Interactive Transcript
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So, our next patient is a 50-year-old
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woman with a large left lymph
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node seen on screening mammogram.
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So, compared to prior mammograms, this
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lymph node became larger over time, and
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she was recalled for axillary ultrasound.
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She subsequently had a biopsy that showed
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metastatic breast carcinoma, and her
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mammography was negative, and MRI was
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performed to find the primary tumor.
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And this is the patient's MIP.
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A lot of blood vessels, which are
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kind of obscuring some of the tissue.
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So we're just going to
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look at images separately.
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And here's T1-weighted images and
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post-contrast subtraction images.
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And we can see up here in the left axilla,
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there's a big lymph node here with a
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susceptibility artifact from a biopsy clip.
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So that was the biopsy lymph node
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showing metastatic carcinoma.
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There's a second smaller, but still abnormal
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lymph node anterior and inferior to this.
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So she does not have
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very dense tissue.
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She has scattered fibroglandular tissue.
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And one would think that with this
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kind of tissue, we'd really be able
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to see breast cancer pretty easily,
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but that wasn't the case. Her mammogram
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looked normal and similar to prior exams.
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So, we basically went through very
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carefully, looking at everything.
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She has a few foci of enhancement,
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but what we did see was
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one spot that was a little bit
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more prominent on the left side.
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And it's right here.
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So left anterior breast, small mass. I think
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it was eight by four millimeters. You know,
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really one that you could pass by
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pretty quickly, but that stood out to us.
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And I think even going back, looking at
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her MRI, even though there are lots of
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blood vessels, you can still see that
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little spot maybe stands out a little bit.
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And we looked at her pre- and post-images,
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and there's that little mass again.
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And we recommended that for biopsy
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because it was the only thing that
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really stood out as being different.
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And that was an invasive ductal carcinoma.
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So that was the source of
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her metastatic lymph node.
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And again, this was coded as a BI-RADS 4.
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