65-year-old woman with history of left breast cancer 12 years ago. Annual follow up
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And our next patient is a 65-year-old
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woman with a history of left breast cancer
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12 years ago, for a routine follow-up.
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So here are the CC and MLO views for this
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patient, and she has had a lumpectomy on
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the left, so her scar is marked with that
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interrupted line sticker, and so this is
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her lumpectomy scar and her lumpectomy site.
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And we compared to earlier prior mammograms.
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Looking at that same lumpectomy site,
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there was a feeling, you know,
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even though she had a lot of distortion back
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here, it looks as if the lumpectomy site
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maybe became a little bit more dense.
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And then on the MLO view, there's a lot of
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distortion back here and on her prior exam,
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but it looks like compared to the new one, the current
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study, the lumpectomy site looks more bulky.
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So a lumpectomy site, even if there's
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really significant distortion,
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it should stay the same over time,
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or maybe the scar retracts a little bit.
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We may see some calcifications forming,
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but usually either things stay the
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same or they get better appearing.
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You know, there's an improvement in the appearance
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of the scar over time, and we don't want to see
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the scar looking more bulky or more prominent.
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So just looking at this in the tomosynthesis
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images, you can see that as we scroll
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through, there's some calcifications there
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at the lumpectomy site, and there's also
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this extra sort of bulky tissue at the
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posterior aspect of that lumpectomy site.
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And on the CC view, you know, lots of
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calcifications there and some extra
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bulkiness to that lumpectomy site.
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And just scrolling through,
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there's some calcifications that
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are sort of fine linear branching.
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They don't belong there.
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It's not our typical dystrophic
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looking calcification.
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And then it looks like there may be more
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mass-like tissue there at the lumpectomy.
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And it's definitely difficult
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to look at lumpectomy sites.
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Because they can be very distorted,
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but they shouldn't look worse over time.
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So we ended up doing some extra views
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with ultrasound.
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So we went to ultrasound and lumpectomy
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site can be very difficult to evaluate
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with ultrasound because there's a lot
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of hypoechoic scarring at the site anyway.
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And you may not really have a comparison, but we
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knew where the scar was on the patient's skin.
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And it just looked like there was more
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mass than we would expect when we scrolled
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through, so we thought this was probably
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new, and there was some blood flow to it.
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Here was the scar coming from her skin,
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but then this seemed to be extra tissue.
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We also looked at her axillary lymph nodes.
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There's a lymph node here with a very thin cortex.
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And there's a lymph node here
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with a much thicker cortex.
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So, our recommendation was to biopsy
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this mass, and we biopsied the
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lymph node with the thicker cortex.
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And this was invasive ductal carcinoma in
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the breast and metastatic carcinoma involving
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that lymph node, where the cortex was thicker.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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