0:00

Number case number eight the only history

0:03

you have is screening.

0:09

We'll go the next image.

0:14

Okay, I'll go

0:17

on to the question. We can come back to the images.

0:24

Please let me go back and slide. I think we'll stick.

0:28

with the ultrasound

0:31

and then I'll flip back to the mammogram for those who are

0:34

interested to see that as well.

0:36

Excellent. Everyone got it, invasive technical

0:39

person. I'm with us static disease the excella and

0:42

it would be virus 5.

0:45

me

0:46

and so on here we have this.

0:50

Asymmetry in the upper outer in the

0:53

upper outer right breast with multiple calcifications. So

0:56

yes, there is probably a component of gcis in it. But you

0:59

know, the important thing here is this is invasive disease and then

1:02

harder to tell you can't really see the

1:05

axola the nodes that well on the mammogram, but

1:08

when they have the ultrasound we see that the regular Mass

1:11

with a feeding vessel hypocope with

1:14

posterior shadowing.

1:16

And then when we look at the axilla, we see

1:19

this lymph node that has a hypocrine cortex,

1:22

but we see that the cortex is thickened. So

1:25

the normal critical thickness is three millimeters and it's up

1:28

to eight here and it's vocally you can see here. It's probably about

1:31

normal and so focal thickening and here you

1:34

can see characteristic rat bites kind of where the cortex

1:37

is going into the highlands the highlands the

1:40

epigenic area. The hypocratic area is the cortex you

1:43

can kind of be spoke a little it looks like someone's taking a bite

1:46

out of the Highland and this is very concerning for metastatic disease

1:49

versus if it was uniformly thickens,

1:52

you think more something systemic reactive thing like

1:55

that. So very good and of course this, you

1:58

know is a cancer right? We don't even have to question that