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BI-RADS 5 – Left Breast Cancer, MRI Shows Right Cancer

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Our next case is a 70 year old woman

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who had a remote history of left breast cancer

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and recent diagnosis of left invasive lobular carcinoma.

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And we did an MRI to evaluate extent of disease.

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I can recall that she was being seen for routine follow-up

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and she had a left lumpectomy with a lot of distortion

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at the lumpectomy site.

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And it just seemed like the distortion was more

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significant on the left than it had been before.

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And the right side, we thought was normal.

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She had a lot of dense tissue in the lateral breast

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but nothing new.

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And this was a 2D mammogram by her choice.

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So we recalled her for the apparent,

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increase in distortion in the left breast.

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And then she had a further evaluation with ultrasound that

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showed some very vague mass like areas on ultrasound.

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It was just a little bit difficult to know exactly where

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the cancers were, how many there were.

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It seemed like there was more than one.

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I think she had two biopsies showing invasive lobular carcinoma,

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so that we thought the MRI would be very helpful.

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Just going to show you her MIP,

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and this is her left breast, which is smaller than the

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right because she's had a prior fairly large lumpectomy,

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and this shows multiple masses in the lateral left breast.

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So,

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you know, that's the area that we were interested in.

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We thought her right breast was normal,

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mammographically,

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but

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surprisingly, there's a large enhancing mass.

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They are in the lateral right breast.

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So we're going to investigate this a little further.

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I'm going to show our T1-weighted images

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and our post contrast images.

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And just looking at that area where we

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were interested in the left breast,

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there's a lot of non mass enhancement with

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kind of smaller irregular masses and this,

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most of this had already been biopsied.

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It was a little bit more extensive than

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we thought, and of a larger area.

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And she had already been treated previously with

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lumpectomy and radiation to this breast.

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But several masses, they are on the left.

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And then, the surprise finding was this quite large mass.

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Almost 3 cm mass in the right breast

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that was hiding in this area of extreme fibroglandular tissue,

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like her overall pattern is heterogeneous, but she's,

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she's pretty glandular right in this area.

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And on her 2D mammogram,

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that was completely dense. And of course,

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2D we had no thin slices to go through, but we,

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totally couldn't see this large mass that was sitting right there.

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So,

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we were

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very worried about that mass on the right side.

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So, we did a second look ultrasound.

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That's what had been recommended.

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And a second look ultrasound was performed,

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showed a mass and it was biopsied,

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and it was an invasive carcinoma.

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So,

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this patient elected to have bilateral

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mastectomy in light of these findings.

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And I have to credit MRI here because the mammography

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did not find this mass on the right side, and it actually

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is quite significant,

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biologically significant mass.

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And, you know, we also looked at T1-weighted source images,

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pre and post contrast,

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and it just shows you that that mass is sitting here in a sea of

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fibroglandular tissue, so easy to, easy to hide.

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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