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Okay case number four 76 year

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old female presents with a palpable area of concern in her

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right breast.

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So by definition this should be a diagnostic study.

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She's presenting with a with a complaint.

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So you can see she's got that

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we use this triangular marker to indicate that this is

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a palpable area of concern.

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So you can see in her right up or outer brush. She has

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an irregular spiculated. This is a true Mass. It has

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convex borders.

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Um, so what do you do next?

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Here we would get some spot compressions. And

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actually you see now that

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the math persists you can see some calcifications associated

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with it. You also see this more

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circumscribed appearing math.

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Just posterior to it. So next step.

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Let me give you a minute to think about what we're going to do. Obviously,

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we're leading down the road of

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biopsy. But before we even do that, we're going to go to ultrasound.

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So you can see in the right breast a twelve o'clock four centimeters

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in the nipple. There isn't a regular hypochoic mask

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the corresponds to the mammographic finding at 1.9 centimeters.

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She has another massive right

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behind it about 1.3 centimeters

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behind it. So you're next

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step.

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We always look at the lymph nodes here at

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Cooper not all places

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do that. But our surgeons like it so you can

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see that it's an asymmetrically thickened cortex.

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So by Reds what

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virus would this be? You know four or

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five is appropriate. And in this

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case, actually the the one behind it was actually I

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think it was a cyst. It ended up aspirating but

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the main dominant Mass was invases. That's all

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the most common type of cancer and that was metastatic lymph

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node. It's always going to tell you the ER

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PR and her two positivity. This

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is really important. Each patient's

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cancer is treated completely differently based on

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the ER PR and her two positive. So always

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want to look at that too.

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So like I said stock compression views, it's when

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you apply more pressure on the on the

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breast to make something either go away or see

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a bit better see the borders a little bit better. It's used

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for asymmetries and masses it's going to decrease the

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amount of super input imposition of to decrease superimposed

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tissue and allows you to evaluate the

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margins better.

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A smaller paddle will give you more focal compression.

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So if you have something we

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really want to go away use a small paddle a larger

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paddle provides a little bit less compression, but it gives you a bigger

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field of view. So it's going

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to give you better anatomic landmarks, which sometimes

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you need.

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So if a math persist on the spot compression, what's going

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to be the next step?

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So you're always going to want to use breath ultrasound. So

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we typically use a high frequency transducer. We

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have actually use 12 or 18 here megahertz. You're

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always going to want to in annotate the

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images as clock positions and different

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distance from the nipple. You can either do rad

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and a Rad or sad and

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trans depending on how your institution

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does it. I like

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I prefer it red and Arab like the wheel rad is

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along the spokes of a wheel and Arad is anti-parallel to

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those.

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And this is something that

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we've been asked on the boards in the past. So I

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put this the high yield fact.

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Compression views you want to leave the collimator open

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giving you a larger field of view and helping to ensure that

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you've included the area of Interest.