0:00

This is a 42-year-old woman, uh, who

0:02

presented to our institution with non-

0:04

right breast cancer for cancer staging.

0:07

So her cancer is invasive ductal, grade two, ER/PR

0:11

positive, HER2 negative, and she has Ki-67 of 5%.

0:17

She has very dense breasts, and we can see,

0:20

uh, a clip in the right outer breast.

0:23

Not much of a low energy finding, except for maybe,

0:27

uh, one-view asymmetry on the craniocaudal view.

0:31

When we do, uh, CM and recombined images, the CM does

0:36

demonstrate a mass in the right outer breast.

0:39

So that's our known cancer.

0:42

Uh, it's an enhancing mass, but she just

0:45

happened to have at least moderate background

0:48

parenchymal enhancement, uh, moderate to marked.

0:51

And point of this case is basically that

0:55

is a limitation that we have to deal with.

0:57

So especially at the beginning when you are just

1:00

establishing your program, that can make you

1:03

quite nervous, all the, uh, findings that you can

1:06

find or that you can imagine on the case with,

1:10

uh, marked to moderate background enhancement.

1:13

So like in this case, is this something?

1:16

So we did a, a spot compression

1:19

view, which you can do with CM.

1:21

Didn't really see anything.

1:23

They are persisting.

1:25

There was nothing really, uh, on the MLO views,

1:28

which I'm not showing here, but I am showing here

1:30

some additional possible findings on a left MLO.

1:35

Is that a real finding?

1:36

Is the upper breast asymmetry a real finding?

1:40

We did the lateral.

1:42

It didn't really persist.

1:43

It blended with the rest of

1:45

the background enhancement.

1:47

So we did do bilateral ultrasound and did not really

1:52

find anything suspicious besides the non-right cancer.

1:56

So the non-right cancer is a definite

1:59

irregular mass with spiculated margins.

2:03

But other than that, just non-specific

2:05

fibrocystic changes everywhere.

2:08

This was one of those cases that after just

2:11

struggling a little bit, it was one of my earlier

2:14

cases, dismissed it as a background enhancement.

2:17

So just keep in mind that in some cases there will

2:20

be so much patchy background enhancement,

2:23

you just have to accept.

2:25

Just like with MRI, it's a limitation.

2:28

And on surgical pathology, uh, on segmental

2:31

mastectomy, it was invasive ductal cancer, grade two.

2:35

1.6 centimeter increased in size.

2:38

So she had a segmental mastectomy, uh, she

2:42

has had her sub-radiation and hormonal therapy.

2:46

And, uh, one year afterwards, uh, she had a breast MRI

2:51

and, uh, of course the background enhancement much

2:54

decreased due to her, uh, anti-hormonal treatment.

2:57

But we know that we

2:59

haven't missed any cancer in the other

3:01

breast or elsewhere on the right.

3:03

So that was an illustration of a real,

3:06

real-life struggle with, uh, moderate to, uh,

3:10

marked background parenchymal enhancement.