78-year-old woman with palpable lump in right upper outer breast
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Our next case is a 78-year-old woman with
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a palpable lump in the right upper outer
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breast, and she had not had a mammogram
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since 2009, so it had been several years.
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So for this patient, we have bilateral CC (craniocaudal)
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views at the top of your screen, and bilateral
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MLO (mediolateral oblique) views at the bottom of the screen.
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Again, we have our triangular skin marker over
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the area of palpable concern, and you can see
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that, uh, adjacent to that triangular skin marker,
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there's a round, dense mass with speculated
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borders or margins and internal calcifications.
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On the MLO view, we also have
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that round mass, uh, visible here.
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We use a circular skin marker to denote that.
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Skin lesions like moles.
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So there are a couple of those
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that are marked, but the triangular
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marker corresponds to this mass.
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So as we scroll through this mass with
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tomosynthesis, we really get an idea of that
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speculated margin, thin lines radiating out
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from the mass, the calcifications internally.
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which have linear forms, coarse heterogeneous
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calcifications with some linear forms.
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So all of this is very suspicious.
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So looking at the full-field MLO view, again,
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we see that dense mass with calcifications
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internally and tomosynthesis images going
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through this mass, demonstrating those kind of
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speculated margins and internal calcifications.
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So this is a much more suspicious lesion
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than some of the other things that
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we've looked at in the previous cases.
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We, of course, are screening both
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sides, so we want to make sure that
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we look at the other side as well.
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So here's our left CC view
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and tomosynthesis images through that image.
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You can see some nice vascular
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calcifications here immediately.
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And normal tissue.
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Then we have our full left MLO view
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and our tomosynthesis images
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through that left MLO view.
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Again, showing vascular calcifications
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and normal tissue, nothing else there.
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So our next step for this patient
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would be to perform an ultrasound.
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So we did that next ultrasound
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of the palpable area of concern.
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And here we are imaging the area of concern,
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which is in the right breast at the 11 o'clock
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position, seven centimeters from the nipple.
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And we see a hypoechoic mass with
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internal echogenic areas,
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which correlate with the calcifications.
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There's a little bit of a
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hyperechoic rim around the mass.
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And, um, the size is a good match for
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what we're seeing on the mammogram,
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it's about two and a half centimeters.
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Um, there is some surrounding vascularity
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and a little bit of internal vascularity.
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We also looked at the axilla in this
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patient, um, because the mass is suspicious.
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We're expecting that this is most
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likely going to be a breast cancer.
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So we want to check the axilla as well.
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And we can see some normal,
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small lymph nodes within cortex.
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Here's another lymph node, big fatty hilum,
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very thin cortex, so nothing suspicious there.
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So our BI-RADS category for this exam is going
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to be BI-RADS 5, this is almost certainly a
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breast cancer, highly suggestive of malignancy,
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and we can biopsy this using ultrasound
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guidance, so that was what was recommended.
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So ultrasound-guided biopsy that was performed,
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and this was an invasive ductal carcinoma.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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