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Thank you so much. And thank you to everyone for logging in

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today. Thank you for that introduction. Today.

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I'm going to be talking I'm gonna be showing some

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breast Imaging cases with the emphasis

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on appropriate workup and management. I hope

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you find it helpful. So the goals of the lecture

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are to review the appropriate workup of screening and diagnostic findings

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to emphasize important management issues

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and discuss special circumstances and breast Imaging

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and Justice as a disclaimer. I hope I

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don't get interrupted but yourself a clinic right now, so I

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might get interrupted, but I hope not.

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So before we get started, I'm going to give you

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guys some pre-test questions to test your knowledge before

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we even get started.

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A patient presents with a palpable area of concern diagnostic

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mammogram is negative. What is

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the next appropriate step?

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And I just want you to answer this in your head. You don't

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actually need to put up the polling feature because I

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didn't give the answer yet. But we're going to come to this later in

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the talk. So think about this what you want to

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do for this palpable with a negative mammogram reassure ultrasound

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MRI or surgical consultation.

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And patient had a biopsy which

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revealed a typical ductal hyperplasia. What is your recommendation? You

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followed up in six months with a birads three

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say it's benign follow up in one year surgical excision

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with a needle look or surgical excision with stereotactic biopsy.

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So you can take a minute and answer that in your head.

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We will learn the answer if you don't know it already.

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And what is a difference between multifocal and

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multi-centric breast cancer? So multifocal involves

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more than one quadrant multi-centric involves

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one quadrant be multicentric involved

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more than one quadrant multifocal involved one quadrant, you

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know gets a little confusing with this multifocal multi-centric.

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So we're going to talk about you know, which one is which going

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forward?

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All right. So 70 year old female presenting with a palpable

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area of concern in her right upper outer breast.

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This is her Baseline study.

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And when you're reading a case in mammo, it's really important to

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just it to determine whether

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it's a screening or diagnostic study. So, you know

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for starters a screening study is an eighth symptomatic patient. So

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by definition this should be a diagnostic study

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if it's not yet to call them back but palpable should

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be a diagnostic study. So already we kind

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of are thinking it's a Diagnostics study. So keep that in mind when you're

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giving your buy rides because it does make a difference.

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So these are

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this is her CC view. She has a

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palpable in her right upper outer breast and certainly

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you can see in a regular stipulated mass and

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her right upper outer quadrant, but take

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a minute and just see if you see

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anything else particularly in the other breast.

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Satisfaction of search is a big problem or diagnostic

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dilemma in breast Imaging. So

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even once once people find the cancer, they're natural

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tendency is to stop and and stop

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looking. But if you look you'll notice

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that there is actually a foot. There's two focal asymmetries in

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the left breast. So let me

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What is that not coming up? So she's got one here,

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which is in the left.

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Upper inner breath and then also one in the

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left upper outer breast.

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Which you know you could get I would

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recommend getting spot compression for those to see

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if it persists.

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And then we would proceed to ultrasound for

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both sides. So, you know when you're looking at the left left

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upper inner so I always want you to think about what quadrant

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we're in in terms of clock position because that becomes

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important when you're looking at an ultrasound and make sure you find a correlate.

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And so in the right breast, this is

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her palpable area of concern. You can see a large.

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Irregular hypoechoic math corresponding to

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the area of palpable concern. I don't have calibers on here,

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but it certainly over two centimeters and then always,

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you know, we it really is

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institutional dependent. But at our institution if you see something that's

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highly suspicious for malignancy. We always look in the axilla to

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see if there's any abnormal nodes. And in

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the last remember we said that there was something in the left upper outer

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quadrant, so

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I'm sorry, there was something in the left upper inner quadrants. This is left upper

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inner so there's a regular mass of 10 and then

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there was a second one at two eight. So these

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are different quadrants of the left breast. So

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I want you

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to think is that multi-centric or multifocal on the left?

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And what by Reds would you give so you want

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to give that a buy red five? So we're

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gonna take a minute to talk about multi-centric multifocal cancers.

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So multicentric is more than one quadrant. So

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on the left when it's ten o'clock, so it's left upper inner

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and then two o'clock which is left upper out or that would be multi-centric.

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Multifocal is when you have two areas

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of disease in one quadrant or a fairly close

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together.

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And synchronous so she also had this so she

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had synchronous cancer. So two term two tumors diagnosed

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within six months of each other or metacranous

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means two tumors diagnose

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greater than six months apart. So it's

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not uncommon to find something in the other breasts where you

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know in the other quadrant, that's why we get staging memorized to see,

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you know, if you didn't really find that on the screening mammogram or

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the diagnostic mammogram, you would certainly find it are

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the staging work up with an MRI.