0:00

72-year-old woman who was recalled

0:02

from her screening mammogram.

0:05

And, uh, there was, uh, a mass

0:07

and microcalcifications.

0:10

So at first, uh, this is just, um, bilateral

0:13

craniocaudal and mediolateral oblique low-energy images.

0:18

Already, here, you can see that there is

0:19

a mass in the right inner breast.

0:23

This is, uh, the recombined images of the same

0:26

breast and, uh, you can see a little different

0:28

background pattern than what we've seen, uh, so far.

0:32

It's a little tiny speckle.

0:34

So this is, uh, still mild, broad symmetric

0:39

background parenchymal enhancement.

0:41

But take a look.

0:42

Uh, so remember this is the mass in the

0:44

right and take a look on the recombined image.

0:48

There is a well-circumscribed round

0:51

dark, uniformly dark mass with a very

0:55

thin and uniform rim of enhancement.

0:59

So this is a classic sign of a benign cyst called

1:04

Eclipse Sign, and it's very pneumonic for a cyst.

1:10

This is a DBT slide showing a nicely

1:13

circumscribed mass,

1:17

and this is a close-up of that

1:20

Eclipse sign. Again, very thin.

1:22

And the inside of that cyst, it's a very dark

1:25

uniform to be representative of the Eclipse sign.

1:30

It doesn't need to be very thin and, uh, uniform,

1:33

especially the inside of that rim enhancement.

1:37

Uh, we did an ultrasound and

1:39

it's a simple cyst.

1:42

But, uh, another, uh, issue with that, uh, mammogram

1:46

was that the patient had microcalcifications

1:48

in the outer breast or central outer breast.

1:52

Uh, this is a magnification view,

1:55

so it was lower outer breast.

1:57

And you can see that there are some

1:58

suspicious microcalcifications, uh,

2:01

this is a magnification view again.

2:04

But looking back at the recombined images,

2:07

so on the right in the square, that's

2:09

the area of those microcalcifications.

2:12

Of course, we don't expect to see them well on

2:15

these, uh, monitors and, uh, on the full field view.

2:18

But even knowing that there are some

2:21

suspicious microcalcifications, there

2:23

is nothing really suspicious at all

2:25

from the enhancement standpoint. So the enhancement is

2:29

pretty uniform here and the same in the lower breast.

2:32

So the calcifications are here and there

2:35

is nothing focal or suspicious or different

2:38

in that area on the recombined images.

2:42

We ended up doing a stereotactic biopsy of that

2:45

area of calcifications, and it was benign.

2:50

So fibroadenomas associated with micro

2:52

calcifications. So in this case, it

2:54

was a true negative recombined image.

2:58

However, uh, as you probably remember from

3:01

Dr. Phillips's lecture, we are taking

3:05

the contrast-enhanced mammography as a whole.

3:07

So if there are suspicious findings on low-energy

3:10

images, if they're suspicious enough, we are

3:13

taking that seriously and we need to biopsy

3:16

it even if there is no enhancement, at least,

3:20

uh, when we're talking about calcifications.