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32-year-old woman, 21 weeks pregnant, with palpable lump left breast

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Our next patient is a 32-year-old

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woman, currently 21 weeks pregnant,

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with a palpable lump in the left breast.

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So we're going to begin with, um,

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ultrasound, and then add a mammogram

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if we feel like it's necessary.

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For this patient, we performed an ultrasound

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of the area of palpable concern, which is at

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the left breast at the 11 o'clock position.

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In her palpable area, there's some cystic

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spaces here, but there's also a fairly

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large hypoechoic mass that looks a little

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different from the surrounding tissue.

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And the best measurements we

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could get of this were about

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2.4 centimeters, a little bit

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smaller in the other dimensions.

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And there was some internal vascularity.

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And this really doesn't have

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very circumscribed margins.

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The margins are a little bit microlobulated

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where we can see them, and then in other

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areas, it's difficult to see the margins.

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So the person who saw this patient

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recommended biopsy as a first step.

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Uh, ultrasound-guided biopsy was

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performed, and this was in a poorly

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differentiated invasive ductal carcinoma.

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The patient then went on to have

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a bilateral diagnostic mammogram.

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So this is the bilateral mammogram,

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uh, performed on this patient.

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And as I mentioned, the, um, biopsy had already

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been performed in that left breast mass.

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So we can see the clip here, the coil-shaped

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biopsy clip, and then the triangular

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skin marker over the palpable area.

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And there's not a whole lot that

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we're seeing with the mammogram.

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One of the reasons to do mammography would be

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to, you know, make sure that there's nothing

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else in this breast or the other breast.

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Her breast tissue is quite dense, which is

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why ultrasound is a good, um, starting place.

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And just to look at her tomosynthesis

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imaging, it's interesting.

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She has that fairly large mass in the left

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breast, and you do sort of see part of it.

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It looks like her clip is actually a little

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bit displaced, and then just looking at

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the other view, here's her triangle on her

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skin, and her mass is kind of back in here.

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We didn't see anything else on either breast.

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We ended up doing an ultrasound of both

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breasts just to be sure that there wasn't

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anything else we were missing because

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she was not going to be able to get

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an MRI to, to look at this more closely.

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So what we saw was that here was the

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mass in the left breast with blood flow.

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And then we were able to see that her clip

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was sitting off by itself here to the side.

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So we were able to give the option of

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placing another clip inside the mass

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if that was going to be necessary.

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And we were able to give a distance from the

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center of the mass to the clip, and that could

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be important if the patient was going on to

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neoadjuvant chemotherapy, where you would actually

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want the clip to be centered within the mass.

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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