0:00

So our next patient is a 64-year-old

0:03

woman who was recalled from screening

0:05

for evaluation of calcifications on

0:06

the right and an asymmetry on the left.

0:09

So it's not uncommon that your,

0:11

the recall is for more than one thing.

0:14

And it may be for more than one side.

0:16

So it's easy to, um, you know, kind of

0:19

get lost in the details, but you have to

0:22

fully work up each area that was recalled.

0:25

So, here's our screening mammogram for

0:27

this patient, and she was recalled for this

0:30

developing asymmetry, which was here in

0:33

the left upper outer breast, and then some

0:36

calcifications in the right inner breast.

0:40

So when we brought her back, we did some

0:45

magnification views of the calcifications,

0:47

which is our normal protocol.

0:50

So this was the CC magnification

0:53

view of these calcifications.

0:58

So there's a little group of calcifications,

1:00

but also a little density with them.

1:02

So, although this is likely going to be fat

1:06

necrosis, you know, there was some concern

1:09

about the increased density around that area.

1:12

And then we did the extra views

1:16

on the developing asymmetry.

1:19

So here's the CC magnification view and

1:23

Lateral magnification view.

1:27

And then of course these both had tomosynthesis,

1:35

so this is the MLO spot compression view.

1:40

You can see there may be a little bit

1:41

of distortion in here, and it looks like

1:43

there's a central kinda density there.

1:49

And this is the CC spot compression view.

1:52

So that area of density really doesn't go away,

1:58

you know, and there may be

1:59

something that we can find with

2:02

ultrasound.

2:04

So we did ultrasound of the

2:06

area of developing asymmetry.

2:10

And interestingly, you know, here's,

2:15

here's a mass hypoechoic mass with a

2:18

little bit of echogenic area in the center,

2:24

and it's about eight millimeters in size.

2:26

And there's a little bit of echogenic tissue

2:28

around it that probably is it's making up the

2:32

rest of the asymmetry because it's not just

2:34

this mass, it's probably the tissue as well.

2:38

So this could be a target for biopsy.

2:43

This could either be biopsied using mammogram

2:46

guidance or ultrasound guidance, but you

2:48

know, something truly developing in that

2:49

area over time, we would want to biopsy that.

2:54

The calcifications in the right breast were

2:56

judged to be suspicious, not very suspicious,

3:00

but a little bit suspicious because they were new.

3:02

And there was a little bit of

3:03

an asymmetry along with them.

3:05

So this was given a BI-RADS category four

3:09

and bilateral biopsy was recommended.

3:11

And when the biopsy was performed,

3:14

the hypoechoic mass was invasive ductal

3:18

carcinoma with ductal carcinoma in situ.

3:21

So that's what made up the left breast asymmetry.

3:24

And then the calcifications

3:25

were benign on the right side.

3:27

So that was coarse

3:28

calcifications with fat necrosis.

64-year-old woman recalled for calcifications and developing asymmetry

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0:00

So our next patient is a 64-year-old

0:03

woman who was recalled from screening

0:05

for evaluation of calcifications on

0:06

the right and an asymmetry on the left.

0:09

So it's not uncommon that your,

0:11

the recall is for more than one thing.

0:14

And it may be for more than one side.

0:16

So it's easy to, um, you know, kind of

0:19

get lost in the details, but you have to

0:22

fully work up each area that was recalled.

0:25

So, here's our screening mammogram for

0:27

this patient, and she was recalled for this

0:30

developing asymmetry, which was here in

0:33

the left upper outer breast, and then some

0:36

calcifications in the right inner breast.

0:40

So when we brought her back, we did some

0:45

magnification views of the calcifications,

0:47

which is our normal protocol.

0:50

So this was the CC magnification

0:53

view of these calcifications.

0:58

So there's a little group of calcifications,

1:00

but also a little density with them.

1:02

So, although this is likely going to be fat

1:06

necrosis, you know, there was some concern

1:09

about the increased density around that area.

1:12

And then we did the extra views

1:16

on the developing asymmetry.

1:19

So here's the CC magnification view and

1:23

Lateral magnification view.

1:27

And then of course these both had tomosynthesis,

1:35

so this is the MLO spot compression view.

1:40

You can see there may be a little bit

1:41

of distortion in here, and it looks like

1:43

there's a central kinda density there.

1:49

And this is the CC spot compression view.

1:52

So that area of density really doesn't go away,

1:58

you know, and there may be

1:59

something that we can find with

2:02

ultrasound.

2:04

So we did ultrasound of the

2:06

area of developing asymmetry.

2:10

And interestingly, you know, here's,

2:15

here's a mass hypoechoic mass with a

2:18

little bit of echogenic area in the center,

2:24

and it's about eight millimeters in size.

2:26

And there's a little bit of echogenic tissue

2:28

around it that probably is it's making up the

2:32

rest of the asymmetry because it's not just

2:34

this mass, it's probably the tissue as well.

2:38

So this could be a target for biopsy.

2:43

This could either be biopsied using mammogram

2:46

guidance or ultrasound guidance, but you

2:48

know, something truly developing in that

2:49

area over time, we would want to biopsy that.

2:54

The calcifications in the right breast were

2:56

judged to be suspicious, not very suspicious,

3:00

but a little bit suspicious because they were new.

3:02

And there was a little bit of

3:03

an asymmetry along with them.

3:05

So this was given a BI-RADS category four

3:09

and bilateral biopsy was recommended.

3:11

And when the biopsy was performed,

3:14

the hypoechoic mass was invasive ductal

3:18

carcinoma with ductal carcinoma in situ.

3:21

So that's what made up the left breast asymmetry.

3:24

And then the calcifications

3:25

were benign on the right side.

3:27

So that was coarse

3:28

calcifications with fat necrosis.

Report

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Lesson

Sample Lesson

Lesson

Palpable Lumps

Lesson

Breast Pain

Lesson

Nipple Discharge

Lesson

Skin Changes/Inflammation

Lesson

Recall from Screening

Lesson

Surveillance After Breast Cancer Treatment

Lesson

Follow Up Probably Benign Findings - BI-RADS 3

Lesson

Follow up Benign Biopsy

Lesson

Pregnant and Lactating Women

Lesson

Male Patients

64-year-old woman recalled for calcifications and developing asymmetry