51-year-old woman recalled for developing asymmetry in right breast
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Our next patient is a 51-year-old woman who
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was recalled from screening for evaluation
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of an asymmetry in the right breast.
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So, this is the screening mammogram for this
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patient, um, bilateral CC and MLO views.
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And the area that was recalled
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as an asymmetry was this area in the,
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um, posterior lateral right breast.
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And you can see it here in the,
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um, upper breast on the MLO view.
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And that had been developing or was
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new compared to the previous exams.
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So we went ahead and did our standard evaluation,
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which was the CCN MLO spot views and lateral view.
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Show you this in a larger form.
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There was another mass here more anteriorly,
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but that had been stable for a long time.
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So here's our spot compression in the
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CC projection, you can see that area is still
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sort of vaguely visible there, and then
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we did a 3D tomosynthesis, and you can see
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that we have the asymmetry that persists.
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This was the MLO view, we still have
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that asymmetry, and when we look with
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our tomosynthesis spot, it's still there.
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And then we also did a lateral view.
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So here's our lateral view, this was the
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stable mass more interiorly, and then
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we had this other little asymmetry here.
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On our tomosynthesis image,
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there was a persistent asymmetry.
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So we thought there was enough here that
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we might be able to see it on ultrasound, so we
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went ahead and looked with ultrasound and we
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searched and searched and we had just normal
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looking tissue, but we weren't able to find
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an area that was a good correlate for the
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mammogram finding, but the mammogram finding
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was real and we felt that it was a developing
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asymmetry and We recommended a biopsy for this.
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So we coded this as bioreds category four
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and recommended a mammogram-guided biopsy.
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So we went ahead and did that and
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that showed invasive ductal carcinoma
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with ductal carcinoma in situ.
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So it's important to realize that for a
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developing asymmetry, there's still a need to
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biopsy even if there's no ultrasound correlate.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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