0:00

This is a 62-year-old woman who

0:02

presented, uh, to us for screening, uh,

0:05

within one of our research protocols.

0:09

And for her, this happened to be her baseline CEM

0:12

and baseline DBT, digital breast tomosynthesis.

0:16

She happened to have multiple prior

0:18

mammograms, but none of them were done with

0:20

DBT, and none of them were done with CEM.

0:23

This is her low energy mammogram.

0:26

And right here, we can see that on CC,

0:29

on the craniocaudal view, there is

0:31

some asymmetry in the central breast.

0:35

When we do our contrast-enhanced

0:37

mammography on the recombined images,

0:40

there's definitely non-mass enhancement, uh,

0:43

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

0:46

It's pretty asymmetric.

0:47

It's at least, it's moderate

0:50

conspicuity and definitely jumps at you.

0:54

So on the left, it's a low energy

0:56

image. In the middle is the recombined

0:58

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

1:02

And on the DBT, we definitely see

1:04

some kind of architectural distortion

1:06

there, so it looks pretty suspicious.

1:09

However, looking back on prior

1:12

2D mammograms,

1:14

she always had some kind of asymmetry there.

1:17

There was no prior DBT to compare the

1:19

distortion part of it, but the asymmetry

1:21

has been there for several years at least.

1:24

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

1:27

enhancement, so we are definitely concerned about it.

1:31

We went for an ultrasound.

1:34

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

1:37

rather hyperechoic maybe, uh, or slightly

1:40

hypoechoic mass with indistinct margins.

1:44

We believe that this corresponded to

1:45

our mammographic finding, and we ended up

1:49

doing an ultrasound-guided biopsy of it.

1:52

And then, as you can see, the clip

1:54

is exactly in the area of concern.

1:57

And it was a minimal usual ductal hyperplasia,

2:00

apocrine metaplasia, minimal fat necrosis.

2:04

She did not report any history of trauma.

2:08

The point is it was stable on the images, but

2:12

it was enhancing, so we ended up biopsying it.

2:15

It was a false-positive DBT and

2:20

recombined images, uh, false-positive.

2:23

You definitely will encounter cases like that.

2:25

It's very hard to dismiss them on the first

2:28

CEM, but just know that false-positives

2:31

like that exist and are not infrequent.

2:34

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

2:37

the upper outer breast, there is a skin mass.

2:40

It's one of those, uh, cutaneous

2:42

hemangiomas, but the larger one. It has

2:45

been stable on multiple prior images.

2:47

So...

2:48

Right here, you can see an enhancing

2:50

mass bright on the skin surface.

2:52

So another example of an enhancing cutaneous mass.