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So, our next patient is a 50-year-old

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woman with a large left lymph

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node seen on screening mammogram.

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So, compared to prior mammograms, this

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lymph node became larger over time, and

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she was recalled for axillary ultrasound.

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She subsequently had a biopsy that showed

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metastatic breast carcinoma, and her

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mammography was negative, and MRI was

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performed to find the primary tumor.

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And this is the patient's MIP.

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A lot of blood vessels, which are

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kind of obscuring some of the tissue.

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So we're just going to

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look at images separately.

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And here's T1-weighted images and

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post-contrast subtraction images.

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And we can see up here in the left axilla,

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there's a big lymph node here with a

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susceptibility artifact from a biopsy clip.

1:02

So that was the biopsy lymph node

1:04

showing metastatic carcinoma.

1:07

There's a second smaller, but still abnormal

1:11

lymph node anterior and inferior to this.

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So she does not have

1:20

very dense tissue.

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She has scattered fibroglandular tissue.

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And one would think that with this

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kind of tissue, we'd really be able

1:29

to see breast cancer pretty easily,

1:33

but that wasn't the case. Her mammogram

1:35

looked normal and similar to prior exams.

1:39

So, we basically went through very

1:42

carefully, looking at everything.

1:44

She has a few foci of enhancement,

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but what we did see was

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one spot that was a little bit

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more prominent on the left side.

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And it's right here.

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So left anterior breast, small mass. I think

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it was eight by four millimeters. You know,

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really one that you could pass by

2:11

pretty quickly, but that stood out to us.

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And I think even going back, looking at

2:21

her MRI, even though there are lots of

2:24

blood vessels, you can still see that

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little spot maybe stands out a little bit.

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And we looked at her pre- and post-images,

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and there's that little mass again.

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And we recommended that for biopsy

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because it was the only thing that

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really stood out as being different.

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And that was an invasive ductal carcinoma.

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So that was the source of

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her metastatic lymph node.

2:54

And again, this was coded as a BI-RADS 4.