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BI-RADS 5 – Suspicious Mass in Left Breast, Not Biopsied Yet

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0:01

So our next group of cases was characterized as BI-RADS 5.

0:06

We'll go through these one by one.

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So our first case is a 50 year old woman with an outside mammogram and ultrasound

0:14

showing a suspicious mass in the left breast.

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And this had not yet been biopsied,

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so we didn't have biopsy proof of what this was.

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An MRI was requested for further evaluation.

0:29

I think there was some delay getting the biopsy done.

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So in the meantime, they did an MRI.

0:34

So here's her MRI, and we'll start with the MIP.

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And the MIP image shows moderate background enhancement,

0:44

which is really characterized by scattered foci of enhancement.

0:48

These sort of similar appearing foci bilaterally.

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And then there's an enhancing mass here

0:54

in the left posterior breast, kind of suspicious looking.

1:00

So we will go and take a look at some of these other sequences.

1:05

So I'm just going to pull in our usual

1:07

friends, the T1-weighted non-fat saturated sequence and the first post contrast subs,

1:15

and just take a look at this.

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So if we start from the top, we can see that there's a very large lymph

1:24

node in the left axilla, which is abnormal.

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And then as we scroll down, we get into this mass,

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that's homogeneously enhancing, irregular, and that is suspicious.

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So that will need a biopsy.

1:45

This patient had had previous surgery on the right side.

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So you can see that over here, sort of distortion,

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but without enhancement.

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Just going down through her breast tissue.

2:01

So there are some other areas of enhancement.

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There's sort of an elongated oval mass here and there's some linear non mass

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enhancement here on the left side, really quite discreet from the rest

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of the tissue.

2:30

And then back into that mass again.

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Everything else looks like foci.

2:36

So, I think the first step

2:41

is going to be to recommend a second look ultrasound and biopsy of the abnormal

2:49

looking lymph node and the mass in the left upper outer posterior breast.

2:58

And then furthermore, one could consider

3:03

biopsy of this linear non mass, which is quite a distance away,

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and then consider evaluation of this oval mass in the right breast.

3:15

And if I remember correctly, the oval mass was stable mammographically

3:21

for several years, but this hadn't been seen before.

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So the linear non mass was biopsied using MRI guidance and that was benign.

3:31

So the patient was able to have treatment

3:34

for this area, which was a cancer, diagnosed by ultrasound-guided biopsy.

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And the lymph node did demonstrate metastatic disease.

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And our other sequences basically show similar findings.

3:52

These are our source images.

3:56

Sometimes the additional imaging gives you a little bit more information.

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And the second and third post contrast series, we're usually, you know,

4:06

using them for sort of confirmation and for kinetic information.

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But our best source of information is

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usually going to be this first post contrast sequence and in comparison

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to the precontrast, which essentially gives you the subtraction images.

4:26

Okay.

4:27

And that's pre and post contrast imaging of that mass.

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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