0:00

Here's, uh, the next case. This is a, this is a tricky case. This was a, um,

0:04

showing the left, this is actually an X C C L view, so an exaggerated CCC view,

0:08

so you can see the outer breast well and, um, an MLO view.

0:13

Um, so this patient has lots of, of surgical eclipsing from a prior lumpectomy,

0:18

but she was noted to have a new, um,

0:21

a new focal asymmetry at the lumpectomy site,

0:24

and I think it's better seen on our spot views.

0:27

So I'm just gonna go to the spot views here,

0:29

but you can see there's a small mass or focal asymmetry here in the upper

0:35

outer left breast. Very posterior depth. Um,

0:38

this is new compared to prior exams.

0:39

The patient had had this lumpectomy many years ago, uh,

0:44

and so it was considered suspicious. It's a ti a very, very small finding,

0:47

but regardless, we still recommended doing an ultrasound. Oh,

0:50

lemme just go ahead and show the, or tomosynthesis lysis here.

0:54

So here is on the, on that X C C L view,

0:59

you can see this very small

1:04

mass.

1:08

And here's our M l O view,

1:16

and we can see that mass on the m l o view also. And again,

1:20

this was new compared to her prior exam, so was considered suspicious.

1:27

We did an ultrasound. Um,

1:29

in this one we do not able to find a sonographic correlate for that finding.

1:34

So a new, a new finding at a lumpectomy site. Um, it's considered suspicious.

1:39

We wanna make sure we biopsy.

1:40

And so this is another great example of where we can use, um,

1:43

tomosynthesis guided biopsy. So here is our, um,

1:47

our scout image of our tomos and thesys guided biopsy. And this was challenging.

1:50

It was like very posterior in the breast. Um,

1:55

and it took a while, you know, to get, to find the area. But, um,

2:02

we, um, we found this asymmetry here. Um,

2:06

and so this was what targeted for biopsy. So we did the biopsy and like I have,

2:10

um, repeatedly said, we placed a clip to, uh, to, uh,

2:15

mark where it was that we took the biopsy from.

2:17

So we did that post clip mammogram, and we saw the biopsy clip.

2:21

But as we looked at the, the case after doing it,

2:23

we saw that she still had that small mass in the upper outer,

2:28

outer breast, further posterior from where we had biopsied. So we,

2:32

we spoke with the patient and she actually was willing to just have another

2:35

biopsy done that day. So she came back to the, um, biopsy table.

2:40

We did another gout image here.

2:45

And here's my, here's the biopsy clip from the first biopsy.

2:50

And at the very, very back of the screen, we saw this other mass here.

2:58

So it

2:58

Was, it was, it was close. But if you remember from our first biopsy,

3:01

this was at the very back of our, of our biopsy window.

3:03

It's a small window that we're able to look at, um, where we had biopsied.

3:09

Uh, so with this, this other area was not in our initial biopsy window.

3:13

We then biopsied the second area. Um,

3:16

on that same day we put another biopsy clip in,

3:19

and that was in the correct area on her post clip mammogram.

3:23

We got our pathology back a few days later.

3:25

That first biopsy site was benign breast tissue with associated rare micro

3:30

calcification. That second spot when we had her come back and, uh,

3:35

biopsy the initially, uh,

3:37

describes suspicious finding represented in invasive ductal carcinoma,

3:41

moderately differentiated with mu mucinous features measuring five millimeters,

3:45

and there was also associated microcalcifications. Um, so I think, um,

3:49

there's just a great example of why we wanna make sure we're,

3:51

we're looking at that post clip mammogram image and, um, making sure that the,

3:56

the finding, um, whichever modality is being biopsied with, uh,

4:00

really is, uh, matches up with our initial mammographic finding.