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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.

Report

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Tags

Women's Health

Ultrasound

Tomosynthesis

Non-infectious Inflammatory

Mammography

Breast

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