69-year-old woman recalled for developing asymmetry in right breast
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Our next patient is a 69-year-old woman
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who was recalled from her screening
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mammogram for evaluation of a developing
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asymmetry in the right breast.
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So here's our screening mammogram on this patient
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and she was being recalled for an asymmetry in the
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right upper outer breast at anterior depth and it
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was actually right in here and here and then if we
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look back to mammograms a few years before this.
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You can see that there's tissue in this
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area, lateral to the nipple on the right,
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but it's not as dense as it is now.
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So there's an increasing asymmetric density here.
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It's a little bit harder to see on the MLO (mediolateral oblique)
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views, but you can really see it on the CC (craniocaudal) view.
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So, when we brought her back, we did additional
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views, and for focal asymmetry, which this was, or
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developing asymmetry, our protocol is CC and MLO
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spot compression views and a full lateral view.
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So that's what we did.
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So here's the MLO spot compression view.
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You can still see that almost like
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a little triangle of density here.
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And then this is the tomosynthesis
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imaging through that area.
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You can see that it almost looks like
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a little triangle sticking out there.
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And then we did a CC spot compression view.
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With tomosynthesis.
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You can see again almost like a little
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triangular area of tissue density there.
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So it persisted with spot compression.
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We also did a lateral view and you can see
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that little triangle poking out there and
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the lateral view also had tomosynthesis.
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So we can show those images and we get
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to that little triangular place there.
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So because this looked like a real finding,
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we went ahead and did ultrasound to see
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if we could find it with ultrasound.
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And we imaged in the upper outer breast centered
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at the 10 o'clock position, but this says
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5 centimeters from the nipple, but I know we covered
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from the nipple all the way out to 5 centimeters.
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But there really wasn't any obvious finding there.
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So we went ahead and recommended, since this is
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a developing asymmetry, we know that even with no
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ultrasound correlate, recent literature suggests
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up to 20 percent malignancy rate for these.
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So, you know, we recommended a tomosynthesis
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guided biopsy, and that
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was performed, and it showed fibrocystic
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change and PASH, so pseudoangiomatous
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stromal hyperplasia, or PASH.
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So we thought that was a concordant
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result, benign and concordant.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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