56-year-old woman for follow up of probably benign clustered microcysts in right breast
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Our next patient is a 56-year-old
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woman for follow-up of probably benign
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clustered microcysts in the right breast.
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So, here's our patient CC and MLO views.
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I think we were at the one-year follow-up
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point, and that's why we did a bilateral exam.
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And we were going on to ultrasound
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to evaluate the clustered microcysts
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that had been seen previously.
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And as we scrolled through
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everything, the left side looked fine.
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The finding of interest was on the right side.
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What we were interested in
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was that we really couldn't see the clustered
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microcysts, but what we did notice was an
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asymmetric density in the lateral right breast.
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So as we scroll through her images,
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it was this density, maybe even a
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little distorted, that caught our eye.
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So we had that area, and we thought
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that she had had an asymmetry
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before, but it maybe looked worse.
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And here it is on this view, just
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going through the tomosynthesis images.
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There definitely seems to be
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something a little asymmetric there.
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So we did some extra work on that area,
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because that had not been on the radar before.
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So we did a spot compression view
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with tomosynthesis, and there's,
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you know, definitely some density there.
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And then a spot compression MLO view.
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Still seeing something there.
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It doesn't really fade or
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go away as we're imaging.
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So when we went to ultrasound, we're not only
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looking for the clustered microcysts that we
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were supposed to be following, but also this
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area of concern in the upper outer right breast.
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So here's our little clustered cysts that
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we're not very worried about; very small area.
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And then we had this
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hypoechoic mass with posterior acoustic
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shadowing, a lot of internal blood flow.
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And this is at the 10 o'clock position,
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11 centimeters from the nipple.
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So here it is in radial and antiradial.
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And it probably isn't quite as
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big as what's measured here.
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It's probably only this big,
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but has a lot of posterior shadowing.
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So this is really a very suspicious finding.
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The clustered microcysts were not suspicious,
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but this new area is very suspicious.
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So we recommended biopsy for this,
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and this was an invasive ductal carcinoma.
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So I think it's important to keep in mind
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that even though you're following up some
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probably benign area that isn't worrisome,
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you have to always be on the lookout for
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cancer is developing in that area or some
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other part of that breast or the other breast.
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So, even though it seems like an easy task to
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follow up the probably benign finding, be on
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the watch for either the lesion growing or
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changing or some other lesion requiring biopsy.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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