural distortion regardless.

2:40

This type of finding, um, uh, warrants a further

2:43

evaluation with diagnostic mammogram and ultrasound.

2:46

The patient did go on to get her diagnostic,

2:49

uh, mammogram, and we can see that same

2:52

finding here in the lateral breast.

2:54

What we presume is the corollary finding

2:56

on the MLO view in the upper breast.

3:00

We switch over to synthesized views again.

3:04

As we scroll through, we can see that same finding.

3:06

It does look like there is some probable associated

3:09

architectural distortion, and we can confirm this.

3:11

Finding does indeed probably relate to

3:14

the finding that we see in the CC view.

3:17

So when we tell our sonographers where to

3:19

go look, uh, in this patient, we would

3:21

tell them, wanna look in the left breast.

3:24

And if we measured out, uh, from where we presume

3:27

the nipple to be, somewhere around right here,

3:29

somewhere around seven centimeters from the nipple.

3:32

She did have an ultrasound.

3:37

In this, seen a clip at two

3:38

o'clock, uh, in the left breast.

3:40

Seven.

3:41

Seven nipple.

3:42

As we scroll through, we see this hypoechoic

3:44

area with some shadowing, indistinct

3:47

margins, subtle hyperechoic halo.

3:50

This finding is compatible with

3:52

the one we see on the mammogram.

3:54

This was subsequently biopsied.

3:56

That's an invasive ductal carcinoma.

3:57

It's considered recurrence in this patient, and

4:00

recommend further evaluation with surgery.