Interactive Transcript
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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.
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