0:01

So I'm going to shift gears here

0:08

This is a tough topic because there's

0:14

And that's because in order to show

0:16

that there is between a zero and 2% chance

0:20

a lot of cases in the study and we just

0:27

But I am going to go over

0:32

of evidence and expert opinion to support

0:37

But this is also really an evolving topic

0:44

years that we'll have larger studies

0:49

what findings we should

0:53

But I think we'll also be moving towards

1:02

often as we can to really limit the number

1:07

due to the cost and the logistics

1:13

But with that being said,

1:15

This is the first finding that...

1:17

There's agreement that fit criteria

1:20

And it is a long kind of a theme

1:23

and this is that oval circumscribed mass.

1:25

So I'm starting off by showing a MIP MRI

1:28

image and I like looking at these MIP

1:34

because it kind of gives a lay of the land

1:39

And right away we see this mass

1:43

at the MIP, we don't know if it's upper or

1:50

We like to use the subtraction view

1:58

So here's our first run subtraction.

2:00

We typically do three post-contrast

2:06

This is the first of those

2:09

post-contrast images and it's

2:13

So the only things that are bright

2:17

there's contrast in them

2:19

And here is this mass

2:23

It's in the upper inner left breast.

2:28

It is homogeneously enhancing,

2:32

it has an oval shape

2:37

And this is very typical

2:43

similar to what we saw

2:45

This is that oval circumscribed mass

2:51

this could be an appropriate BI-RADS 3.

2:53

We do need to check a few other things

2:55

before we can conclude that this

2:59

So first is we want to look at the T2.

3:08

We want there to be a T2.

3:12

We want it to be hyperintense on the T2 series.

3:19

So here is that finding on the T2 and we

3:26

So that is also consistent

3:32

And then we like...

3:33

we want to look at the kinetics

3:34

and make sure that the

3:40

This is a MIP of the kinetics.

3:45

We see that finding here

3:48

That's Type 1 persistent kinetics,

3:52

that's suggestive of a more benign

3:57

So this does fit criteria

4:03

We could do a six-month follow-up MRI.

4:07

But sometimes we'll also recommend,

4:12

we'll recommend that we do a second

4:18

And if we can see the finding

4:19

on ultrasound, then we can follow

4:23

And that's going to be a lot more

4:25

comfortable for the patient, a lot less

4:31

It's also helpful because we have much

4:33

larger data to support the use

4:37

So if the finding meets all of those

4:40

we feel very comfortable

4:45

an ultrasound correlate, if we can't see

4:49

ultrasound, then we would do a six-month

4:54

And similar to mammogram and ultrasound,

4:57

we would want to show stability at 6

5:03

with an optional additional

5:08

to show that this finding is not changing.

5:13

we could change the BI-RADS to a BI-RADS 2,

5:16

if we feel that it's changed in a way

5:21

or if it's increasing in size or changing

5:25

we could change to a BI-RADS 4