0:00

In this case, we have a 44 year old female presenting with a

0:04

palpable abnormality in the left axillary tail or left axilla. We're looking

0:12

for further evaluation. In our institution, we get,

0:16

since it's this particular patient, this was her baseline exam, so we get

0:20

the standard screening views, CC and MLO projections. Again, looking at

0:25

image quality, you see that this is a pretty good exam.

0:29

Some asymmetry in breast size, left side being a little bit larger than

0:33

left. This pec is a little bit concave,

0:35

but overall, pretty decent exam. As we move on to getting,

0:41

just focusing on the left hand side, I'm going to pull down our

0:44

left CC, our left MLO. Now the first thing that you might notice

0:49

is that there's no marker on the left CC to know where the

0:54

palpable finding is. This is likely related to the fact that this area

0:58

just cannot be imaged if it's high up in the axillary tail or

1:01

even in the axilla itself. The technologist probably wasn't able to get

1:04

that in. Occasionally, we may be able to see that marker on an XCCL view

1:10

if it's far enough or just lateral enough and we can barely get

1:13

it on there, but in this case, that didn't work.

1:16

So we'll focus just on the MLO view for this case.

1:20

You can see our palpable BB marker here, high up in the left breast. And

1:26

underlying on this SM view, we can see a little bit of kind of wispy, what

1:30

looks like normal glandular tissue at this point. At our institution,

1:34

we got a spot compression view and our technologist was able to do

1:37

that view high up in this left breast.

1:41

As I switch over to the DBT slices,

1:45

we'll start in the lateral aspect and scroll medially. We'll stop just momentarily

1:51

on the palpable BB marker and underline, we can see some wispy fiber glandular

1:57

tissue, but no definite underlying mass. Now, of course, we'll scroll through

2:00

the whole imaging set just to make sure that we don't see anything.

2:04

And we'll also make sure we look sort of deeper into the tissue.

2:08

We see the pectoralis muscle here and some normal looking lymph nodes,

2:11

but nothing in particular stands out in this case. Now based on this,

2:17

I think most practices and most people would probably recommend an ultrasound

2:21

at this point just to verify the fact that this is normal fiber glandular

2:24

tissue, nothing to worry about. There are some people that would argue,

2:27

though, however, that this mammographic finding that is basically

2:31

no tissue or phenomenally fat, that you could potentially forego ultrasound

2:36

in this case and just send the patient back for routine screening.

2:40

You could also potentially ask this patient if this area, what this area

2:45

feels like to her. She may say, well, I just feel a little

2:48

bit thickened. I don't feel any particular mass. Those would all be

2:51

markers that this is just normal fiber glandular tissue. And of course,

2:56

one other potentially good question is to ask if this area became more

3:01

tender or larger in size during pregnancy, if the patient had a history

3:05

of pregnancy, because this glandular tissue is also hormonally sensitive

3:10

and of course during pregnancy will also increase in size and patients may

3:13

endorse that history further proving that this is just normal fiber glandular

3:17

tissue.