0:01

Okay, next case. So 48 year old female presenting for

0:04

screening.

0:09

So this is her CC view her mllo

0:12

view. I'm going to point out that this the

0:15

tech has snuck on a little palpable marker. I'm just

0:20

going to tell you her mammograms normal, but remember she's screening and

0:23

she's presenting with the palpable area.

0:26

So what is your favorite needs to

0:29

be a zero all palpable lesions need to

0:32

have an ultrasound?

0:34

All palpable lesions need to have an ultrasound. So if

0:37

they sneak one on they're like if the tech is doing a screening they're like,

0:40

oh, yeah. I have this area of palpable. They should be calling you and

0:43

letting you know, but if it flips by if you

0:46

see it in their note or you see that palpable marker, you have

0:49

to call them back for an ultrasound. So in

0:52

this case, we you know called her back

0:55

for an ultrasound. We did a spot compression. That'd be

0:58

really don't see anything. We do an ultrasound and

1:01

the area we don't see anything and the byrads there

1:04

is gonna be a birads one. No suspicious finding in

1:07

the area of concern further management should be

1:10

based on clinical assessment.

1:12

And the reason we say that is not because we're trying to cover our

1:15

ass we are but but really there is a real concern

1:18

for malignancies that are not seen on

1:21

Imaging. So if a screener

1:24

has a palpable you must give it a buyer at zero and call the patient back for an

1:27

ultrasound always do an ultrasound and then palpable management

1:30

of palpable lesions with a

1:33

negative mammogram and ultrasound should be Basin clinical

1:36

assessment. Which means

1:38

That if it's suspicious they may require a surgical biopsy the

1:41

rate of cancer with a negative mammogram and

1:44

ultrasound approaches 4 percent. So it's not small and

1:47

these are the cancers that we worry about the ones

1:50

that we're going to miss, you know by our standard Imaging and you

1:54

know, if you send

1:57

them to a surgeon they would decide if they want an MRI or if

2:00

they're going to just do a surgical biopsy based on how it feels we have

2:03

a few cases like that where it was a negative mammogram and ultrasound and

2:06

it did end up being a cancer.