0:00

Next we have a 40 year old female with a

0:03

strong family history of breast cancer presenting for a

0:06

screening Mr.

0:07

This is the only image.

0:12

I will go to the question.

0:16

And a hundred percent of people correctly answered lineal

0:19

linear ductal enhancement. So let's

0:23

think there's a second question. Let's do the second

0:26

question and then we will go back to the images and we will

0:29

talk about it.

0:32

All right, and people questions see people answer

0:35

details and IDC and the correct answers DCS and

0:38

we'll go back and discuss it as they said in a

0:41

minute, but what's the next most appropriate step given

0:44

the findings?

0:46

And Mr. Guided biopsy 20% of you answered correctly

0:49

is emerged biopsies and let's go back and

0:54

look at the images. So what you're seeing here is you're seeing a duct

0:57

emanating from the nipple. It is definitely linear enhancement

1:00

in a ductile distribution. And then at the

1:03

end you're seeing some non-math enhancement that signifies probably

1:06

since some more abnormality in

1:09

the lobule. So you're seeing a lobulous like a

1:12

whole segment segmental ductal enhancement.

1:15

um, this has happened mnemonic for dcis now the

1:18

decision on

1:20

what's biopsy

1:22

The decision on what to biopsy is done

1:25

based on what modality you see it on the best.

1:27

So we see the ductile enhancement on MRI.

1:31

So we would biopsy it on MRI.

1:34

You know it the Assumption here is they've

1:37

already had a mammogram and an ultrasound that were normal for them

1:40

to go undergo this MRI or a mammogram. That

1:43

was normal. I should say ductile and non-math enhancement.

1:46

We don't do a second look ultrasound for second. Look ultrasound

1:49

after Mr. Are really best for math enhancement or

1:52

other abnormalities like abnormal lymphos, but when you come

1:55

to non-math inductile enhancement, it's not very likely

1:58

that you're going to see something on ultrasound. So we tend to go

2:01

straight to Mr. Guided biopsy on that.

2:03

So the differential for linear ductile handsome

2:06

are on MRI is decis papilloma and

2:09

fibrocystic change. So just because it's

2:12

linear ductile enhancement doesn't necessarily mean it's dcis,

2:15

but it's the most it's one of the things in the

2:18

differential it was the only choice from this differential in our question,

2:21

but you can also see papillomas or papillomatosis look

2:24

like this and you can even see not quite this

2:27

This image probably would never be fibrocystic change.

2:30

It could be papillomatosis, but sometimes fibrosis to change you

2:33

can see some linear ductal type enhancement as

2:36

well.