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Now we have a 43-year-old woman, uh,

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who has breast implants, uh, who presents

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for right breast cancer staging.

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These are, uh, full-field digital mammograms,

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uh, because when we are doing a case with,

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uh, implants, we do implant in views with

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just, uh, full-field digital mammography, and

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we do CM only on implant-displaced views.

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So this is FFDM of her breasts with implant-in.

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So you can see that the breasts are dense, the

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implants are relatively large volume, so it's

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pretty hard to see anything on these views.

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These are her displaced views, and the displaced

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views are done in CM. So— and these are low-energy

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images of the CM on the implant-displaced views.

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Again, we don't see much.

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We see the, the known mass in the

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right breast with the clip in place.

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And, uh, these are, uh, the recombined images of that

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implant-displaced portion of the— with the study.

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And you see an example of regularly,

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uh, rim enhancing mass in the right breast.

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So, again, so—

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This is not by any means, uh,

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looking like an eclipse sign.

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So it's a very irregular, especially inside.

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So we, we don't have a nicely

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circumscribed dark spot.

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Instead, we would have this very

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irregular-looking enhancement.

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In this case, we already know that

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there's a cancer, so this is just an

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example of a solitary enhancing mass.

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And in a breast like this, in a dense breast,

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it's very helpful because now we know that

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this is a real, truly solitary finding, and

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we don't have to worry about anything else.

1:53

And, uh, this is her ultrasound showing an irregular

1:56

mass in, in the periareolar breast, two o'clock.

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I just wanted to show you how it compares to a breast MRI.

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42 00:02:04,410 --> 00:02:06,870 This patient just happened to have a breast,

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MRI also, and it's very similar in appearance.

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So again, MIR T1 post-contrast subtracted image

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demonstrated an irregular rim-enhancing mass.

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It was a T2 bright inside, so that's where

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the— it could be mucin, it could be, uh,

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necrotic parts of this, or it could be hematoma.

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And this is her MIP.

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So the MIP looks pretty similar to the MIP.

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So, it's a maximal intensity projection of, uh,

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T1 post-contrast images, and this is the

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appearance on the subtracted sagittal views.

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And, uh, she went for a segmental mastectomy and it

2:47

was invasive ductal carcinoma with mucinous features.

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Grade two, the ER/PR+, HER2-

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It also had some, uh, ductal carcinoma in situ.

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And invasive cancer was 1.8 centimeter

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in diameter, which is very similar

3:03

to what we saw on both CM and MRI.

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So basically, one, just wanted to emphasize the

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possibility of doing contrast-enhanced mammography

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on patients with implants.

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And also, you may notice on these

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images some very faint vertical

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lines, dark lines.

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So that's a grid artifact of recombined images.

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It's not, uh, really preventing us from,

3:33

uh, making, uh, adequate diagnosis.

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It's, uh, doesn't make the study non-diagnostic.

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Uh, but it's, it's visible.

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So if you know what it is, you can contact your

3:42

vendors and work on that, or, or just work around it.