0:00

So this case is a woman who’s again,

0:03

extremely dense. On the bottom are her new

0:07

mammograms, and on the top are her older

0:09

ones, which were about 16 months apart.

0:13

This was during COVID.

0:14

So we’ve had a little bit of screening delay.

0:17

Anyway, you can see she’s extremely dense.

0:19

She’s somewhat difficult to position.

0:21

You can see consistently her right breast

0:24

looks a little bit smaller than her

0:25

left, but there’s really nothing focal.

0:27

There are some calcifications

0:28

that you can see here.

0:30

And maybe back here, remember those, but

0:33

those are really stable compared to the prior.

0:36

You can see them before.

0:37

So no remarkable change over time with her.

0:40

And because of her extreme density again,

0:42

she was prompted to have supplemental

0:44

screening with the abbreviated MR study.

0:46

And I’ll show you that.

0:49

Okay, so now here’s her abbreviated MR study and

0:52

again, we’ve got the scout here, and then we’ve got

0:54

her T2 up here and really nothing remarkable.

1:00

She again, postmenopausal woman, pretty

1:04

juicy looking breasts here, but nothing

1:07

popping out on her T2. Here it is up close.

1:11

Interesting, maybe a little more

1:13

focal fluid back in this area.

1:15

Keep that area in mind.

1:16

Here’s her pre-contrast.

1:18

Transcribed T1, everything looks pretty good.

1:22

Don’t see anything that looks distorted.

1:24

Nothing else.

1:26

Okay.

1:26

This is her post-contrast, non-subtracted.

1:29

You can see some background print

1:32

enhancements that look pretty symmetric.

1:34

Some patchy little areas bilaterally.

1:37

I think you can see.

1:38

But now, what we see is in the superior breast,

1:42

this large area that looks distorted as well.

1:47

I think you can see that in the right

1:48

side, superiorly, sort of at the 12

1:51

o’clock-ish area, maybe a little bit

1:53

medial towards the 1 o’clock area.

1:57

So, let’s go back and look at

1:58

that and how that correlates.

2:01

Here we are.

2:02

You can see it is sort of where she had a

2:04

little bit more fluid up top of her breast.

2:07

Again, nothing mammographically seen.

2:10

So let me now show you her subtraction images.

2:15

So, now I’m showing you her subtraction image,

2:17

and I think you can again see this very enhancing

2:20

in an irregular spot in her upper breast again.

2:25

You know, you saw her mammogram

2:26

really nothing there.

2:28

It is correlated with her study on the top.

2:32

Co-locate.

2:33

So again, in the superior

2:35

breast, I think you can see it.

2:38

It's a very large area.

2:41

And so the next step here, you know, reviewing the

2:43

mammogram, there was nothing that we could see.

2:45

She's extremely dense.

2:47

This is a large area.

2:48

You go to targeted ultrasound.

2:50

Of course, this is definitely a suspicious,

2:53

you're going to biopsy, but having that

2:54

targeted ultrasound is going to help you.

2:57

So here's the targeted ultrasound of her right

2:59

breast at the 12 o'clock site, 3 centimeters from

3:01

the nipple, completely corresponding with the M.

3:03

R.

3:04

finding is this irregular area and you can

3:07

actually see punctate calcifications within it.

3:10

So, then we go back to the mammogram

3:12

and remember, there were a couple of

3:13

calcifications, but they were stable.

3:15

Certainly.

3:15

We didn't see any distortion on the tomo images.

3:18

We really didn't see any of this.

3:20

We did the ultrasound guided core biopsy,

3:22

and this was an invasive ductal carcinoma.

3:25

poorly differentiated ERPR positive, HER2

3:28

negative with high grade DCIS associated with it.

3:31

That makes sense.

3:32

And she also had some micropapillary DCIS subtype.

3:36

She did have a sentinel node biopsy and

3:38

thank goodness that was completely negative.

3:40

So again, you know, it's a significant

3:44

cancer found by abbreviated MR and not

3:47

at all seen on her tomosynthesis imaging.