Interactive Transcript
0:00
So our next case is a 42 year old woman
0:03
with a recent diagnosis of right breast cancer, which was initially discovered
0:08
on a baseline screening mammogram as a right retroareolar mass.
0:13
And that mass was biopsied and found to be
0:17
an invasive ductal carcinoma, which was kind of a surprise.
0:22
And she had fairly dense breasts on mammography.
0:27
The size of the tumor was a little bit
0:29
unclear based on the mammogram and ultrasound.
0:32
So MRI was requested for evaluation of extent of disease.
0:38
So here's the patient's MIP,
0:42
which really shows a lot going on here in the right breast.
0:47
So the area behind the nipple that had been biopsied was just this mass.
0:52
But you can see that there's a lot more going on in the right breast.
0:56
There's some non mass enhancement.
0:58
There may be other masses.
0:59
There's a suggestion of a lymph node here in the axilla,
1:05
and she has a fair amount of background parenchymal enhancement as well.
1:09
So we'll go ahead and look at this a little bit more closely.
1:13
We'll pull in our T1 and our post contrast sub,
1:18
and you can see that this patient has a lot of fibroglandular tissue,
1:24
and on a mammogram, that would manifest as breast tissue density.
1:28
So she does have heterogeneously dense to dense breasts on mammography,
1:34
and that was making it difficult to interpret her mammogram.
1:41
But on her MRI, you can see that even in places with denser tissue or more
1:49
fibroglandular tissue, she doesn't really enhance very much.
1:54
But then on the right breast, she has a lot of enhancement.
1:59
So the area that was biopsied was this mass.
2:03
So that's an invasive ductal carcinoma.
2:05
But then she had
2:08
sort of this surprising amount of non mass enhancement in the lateral right breast,
2:16
kind of extending from front to back, and then another mass or masses posteriorly.
2:27
Most of her issue is here in the central
2:30
breast to upper breast, but it does extend lower as well.
2:34
And there are a few other masses
2:35
in the medial breast as well here, anteriorly and posteriorly.
2:44
And she also has multiple large lymph nodes
2:49
in the right axilla that are enhancing, several large lymph nodes.
2:58
So we looked at this with our source images as well, T1,
3:04
pre and post contrast, and you can see the same findings,
3:14
particularly these large axillary lymph nodes.
3:17
So we read this as a BI-RADS 4, because what we wanted to do was biopsy or
3:26
do a second look ultrasound and biopsy of one of those right axillary lymph nodes.
3:31
And there was some discussion before
3:35
reading this, as to whether she would need anything else done in the breast
3:41
on the right. All of this enhancement was suspicious
3:46
on the right kind of BI-RADS 4/5, almost certainly cancer.
3:54
We elected not to do additional biopsies in the right breast because it was felt
3:58
that this would probably be needing to be a mastectomy.
4:01
And we went ahead and did a biopsy, ultrasound guided biopsy of a lymph node
4:09
in the right axilla, and that showed metastatic disease.
4:14
So this was BI-RADS 4.
4:16
And, you know,
4:19
I think in some of these cases, there's a fine line between BI-RADS 4 and 5.
4:23
This is almost certainly going to be a cancer.
4:28
So BI-RADS 4 or 5 would be appropriate here.
© 2024 MRI Online. All Rights Reserved.