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BI-RADS 4 – Right Extensive DCIS, Left Dominant Focus

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Our next case is a 42 year old woman with

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a recent diagnosis of right breast

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ductal carcinoma in situ for preoperative evaluation.

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And I'm going to show you her MIP images.

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And you can see that this woman has a lot of

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background parenchymal enhancement.

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She has segmental non mass enhancement with some

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maybe some masses in the right medial breast,

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and that's the location of her ductal carcinoma in situ.

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We can also see that there's something

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enhancing here in the left anterior lateral breast.

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Focus or small mass.

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So we're going to investigate further.

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I'm going to pull in her T1

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and her

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first

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post contrast subtracted image.

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Just wanted to show you what she has here.

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So this

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this is her ductal carcinoma in situ, here in the medial

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aspect of the right breast.

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All of this segmental

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non mass enhancement.

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You can see that it just sort of continues along that medial side.

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There had been a thought that this was actually a smaller size on

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her pre MRI imaging and possibly because of dense tissue,

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it wasn't possible to see all of this.

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But MRI showed us the extent of disease on the right side and

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it made it very likely that the patient was going to require

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mastectomy to get clean margins,

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and that was indeed what she had elected to do.

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So, our focus then shifts to the other side because we want to be

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sure there isn't anything else that we are...

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should be concerned about, and this

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little enhancing focus or small mass really stands out

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with relation to the rest of the tissue.

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Very bright.

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We're going to look at our STIR sequence

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to see if it's T2 bright.

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And I think it's really hard to tell because her

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breast tissue in that area is also so bright,

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I don't think we can really tell about it.

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And in this setting where the patient has breast cancer on the

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right side, and we're probably going to need

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a mastectomy on the right side,

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it makes sense to do a biopsy of this area on the left.

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And we can do, you know, some further investigation with other

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sequences. This is the pre and post imaging.

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We still see the same thing there and basically we decided to go

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ahead and do a biopsy of this area, and we had

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a result of atypical lobular hyperplasia.

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So in the setting of her cancer on the right side,

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the patient had an excisional biopsy of the left breast atypical

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lobular hyperplasia, with no upgrade at surgery.

Report

Description

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Tags

Women's Health

Neoplastic

MRI

Breast

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