69-year-old woman recalled for architectural distortion in left breast
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Our next case is a 69-year-old woman.
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Recalled for evaluation of architectural
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distortion in the left breast.
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So here are the screening
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mammographic views for this patient.
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And our concern was really
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here in the left upper breast.
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Now she has busy breast
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tissue in the right breast.
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She's had several biopsies.
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There's biopsy clips and calcifications.
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There's a lot of distractors, but here in
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the left upper breast, it looks like the
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tissue may be slightly pulled in here.
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Maybe there's some distortion.
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And then we have tomosynthesis
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views through that area.
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So we'll look at that next.
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On the tomosynthesis, I can stop right
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here, and it looks like there's some tissue
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that's kind of coming into a central point.
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Then I'm out of it.
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So it's kind of right in
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here that we were concerned.
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So we brought the patient
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back and did some extra work
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to try to sort this out.
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So this was a repeat MLO view, and we still
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thought we had maybe some tissue density,
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but we also had a potential distortion there.
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So we looked at that with our tomosynthesis images
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and we thought that right in
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here there was some distortion.
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So no real central mass, but just radiating
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lines. You might be able to see that better
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if I blow it up a little bit, basically
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radiating lines to a central point.
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So about this size.
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And as we scrolled through, we thought
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we had a definite distortion there.
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So we did some extra views, which
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didn't really help us all that much.
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So this was the lateral view for that
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patient with tomosynthesis images.
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You can kind of see that area right in
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here where the tissue looks pulled in.
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We also looked with ultrasound, hoping to
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find this with ultrasound, and we did think it
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was lateral based on the position finder for
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tomosynthesis, and we could not find anything.
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So we still had an architectural distortion really
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best seen in one view, because when we went back
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in time, even to the CC view, it was very hard to
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see anything that we thought correlated with this.
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We knew it was lateral when
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we looked at the lateral view.
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We thought maybe it was in this tissue
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here, the very most lateral part of
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the tissue, but it was certainly better
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seen on the MLO and lateral views.
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So we went ahead and recommended a
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tomosynthesis-guided biopsy called the
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BI-RADS 4, and the final pathology on our
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biopsy was a complex sclerosing lesion, and
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there was associated ductal carcinoma in situ.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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