Get a Group Membership for your Organization. Free Trial
Pricing
Free TrialLogin

Breast MRI Case 12

HIDE
PrevNext

0:00

Let's go to case 12.

0:04

And I'm zoomed up on the left breast.

0:07

But what I want to show you in this

0:09

patient before I show you her MRI, is her mammogram.

0:12

So this is a woman with very small, dense breasts.

0:17

The scar that you you see here is

0:20

from, the scar marker, is from a benign prior biopsy.

0:23

She was called back from screening because of this group here of fairly amorphous

0:29

calcifications, which was very posterolateral in that right breast.

0:34

But they were new. There's some other little scattered ones

0:36

that were not felt to be anything too much and there were no palpable masses.

0:40

So she went to stereotactic biopsy of this posterior group from a lateral approach

0:48

and they successfully got the calcifications.

0:50

It came back as DCIS.

0:53

And then she went on to...

0:57

I'm sorry. It came back as both DCIS and

0:59

invasive ductal carcinoma, which people were a bit surprised about.

1:03

And she then went on to have this MRI of her left breast here.

1:07

And what I'm showing you on the left is the gadolinium-enhanced first phase.

1:13

What I'm showing you on the right is the subtraction image.

1:17

And we're just going to focus on one

1:20

little area here and that's this area within the pectoral muscle here.

1:29

Can you see that little area here?

1:31

She also had a ton more enhancement in her

1:34

breast and we were anticipating from the mammogram.

1:36

And she did turn out to have

1:40

very extensive multicentric invasive ductal carcinoma.

1:45

You can just see how much she's got there throughout this breast.

1:49

But she had this one area within the pectoral muscle.

1:53

I'm going to show you on the...

1:56

I have two other images here to show it.

1:59

One is the delayed gadolinium.

2:05

So this is slightly later into the sequence.

2:19

Trying to get that over. Hang on.

2:21

It suddenly not panning on me.

2:25

Now, you can see it here.

2:26

Here's this little area.

2:35

I'm going to show you that on the sagittal

2:36

with any luck.

2:40

Here it is on the sagittal.

2:47

And then I have a T2 of the same area.

2:57

And here is on the T2.

3:01

I can zoom up on that a bit if I can get it to stop wobbling on me.

3:15

So, let's put on the quiz questions for this.

3:24

Zoom on that area.

3:30

All right. So we've got quite a range of people, but a significant number did go

3:34

for post biopsy changes, which is the correct answer.

3:36

So what happened in this patient,

3:38

let me take that zoom off a sec,

3:42

is, what I didn't tell you is,

3:44

as part of her path report, it did say normal pectoral muscle.

3:49

So the stereo came in from the lateral aspect.

3:52

Do you remember how posterior those calcifications were?

3:56

And you see they're directly overlying pectoralis.

3:58

And in a lady with a small breast, it's difficult to not get into pectoralis.

4:02

So, you can see that this is high on T2, although it did have some enhancement.

4:07

It directly follows the track of where the biopsy occurred.

4:12

She had nothing else to suggest pectoral

4:14

invasion and she had no pectoral involvement at the time of her mastectomy.

4:20

Now pectoral invasion, although it definitely should be looked

4:25

for and it should be commented on in the path reports,

4:29

and you should say that in this particular case,

4:33

the tumor, once we decided about this, abuts pectoralis,

4:38

but does not invade it.

4:39

Or you should say, if it invades it,

4:41

but pectoral invasion is nonexclusion

4:43

to surgery because they can remove some or all of the pectoralis muscle, if necessary,

4:48

with a radical mastectomy.

4:50

Chest wall invasion, it's got to be through pectoralis and into the chest wall.

4:55

So that's a different condition altogether.

Report

Faculty

Petra J Lewis, MBBS

Professor of Radiology and OBGYN

Dartmouth-Hitchcock Medical Center & Geisel School of Medicine at Dartmouth

Tags

MRI

Implants

Breast

© 2024 MRI Online. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy