0:00

And this is a 63 year old female

0:03

presenting for diagnostic mammogram after being recalled from a screening

0:09

mammogram. Interestingly, the screening mammogram was performed three years

0:15

prior, and she was just now returning for diagnostic mammogram. This would

0:21

be well outside of the recommendations showing up for a diagnostic mammogram

0:25

at such a late date. However, we can still do the exam and

0:29

do the interpretation. So first looking at the standard screening views

0:34

that we get, CC and MLO projections, we see this exam has good

0:38

image quality. And right away we can see there's a large area of calcifications

0:44

in the upper outer left breast. Look a little bit closer.

0:50

We can see that the calcifications that are demonstrated have a variable

0:55

appearance. Some of them are really small. Some of them are a little

1:00

bit larger in size. Some of them are potentially showing

1:05

a pattern that shows maybe some linear forms associated with them.

1:11

The same imaging findings are seen on the MLO view with a large

1:15

area of calcifications with at least some that would be considered fine

1:20

theomorphic and possibly some such as these that would be considered fine

1:24

linear branching. Now you notice that she also has a biopsy clip from

1:29

her previous biopsy that was benign. But anytime we see calcifications anywhere,

1:34

we want to work us up further with

1:37

dedicated magnified mammographic views. And we can see that the resolution

1:42

of the magnified mammographic views is much better than

1:47

the tomosynthesis full field screening exams. And the reason I say this

1:49

is that we can see a lot more calcifications in this area.

1:53

And we can get a much better sense of some of those branching

1:55

forms. Some of them are here, for example.

1:58

Maybe here. Maybe some of this here. Perhaps this one here.

2:04

I mean, this is also true on the ML view as well.

2:10

So in the end, I would describe this as a segmental area of

2:16

fine theomorphic and fine linear branching calcifications. I would recommend

2:20

stereotactic guided biopsy for these calcifications. Given the large extent,

2:25

you might consider two site stereotactic guided biopsy, defining posterior

2:30

and anterior exemptive disease, for example, and see what you get.

2:34

In this case, this was a classic invasive ductal carcinoma,

2:41

which is not surprising given the extent of calcifications and the fine

2:44

linear branching forms. For the diagnostic exam, I would give that an overall

2:49

BI RADS 4C category because of the fine linear branching components.

2:55

And just for completeness, I'm going to show you the left CC exam

3:02

from the screening exam three years prior. And these were those same calcifications

3:06

called back at that time. And you can see the extent of calcifications is

3:11

much less at that point. And so this is basically the cancer left

3:15

unchecked and growing for three years while waiting for the diagnostic exam

3:20

or while deciding to come in for the diagnostic exam. Anyway, she went

3:25

on to further treatment after proving her malignancy.