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In this case, we have a 65-year-old female, uh,

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presenting for a diagnostic mammogram, uh, with

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a history of focal pain in the left breast.

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Now, interestingly, um, because it had been

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some time since she had a screening mammogram,

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we did full-field views of both breasts.

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Um, looking at image quality,

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everything looks, uh, adequate.

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Right away, we can see something here in

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the right breast on the CC view, far posterior

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depth, um, and probably the corresponding

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item, the inferior aspect of the right breast,

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far posterior depth, almost near the IMF.

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Now, this patient came, of course, for left breast pain.

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Uh, she subsequently had a workup for that,

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which was negative, but we saw these image,

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these, uh, imaging findings in the right

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breast, and so worked them up further.

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I'll show you some spot compression

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views of the right breast.

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Uh, focusing on an area at the far posterior depth.

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Again, on these spot compression S/M

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views, we see this focal asymmetry.

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It's got some concave margins.

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Um, it looks a little bit irregular shaped.

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Um, and we see the corresponding

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finding here on the MLO view.

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If we scroll through our, uh, DBT slices,

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immediately, we see this, um, the inferior

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most aspect of our DBT stack on the CC view.

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As we scroll through, um, we can see that the

1:32

imaging finding really comes into best resolution.

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The few slices in, meaning that it's somewhat

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close to the skin, but it didn't quite

1:38

meet our criteria of being in the skin.

1:40

Um, it looks pretty irregular.

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Hard to tell exactly what it is.

1:46

Look at it in the MLO view.

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We got a great view here, um,

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really focused right at the IMF.

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Good job, our technologists.

1:54

And as we get to approximately the middle

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or maybe slightly lateral side of the image

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stack, we, uh, this finding comes into view

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and looks certainly irregular and different

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than the rest of the, uh, imaging findings.

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Um, and this would be, um, a very

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good description of a focal asymmetry.

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Now of course, we'd want to look back at prior exams

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and see if that area, um, was there previously.

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Now if I pull in the MLO view from the prior exam,

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um, we can see that perhaps, uh, if we looked

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closely we might see this sort of same area.

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Now this was seen on the CC view

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as well, but just barely.

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Um, and so we can call it a focal asymmetry.

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And in this case we see it's getting

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bigger, uh, on our current exam, and

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therefore is a developing asymmetry.

2:40

This finding went on to ultrasound, um, uh,

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evaluation, which demonstrated a corresponding

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mass, um, which I'll show you briefly.

2:49

Um, and was subsequently biopsied, um, and was

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determined to be invasive, uh, lobular carcinoma.

2:56

Now it's pretty subtle.

2:56

On ultrasound, there's this hypoechoic,

2:59

uh, mass, looks pretty small, little bit

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of shadowing, um, measuring only about

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14 millimeters, uh, in greatest dimension and,

3:10

uh, developing.