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This is a 66-year-old woman

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presented for dense breast screening.

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So just wanted to emphasize that screening is not yet,

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uh, among the approved indications for CM. We have a

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research study here, uh, although it is recommended

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as, um, an alternative to screening breast MRI in

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those women who cannot have MRI for whatever reason.

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So, um, extremely dense breasts, very.

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Lumpy, uh, looking tissue and a lot of

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calcifications throughout both breasts.

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So this woman has been coming for

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her screening for many, many years.

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As you can see, it's extremely limiting to

0:43

look at the breasts like that with low energy

0:46

or with the full-field digital mammography.

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So multiple, multiple, uh, asymmetries.

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She has been recalled many times

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before, and you can see that she has

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a scar on markers on the right breast.

0:59

She already had some excisional biopsies,

1:03

so, and this is her, uh, recombined images.

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And immediately you can see that

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something is different here.

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Something that stands out is this enhancing

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mass at 11 o'clock of the left breast.

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She does have a mild, uh, background parenchymal

1:20

enhancement, mostly along the edge of the breast,

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so-called breast-in-breast, uh, artifact.

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But it's pretty symmetric and easy,

1:30

uh, to dismiss once you get used to it.

1:33

But this is definitely something that stands out.

1:37

The interesting part is that when you look

1:40

back on a low energy image, you kind of can

1:43

see that, that there is something there.

1:46

But when you have so many distractors,

1:48

so many masses and asymmetries, plus

1:51

when you're looking back to a couple years

1:53

earlier, there was something there before.

1:56

So it's very easy to dismiss

1:58

it as something stable, but.

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On DBT, we happened to have a DBT

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slice there, you already start seeing

2:06

that this is actually a spiculated mass.

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So this is the MLO view of the

2:11

same breast, so very faint.

2:15

Maybe architectural distortion or a

2:17

symmetry in the left upper breast on DBT.

2:22

Wouldn't say that it's something definite,

2:24

but again, when we are going back to our.

2:27

Recombined images, it's, it's very

2:29

obvious that there is something there.

2:32

So we did an ultrasound, and on ultrasound,

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we saw this mixed echogenicity, more even

2:38

hyperechoic mass with indistinct margins.

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We were pretty sure that that's the correlate, and

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we ended up doing an ultrasound-guided biopsy of it.

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And on this image, you see that the

2:50

clip is exactly in the area of concern.

2:53

So we succeeded.

2:56

On pathology,

2:57

it was an invasive ductal carcinoma

2:59

with tubular features, low grade,

3:02

with focal DCIS, ER/PR positive,

3:05

HER2 negative. She opted for bilateral mastectomy,

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which confirmed the cancer in the left.

3:14

And, uh, she also had a right mastectomy, which

3:17

did not really demonstrate any pathology there.