0:00

This is a another screening mammogram an asymptomatic patient,

0:07

and I think this is a really tough case to see on, um, A two D mammogram.

0:11

I think it's, you know, on our, our high quality, um, image, uh,

0:16

screens that we use in breast imaging, I think it is possible to see it on a,

0:19

on your, on the two D mammogram.

0:21

But I probably on the laptop that you're looking at,

0:23

it's gonna be very subtle here. I'm gonna zoom in on the,

0:27

on the side so you can at least see the side.

0:30

I'm gonna leave it for a second and see if any,

0:32

but is able to identify an abnormality here.

0:43

So this is a, a,

0:44

a subtle architectural distortion in the upper slightly inner right

0:49

breast.

0:52

So while I think very subtle on the two D image,

0:57

I'm now gonna show it on this, on the three D image,

0:59

and I think it's much less subtle here. So let me

1:04

pause so I can circle it. So here's the distortion. This

1:10

is very hard to see on her on the two D image,

1:13

but the three D really allows us to scroll through

1:18

and see that that's,

1:19

that's a true distortion in her breast that needs to be further evaluated.

1:27

This is, um, I think this finding is easier to see on her, um,

1:31

CC view than the m l o view,

1:38

but I'm just gonna help, um, show you where to look with your eyes.

1:42

So if you keep your eyes here,

1:43

I'm gonna kind of scroll back and forth through there.

1:52

And I think you can appreciate how the breast tissue is distorted in that upper

1:56

part of the breast. So this patient was,

2:01

this was a screening mammogram. This patient was recalls.

2:05

We did SP compression views.

2:10

Here is our spot compression, um, CC view.

2:16

And again, I, I do think that that finding is, it's possible to see it on the,

2:21

the reconstructed two D view, but it becomes much more, um,

2:25

obvious on the three D view, um, when we're scrolling through tomosynthesis.

2:29

So let me again pause here. So the finding is,

2:32

is right here in the slightly inner breast.

2:48

In the slightly inner breast. So here's that finding right here.

2:51

Similarly in the m l O view, I think it's,

2:54

it's very difficult to see it on the reconstructive two D view. Um,

2:58

But, but on the, um,

3:01

tomosynthesis slices when we're able to scroll through the finding,

3:04

I'm just gonna draw your attention right here to keep your eyes here.

3:06

As I'm scrolling through,

3:12

we can appreciate that the breast is distorted there.

3:15

So this is in the upper slightly inner right breast.

3:19

We're gonna do a targeted ultrasound to try to find a correlate.

3:24

So here's our ultrasound. This is at the right breast one o'clock position.

3:28

So that's in the upper inner quadrant,

3:30

which is what we would expect to ha where we'd expect to see that finding.

3:32

And we see this, um, hypo coic mass with some speculated margins.

3:38

Um, our last image here shows, um,

3:41

internal vascularity kinda at the margins of this mass. Um,

3:45

so because we were able to see an ultrasound correlate,

3:47

we did an ultrasound guided biopsy. Um, but very importantly, uh,

3:50

we wanted to make sure we placed a biopsy clip because again,

3:53

we wanna make sure that, that,

3:54

that ultrasound finding is truly a correlate for the mammographic

3:58

architectural distortion. So here's our biopsy clip again,

4:03

in that upper inner right breast. Um, I'm just gonna show the CC view,

4:07

'cause I think that's where we can see the finding easiest.

4:10

So here's our biopsy clip,

4:12

and that was where the distortion was on our initial screening mammogram.

4:14

And so we, that clip was well positioned,

4:17

it was po well positioned in the M l O view also.

4:20

So we feel confident that the sonographic finding is truly a correlate for

4:25

the mammographic finding. Um,

4:27

the pathology for this was an invasive ductal carcinoma,

4:30

histologic grade two of three with associated D C I S.