0:00

So the next case is a 50-year-old woman with,

0:03

uh, dense breasts who presented for CM screening.

0:08

We can see her, uh, low energy images, uh, demonstrate

0:13

really heterogeneous dense with extremely dense

0:15

breasts, and we can discern multiple little masses.

0:21

It's one of those cases that the more you

0:22

look, the more of those masses you find.

0:25

And, uh, it has been, uh, this

0:28

changing pattern over the years.

0:30

Some masses appear, some disappear.

0:33

Uh, very difficult to look at these cases because

0:36

it's really hard to tell which of the new masses

0:38

may be of potential clinical significance.

0:42

And, uh, this is for a set of recombined images.

0:46

So you can see multiple little

0:49

kind of punched-out looking

0:52

oval and round masses with dark centers and some

0:57

demonstrate a thin rim of enhancement just like this,

1:02

h, but some of them have some thicker

1:05

rim enhancement or enhancement surrounding

1:08

the finding, and some are more modern than others.

1:11

So in this case, you can also see little circumscribed

1:14

masses, but no internal, uh, dark center.

1:20

So in this case, the multiplicity of these

1:23

findings and the fact that, uh, we could see

1:26

on the prior images that there were masses in

1:28

this area and they actually fluctuated in size.

1:32

We, we can think that the bilaterality and the

1:35

kind of similar symmetric nature of it is more

1:38

towards the benign nature of these findings, probably

1:43

inflammatory, uh, cyst, but, uh,

1:46

have to be careful with this.

1:47

So we ended up doing an ultrasound.

1:51

So on ultrasound, it's very hard to tell which

1:55

of those multiple, multiple cysts that we saw

1:58

on both sides would correspond to the ones

2:01

that demonstrated that brain enhancement.

2:04

So just because we had so many prior studies,

2:07

we were pretty confident that this is nothing

2:10

besides just the inflammatory fibrocystic changes.

2:13

So we dismissed it as a benign finding.

2:18

What I wanted to point out here is that

2:21

depending on the reconstruction, uh, subtraction

2:24

algorithm, different vendors can have a

2:27

little different appearances of the images.

2:30

So if you are planning to do, let's say,

2:32

a six-month follow-up of your studies,

2:34

that's something to keep in mind.

2:37

So on the top, there is a vendor one,

2:40

and on the bottom, it's a vendor two.

2:42

And you can see that the difference is, and

2:44

we know that this is a perimenopausal, uh,

2:46

woman, so to some degree this could be, uh, due

2:50

to a different stage of her menstrual cycle.

2:53

But, uh, even looking at the, let's say this

2:56

slightly thicker, uh, skin, slightly, uh,

3:00

more of a breast and breast artifact, and

3:02

just an overall little different appearance.

3:06

So that was the purpose.

3:07

Just keep in mind that they can

3:09

look a little different.

3:11

So in summary, this was just, uh, benign

3:13

bilateral, uh, fibrocystic changes.

3:18

So, uh, this is APAC approach.

3:21

This is a woman with dense breasts

3:23

and multiple bilateral masses.

3:25

The masses are fluctuating in size and

3:27

number over the years, uh, which is, uh,

3:29

consistent with the changing pattern of cysts.

3:32

But every time the woman comes and the new mass

3:36

appears, it might be challenging to easily dismiss it.

3:41

So in this case, you see, uh, on top is,

3:43

uh, lower energy images for this woman with

3:47

extremely dense or heterogeneous

3:49

dense breasts and multiple masses.

3:52

So when we are looking at the recombined

3:54

images, we can immediately see some of

3:58

those masses demonstrate eclipse sign.

4:04

And some, uh, of those, uh, eclipse signs are

4:07

cleaner, clearer than others like this,

4:10

for example, uh, the left upper outer breast.

4:13

On the other hand, we see a few of, uh, similar

4:16

appearing kind of little fuzzy eclipse signs.

4:20

For example, there is one on the right,

4:22

there's one on the left, you know, breast.

4:24

So when we start going through our images,

4:29

in this case, we had the benefit of having

4:31

digital breast tomosynthesis images.

4:33

So you can actually toggle and see.

4:35

So for example, this mass with the largest

4:39

mass in the central left breast on the craniocaudal

4:41

view has a nice underlying eclipse sign.

4:45

So no questions.

4:46

They are benign, dismissing.

4:48

This one is a little, uh, more questionable

4:51

in the outer breast on the craniocaudal view.

4:53

This is not a clean and thin eclipse sign.

4:58

However, uh, since this woman was coming to us

5:01

for many years, we just had the benefit of comparing

5:04

to the prior studies and we saw that there

5:06

were larger cysts before, so this is actually

5:09

a decrease in size from her prior appearance.

5:11

So this, we were pretty comfortable in this case

5:14

that this was a fibrocystic change, uh, with

5:18

probably some inflammatory change around it.

5:22

So the same, uh, in here,

5:24

this is a left upper outer fibrocystic change with

5:28

a little bit of inflammatory enhancement around it.

5:31

And again, the bilaterality of it and the fact that

5:35

the cysts decreased in size made us comfortable.

5:39

And we did an, uh, ultrasound and also

5:41

confirmed that these were just cysts.