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Enhancing Architectural Distortion and False Positive on CEM

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This is a 62-year-old woman who

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presented, uh, to us for screening, uh,

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within one of our research protocols.

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And for her, this happened to be her baseline CEM

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and baseline DBT, digital breast tomosynthesis.

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She happened to have multiple prior

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mammograms, but none of them were done with

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DBT, and none of them were done with CEM.

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This is her low energy mammogram.

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And right here, we can see that on CC,

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on the craniocaudal view, there is

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some asymmetry in the central breast.

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When we do our contrast-enhanced

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mammography on the recombined images,

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there's definitely non-mass enhancement, uh,

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at least non-mass enhancement at 12 o'clock on the left.

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It's pretty asymmetric.

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It's at least, it's moderate

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conspicuity and definitely jumps at you.

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So on the left, it's a low energy

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image. In the middle is the recombined

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image. On the right, it's a DBT image.

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And on the DBT, we definitely see

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some kind of architectural distortion

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there, so it looks pretty suspicious.

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However, looking back on prior

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2D mammograms,

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she always had some kind of asymmetry there.

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There was no prior DBT to compare the

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distortion part of it, but the asymmetry

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has been there for several years at least.

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But now we know that there is a distortion, there is

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enhancement, so we are definitely concerned about it.

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We went for an ultrasound.

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Found this kind of, uh, mixed, uh, echogenicity,

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rather hyperechoic maybe, uh, or slightly

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hypoechoic mass with indistinct margins.

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We believe that this corresponded to

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our mammographic finding, and we ended up

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doing an ultrasound-guided biopsy of it.

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And then, as you can see, the clip

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is exactly in the area of concern.

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And it was a minimal usual ductal hyperplasia,

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apocrine metaplasia, minimal fat necrosis.

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She did not report any history of trauma.

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The point is it was stable on the images, but

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it was enhancing, so we ended up biopsying it.

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It was a false-positive DBT and

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recombined images, uh, false-positive.

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You definitely will encounter cases like that.

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It's very hard to dismiss them on the first

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CEM, but just know that false-positives

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like that exist and are not infrequent.

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And just for you to notice, in the left breast, in

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the upper outer breast, there is a skin mass.

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It's one of those, uh, cutaneous

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hemangiomas, but the larger one. It has

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been stable on multiple prior images.

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So...

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Right here, you can see an enhancing

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mass bright on the skin surface.

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So another example of an enhancing cutaneous mass.

Report

Faculty

Olena Weaver, MD

Associate Professor

Department of Breast Imaging, The University of Texas MD Anderson Cancer Center

Tags

Oncologic Imaging

Neoplastic

Mammography

Diagnosis & Staging

Breast

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