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54-year-old woman with palpable lump in left breast

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Our next patient is a 54-year-old woman

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with a palpable lump in the left breast.

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So here are the images for our patient.

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We have CC views bilaterally on the top of the

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screen and MLO views on the bottom of the screen.

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And there's a triangular skin marker in the

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left upper outer breast, and you can see it here.

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You can see this oval mass underlying

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the triangular skin marker.

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So we'll take a look at those images closer up.

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So here's our left CC view and then our

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tomosynthesis images of the left CC view.

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Just scrolling through, we can see that

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triangular skin marker here in the lateral breast.

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And then we've got an

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oval mass, but it has microloupulated

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margins, maybe even a little

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irregular in terms of its margins.

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I'm not seeing anything else in

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this breast except that mass.

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And then, uh, looking at the MLO view, we see the

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mass again, but we also see, um, a prominent lymph node

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kind of sticking out of the corner here.

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So we want to keep that in mind as we're

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scrolling through our tomosynthesis images.

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So here's our tomosynthesis, uh, stack.

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We can see that prominent lymph node here

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in the axilla and then, um, this oval mass

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corresponding to the area of palpable concern.

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And nothing else really

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prominent in that, uh, breast.

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And of course, we're looking at, uh, both sides.

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So we want to make sure that we look carefully

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at the other side as well and not fall

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victim to the satisfaction of search error

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because sometimes there may be something

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else that we need to pay attention to.

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So this is the right CC that I'm scrolling through,

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and then we'll go to the right MLO (mediolateral oblique) view

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and we'll look through that one as well.

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So normal-looking tissue.

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And some normal lymph nodes up here in

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the axilla, but nothing surprising there.

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So our next step for this patient is

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going to be to look with ultrasound.

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And here's our ultrasound, uh, for our patient.

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So we're looking at the area

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of palpable concern first.

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And it's at the 1 o'clock position,

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15 centimeters from the nipple.

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And we have this heterogeneous hypoechoic

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mass with those sort of lobulated borders,

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irregular borders, and it's pretty large,

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2.8 centimeters here,

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2.7 centimeters in the other

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direction, some internal vascularity.

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And then, of course, we went to the axilla as

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well because we had that prominent lymph node.

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So here's the lymph node that

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we were seeing on the mammogram

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2.4 centimeters.

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63 00:01:23,140 --> 00:01:25,380 And you can see here, this is a nice

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example of effacement of the fatty hylum.

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So you can see this echogenic.

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Hilum, but it's very much off-center.

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Part of the cortex is thin, but

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the rest of it is very thick.

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And this is an abnormal lymph node.

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So the cortex is up to 1.

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2 centimeters in thickness.

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And normal cortex, we start being concerned

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about a cortex at about 3 millimeters in a

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patient with a suspicious mass in the breast.

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So at 12 millimeters, this is really.

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Abnormal.

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So, our final BI-RADS category for this patient

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was BI-RADS 5, highly suggestive of malignancy.

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We recommended biopsy of both the mass in

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the left breast and the axillary lymph node.

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The mass in the breast was a poorly differentiated

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invasive ductal carcinoma, and there was a

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metastatic disease found in that lymph node.

Report

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Tags

Women's Health

Ultrasound

Tomosynthesis

Neoplastic

Mammography

Breast

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