0:00

So this is another, um, screening mammogram.

0:05

And again, I'm gonna leave this up for a minute, see if you can see any, um,

0:08

abnormalities on here.

0:13

So I'm just opening up the,

0:14

just showing the m l o and CC views of the left breast now.

0:19

And I'm gonna circle the finding. So this is a finding,

0:21

I do think you can see it on her. These are the reconstructed, um, uh,

0:25

synthesized mammogram images. So this is a two D picture,

0:28

but it's reconstructed from our tomosynthesis slices. And we see this,

0:33

um,

0:34

focal asymmetry or a small speculated mass in the upper central breast.

0:40

So though we can see it on the two D images,

0:43

I wanna now show it on the three D images and just show how much more, um,

0:46

clear it is that there is a speculated mass with some associated distortion.

0:51

So just pause it here. So I'm gonna circle it,

0:56

it's right here. And then on the m l o view,

0:59

similarly as I scroll through,

1:04

I'm gonna pause right here. And you can see this, um,

1:09

the speculated mass in the, while it's,

1:11

it is visible on the two D it becomes much more obvious on the tomosynthesis

1:16

images when you're scrolling through it that this does not represent overlapping

1:19

fibro angular tissue like in the first case,

1:22

but instead represents a true finding.

1:27

So we, um, we do spot compression views. These are, these are, um,

1:31

the two D spot compression views. And again,

1:34

I do think you can see the finding here,

1:37

but it becomes much more obvious and much more easy in much easier to

1:42

really, um,

1:43

see the morphology of it when we're scrolling through on the three D slices.

1:49

So again, there's the, on the two D and here, I think on the cc it's most, uh,

1:53

it's easiest to see.

1:54

So we see the small speculated mass in the upper central breast.

1:58

So when we see a small a finding like this on a, on a mammogram,

2:03

we wanna see if we can find it on ultrasound because ultrasound is really the

2:06

preferred way to do biopsies if we're able to see the finding on ultrasound.

2:10

So I always think, I always look at the finding and try to localize it using,

2:14

um, the mammogram. So I know where on the ultrasound to look.

2:17

So this is in the upper, in the upper outer left breast.

2:21

So we go to ultrasound, we're gonna look in the kinda upper, upper central,

2:24

upper outer breast.

2:26

And we saw this small mass at that location.

2:29

It's at the 12 o'clock position, three centimeters from the nipple.

2:34

And there is a, a,

2:36

a small irregular hypoechoic mass with angular margins. Um,

2:40

this looks kind of a similar shape, uh, as that uh,

2:45

mass that we saw in mammogram seems to be in the right right position.

2:48

So what we would choose now to do the biopsy using ultrasound,

2:51

so here's images from our ultrasound guided biopsy of that mass. Um,

2:56

so our first image, we see just the, our biopsy

2:58

Needle lining up before the mass in our second image. We've now fired.

3:03

It's gone through the mass. So we usually take several samples.

3:05

I'm just showing images of one of them. And we place a biopsy clip.

3:09

It's really important for these types of cases to place a biopsy clip because we

3:13

wanna make sure that this finding on her ultrasound is truly a match for that

3:18

mammographic finding.

3:19

So here is our post clip mammogram showing that,

3:24

uh, biopsy clip, um, in the,

3:29

in the upper central left breast. And I'm just gonna pull up, um,

3:33

her initial screening mammogram so that we can just look at the positioning and

3:38

we do see, so first I have the CC views and I see that biopsy clip here,

3:43

and that's right in the, the,

3:44

the same spot where we saw that initial mass on her mammogram sim. Similarly,

3:49

I have the showing the mass on the lateral view, and again,

3:51

it's in the same spot as our initial finding on her mammogram.

3:54

So I feel confident that that ultrasound finding is truly a correlate for the

3:59

mammographic finding. I know my clip is well positioned. Um,

4:03

this did turn out to be an invasive mammary carcinoma with ductal and lobular

4:08

features. Um, it measured six millimeters in the,

4:11

in the material center pathology.