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

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So our next patient is a 64-year-old

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woman who was recalled from screening

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for evaluation of calcifications on

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the right and an asymmetry on the left.

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So it's not uncommon that your,

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the recall is for more than one thing.

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And it may be for more than one side.

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

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get lost in the details, but you have to

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fully work up each area that was recalled.

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So, here's our screening mammogram for

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this patient, and she was recalled for this

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developing asymmetry, which was here in

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the left upper outer breast, and then some

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calcifications in the right inner breast.

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So when we brought her back, we did some

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magnification views of the calcifications,

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which is our normal protocol.

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So this was the CC magnification

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view of these calcifications.

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So there's a little group of calcifications,

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but also a little density with them.

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So, although this is likely going to be fat

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necrosis, you know, there was some concern

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about the increased density around that area.

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And then we did the extra views

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on the developing asymmetry.

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So here's the CC magnification view and

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Lateral magnification view.

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And then of course these both had tomosynthesis,

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so this is the MLO spot compression view.

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You can see there may be a little bit

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of distortion in here, and it looks like

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there's a central kinda density there.

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And this is the CC spot compression view.

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

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you know, and there may be

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something that we can find with

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ultrasound.

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So we did ultrasound of the

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area of developing asymmetry.

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And interestingly, you know, here's,

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here's a mass hypoechoic mass with a

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little bit of echogenic area in the center,

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and it's about eight millimeters in size.

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And there's a little bit of echogenic tissue

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around it that probably is it's making up the

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rest of the asymmetry because it's not just

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

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So this could be a target for biopsy.

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This could either be biopsied using mammogram

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guidance or ultrasound guidance, but you

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know, something truly developing in that

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area over time, we would want to biopsy that.

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The calcifications in the right breast were

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judged to be suspicious, not very suspicious,

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but a little bit suspicious because they were new.

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And there was a little bit of

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an asymmetry along with them.

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So this was given a BI-RADS category four

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and bilateral biopsy was recommended.

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And when the biopsy was performed,

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the hypoechoic mass was invasive ductal

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carcinoma with ductal carcinoma in situ.

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

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And then the calcifications

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were benign on the right side.

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So that was coarse

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calcifications with fat necrosis.

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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