0:01

So our next group of cases

0:02

was categorized as BI-RADS 4.

0:06

And our first case is a 65-year-old woman

0:08

with a history of LCIS and atypia, so

0:13

atypical ductal hyperplasia and atypical

0:15

lobular hyperplasia in the left breast, and

0:18

she's being seen for high-risk screening.

0:22

So we're looking at the patient's MIP first, and

0:25

you can see she has mild background parenchymal

0:27

enhancements, some normal blood vessels, and

0:30

there's sort of a prominent linear non-mass

0:32

enhancement here in the left breast laterally.

0:36

Okay.

0:36

So we'll take another look at everything.

0:41

So we're going to pull in her T1 non-FATSAT

0:45

and her first subtracted image or series.

0:51

And we can see that she has a lot

0:53

of fibroglandular tissue, sort of

0:54

heterogeneous to extreme, and she's

1:00

had prior surgery and biopsies.

1:02

So there's a biopsy clip artifact here in the

1:05

left breast and also here in the left breast.

1:16

And then she's had a post-surgical change

1:21

here with a post-surgical collection.

1:23

So that was at a biopsy site or

1:26

excisional biopsy site for LCIS.

1:32

And we can see that she has fairly mild

1:34

background parenchymal enhancement.

1:41

And as we're scrolling through, the most

1:43

noticeable thing is just this linear non-mass

1:48

enhancement here in the anterior left breast.

1:54

It seems it's a little bit

1:57

more than just this part.

1:59

There's a little bit more to it

2:00

going backwards or going posteriorly.

2:04

You can see there kind of

2:06

extends a little bit longer.

2:09

And this was

2:10

new or certainly more prominent

2:12

compared to prior studies.

2:14

So that was concerning.

2:17

We also looked at the pre and post images.

2:22

Sometimes that gives you a

2:23

different look at this area.

2:27

We can see that it's right at

2:28

the edge of her tissue here.

2:35

It really wasn't anything

2:36

else on any of her images.

2:40

And we went through every, every series.

2:43

So this linear non-mass enhancement

2:46

in a fairly high-risk person who

2:49

has had prior episodes of atypia.

2:53

We were concerned enough about this that we

2:55

recommended an MRI-guided biopsy, which was

2:58

done, and this was a lobular carcinoma in situ.

3:02

So she returned to her surgeon for

3:06

an additional excisional biopsy.

3:10

So this was a BI-RADS 4.