0:00

This was a case of a 70-year-old woman who had the

0:03

right breast invasive lobular cancer and DCIS in 2016.

0:09

Uh, she had a segmental mastectomy, and since then,

0:13

she complains of progressive right nipple inversion.

0:18

So this case, uh, actually demonstrates, uh,

0:21

potential usefulness of CEM in women with a

0:24

personal history of breast cancer, and in my

0:27

personal opinion, might be one of the most

0:29

useful applications of this modality because

0:33

of the difficulties that we experience with

0:35

mammography in this patient population.

0:38

Especially if, uh, patients have dense

0:40

breasts and they are younger and they have

0:43

scars of prior segmental, uh, mastectomies.

0:46

So this

0:47

is potentially a very useful

0:49

modality for that application.

0:50

And there have been some ongoing trials right

0:53

now, like TOCEM trial, Dr. Berg from UPMC to

0:57

demonstrate the potential use of CEM in

1:00

women with a personal history of breast cancer.

1:02

So here's a case.

1:04

This woman has dense breasts.

1:05

This is her low energy images, and uh, you can

1:09

see that she has an architectural distortion

1:12

and the nipple inversion on the right.

1:15

We do know that she had a segmental mastectomy

1:18

there because there are multiple clips.

1:21

But we do also see that this progressively

1:25

kind of contracting, uh, becomes more, uh,

1:28

distorted, and the nipple keeps inverting

1:30

more and more, and that bothers the patient.

1:33

And we know that we are limited in terms of how

1:35

well we can see through all that dense breast

1:38

tissue and the scar tissue on the mammogram.

1:41

This is her DBT.

1:43

So if you look at the DBT slice, again,

1:46

a very distorted, maybe even mass-like,

1:48

as you can imagine, a spiculated mass there.

1:51

But also know that that could be just a

1:54

presentation of an evolving scar with, uh,

1:58

increasing fibrosis. If we do an ultrasound,

2:04

we again expect to see very mass-like,

2:07

irregular appearance with spiculations.

2:11

Uh, very hard to tell anything.

2:13

If there are small masses or some new

2:16

findings developing on this background,

2:18

that would be very hard to tell.

2:20

But here are her recombined images of CEM, and we

2:25

see, uh, absolutely a clean, minimal background

2:29

enhancement and, uh, nothing at all of concern

2:33

in the area of that architectural

2:35

distortion or of that scar.

2:37

So there is no question that this is a negative

2:40

uh, study, that this is scope of surgical scar

2:44

evolving with nothing suspicious about it.

2:48

So this is an example of a true

2:50

negative CEM in the patients with

2:54

dense breasts and postsurgical changes.