Interactive Transcript
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So our next case is a 53 year old woman with a recent
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diagnosis of left breast cancer with a metastatic lymph node.
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And the treatment team is considering neoadjuvant
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chemotherapy and we've been asked
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to assess the extent of disease.
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So here's our MIP for this patient and we can see this
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large enhancing heterogeneous mass in the posterior left
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breast and I think we can see part
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of a lymph node here as well.
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There's not that much else going on in the left breast
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or the right breast. Maybe a few foci here.
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And we'll take a closer look.
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So we'll pull in our T1 non-fat sat,
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and our first subtraction series.
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And just to show you,
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we can see that large lymph node in the axilla
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here on the T1 and post contrast series.
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And there's a second smaller,
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but still abnormal lymph node posteriorly,
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and then as we scroll down, we start to get into this large
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heterogeneous mass and there's a susceptibility artifact
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from a biopsy clip and it's in the center of the mass.
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And she does have some background parenchymal enhancement, which is moderate.
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There's not very much else going on, I think.
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These sequences are not exactly lining up,
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but
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this little mass here, laterally, on the left,
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was evaluated with ultrasound and I
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believe represented a lymph node,
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an intramammary lymph node.
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So just looking at source images.
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Again, pre contrast on the left, post contrast on the right.
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Really just seeing a few little foci,
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but nothing very suspicious and nothing worrisome
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on the other side either, so that's good.
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and then,
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We looked at internal mammary lymph nodes here.
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Just ran through that and there was nothing suspicious there.
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So really, her abnormal lymph node and known
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cancer have already been biopsied.
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This is a known cancer.
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There was no other suspicious finding in either breast
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so that we consider this to be a BI-RADS 6,
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known biopsy-proven malignancy.
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And the treatment team decided that the patient should have
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a neoadjuvant chemotherapy.
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So,
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in keeping with guidelines.
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We often will do an MRI after the neoadjuvant chemotherapy
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so I'm going to try and pull that up here and next.
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So this is post chemotherapy for this patient.
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Here on the right side, pre chemotherapy on the left.
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You can see that
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she has some axillary lymph nodes.
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But they're all much smaller.
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I think this is the one that had previously been biopsied.
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Considerably smaller, although still a little bit prominent.
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And then in the left lateral breast,
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we can see this kind of line of non mass enhancement
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with a susceptibility artifact from the biopsy clip, centrally.
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But that's all that's left of her
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large enhancing mass that we saw previously.
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So, not very much.
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And she went on to have a successful lumpectomy
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and axillary nodes surgery and is doing well.
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So that's another case of BI-RADS 6.
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So we would code this as BI-RADS 6 for
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the pre neoadjuvant chemotherapy
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situation and also in the post neoadjuvant chemotherapy
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situation, even though her mass has gone down to a very
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small size or there's no evidence left of her mass,
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we would still code this as BI-RADS 6, unless
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she's had her definitive surgery.
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So, BI-RADS 6, pre and post neoadjuvant chemotherapy.
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