0:00

Our next case is a 69-year-old woman.

0:03

Recalled for evaluation of architectural

0:05

distortion in the left breast.

0:08

So here are the screening

0:10

mammographic views for this patient.

0:12

And our concern was really

0:16

here in the left upper breast.

0:20

Now she has busy breast

0:22

tissue in the right breast.

0:24

She's had several biopsies.

0:27

There's biopsy clips and calcifications.

0:29

There's a lot of distractors, but here in

0:33

the left upper breast, it looks like the

0:35

tissue may be slightly pulled in here.

0:38

Maybe there's some distortion.

0:41

And then we have tomosynthesis

0:43

views through that area.

0:46

So we'll look at that next.

0:49

On the tomosynthesis, I can stop right

0:53

here, and it looks like there's some tissue

0:56

that's kind of coming into a central point.

1:01

Then I'm out of it.

1:03

So it's kind of right in

1:04

here that we were concerned.

1:06

So we brought the patient

1:08

back and did some extra work

1:11

to try to sort this out.

1:14

So this was a repeat MLO view, and we still

1:18

thought we had maybe some tissue density,

1:21

but we also had a potential distortion there.

1:24

So we looked at that with our tomosynthesis images

1:33

and we thought that right in

1:35

here there was some distortion.

1:38

So no real central mass, but just radiating

1:41

lines. You might be able to see that better

1:44

if I blow it up a little bit, basically

1:46

radiating lines to a central point.

1:49

So about this size.

1:52

And as we scrolled through, we thought

1:55

we had a definite distortion there.

1:58

So we did some extra views, which

2:01

didn't really help us all that much.

2:05

So this was the lateral view for that

2:08

patient with tomosynthesis images.

2:16

You can kind of see that area right in

2:18

here where the tissue looks pulled in.

2:22

We also looked with ultrasound, hoping to

2:25

find this with ultrasound, and we did think it

2:30

was lateral based on the position finder for

2:35

tomosynthesis, and we could not find anything.

2:38

So we still had an architectural distortion really

2:42

best seen in one view, because when we went back

2:46

in time, even to the CC view, it was very hard to

2:50

see anything that we thought correlated with this.

2:54

We knew it was lateral when

2:57

we looked at the lateral view.

2:59

We thought maybe it was in this tissue

3:02

here, the very most lateral part of

3:05

the tissue, but it was certainly better

3:07

seen on the MLO and lateral views.

3:11

So we went ahead and recommended a

3:13

tomosynthesis-guided biopsy called the

3:16

BI-RADS 4, and the final pathology on our

3:21

biopsy was a complex sclerosing lesion, and

3:26

there was associated ductal carcinoma in situ.

69-year-old woman recalled for architectural distortion in left breast

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

Our next case is a 69-year-old woman.

0:03

Recalled for evaluation of architectural

0:05

distortion in the left breast.

0:08

So here are the screening

0:10

mammographic views for this patient.

0:12

And our concern was really

0:16

here in the left upper breast.

0:20

Now she has busy breast

0:22

tissue in the right breast.

0:24

She's had several biopsies.

0:27

There's biopsy clips and calcifications.

0:29

There's a lot of distractors, but here in

0:33

the left upper breast, it looks like the

0:35

tissue may be slightly pulled in here.

0:38

Maybe there's some distortion.

0:41

And then we have tomosynthesis

0:43

views through that area.

0:46

So we'll look at that next.

0:49

On the tomosynthesis, I can stop right

0:53

here, and it looks like there's some tissue

0:56

that's kind of coming into a central point.

1:01

Then I'm out of it.

1:03

So it's kind of right in

1:04

here that we were concerned.

1:06

So we brought the patient

1:08

back and did some extra work

1:11

to try to sort this out.

1:14

So this was a repeat MLO view, and we still

1:18

thought we had maybe some tissue density,

1:21

but we also had a potential distortion there.

1:24

So we looked at that with our tomosynthesis images

1:33

and we thought that right in

1:35

here there was some distortion.

1:38

So no real central mass, but just radiating

1:41

lines. You might be able to see that better

1:44

if I blow it up a little bit, basically

1:46

radiating lines to a central point.

1:49

So about this size.

1:52

And as we scrolled through, we thought

1:55

we had a definite distortion there.

1:58

So we did some extra views, which

2:01

didn't really help us all that much.

2:05

So this was the lateral view for that

2:08

patient with tomosynthesis images.

2:16

You can kind of see that area right in

2:18

here where the tissue looks pulled in.

2:22

We also looked with ultrasound, hoping to

2:25

find this with ultrasound, and we did think it

2:30

was lateral based on the position finder for

2:35

tomosynthesis, and we could not find anything.

2:38

So we still had an architectural distortion really

2:42

best seen in one view, because when we went back

2:46

in time, even to the CC view, it was very hard to

2:50

see anything that we thought correlated with this.

2:54

We knew it was lateral when

2:57

we looked at the lateral view.

2:59

We thought maybe it was in this tissue

3:02

here, the very most lateral part of

3:05

the tissue, but it was certainly better

3:07

seen on the MLO and lateral views.

3:11

So we went ahead and recommended a

3:13

tomosynthesis-guided biopsy called the

3:16

BI-RADS 4, and the final pathology on our

3:21

biopsy was a complex sclerosing lesion, and

3:26

there was associated ductal carcinoma in situ.

Report

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Lesson

Sample Lesson

Lesson

Palpable Lumps

Lesson

Breast Pain

Lesson

Nipple Discharge

Lesson

Skin Changes/Inflammation

Lesson

Recall from Screening

Lesson

Surveillance After Breast Cancer Treatment

Lesson

Follow Up Probably Benign Findings - BI-RADS 3

Lesson

Follow up Benign Biopsy

Lesson

Pregnant and Lactating Women

Lesson

Male Patients

69-year-old woman recalled for architectural distortion in left breast