0:00

Our next patient is a 69-year-old woman

0:03

who was recalled from her screening

0:05

mammogram for evaluation of a developing

0:07

asymmetry in the right breast.

0:10

So here's our screening mammogram on this patient

0:14

and she was being recalled for an asymmetry in the

0:18

right upper outer breast at anterior depth and it

0:21

was actually right in here and here and then if we

0:26

look back to mammograms a few years before this.

0:31

You can see that there's tissue in this

0:33

area, lateral to the nipple on the right,

0:37

but it's not as dense as it is now.

0:40

So there's an increasing asymmetric density here.

0:44

It's a little bit harder to see on the MLO (mediolateral oblique)

0:46

views, but you can really see it on the CC (craniocaudal) view.

0:49

So, when we brought her back, we did additional

0:54

views, and for focal asymmetry, which this was, or

0:57

developing asymmetry, our protocol is CC and MLO

1:02

spot compression views and a full lateral view.

1:05

So that's what we did.

1:08

So here's the MLO spot compression view.

1:11

You can still see that almost like

1:13

a little triangle of density here.

1:17

And then this is the tomosynthesis

1:20

imaging through that area.

1:25

You can see that it almost looks like

1:26

a little triangle sticking out there.

1:33

And then we did a CC spot compression view.

1:39

With tomosynthesis.

1:43

You can see again almost like a little

1:45

triangular area of tissue density there.

1:48

So it persisted with spot compression.

1:52

We also did a lateral view and you can see

1:55

that little triangle poking out there and

1:59

the lateral view also had tomosynthesis.

2:02

So we can show those images and we get

2:05

to that little triangular place there.

2:08

So because this looked like a real finding,

2:11

we went ahead and did ultrasound to see

2:13

if we could find it with ultrasound.

2:16

And we imaged in the upper outer breast centered

2:23

at the 10 o'clock position, but this says

2:27

5 centimeters from the nipple, but I know we covered

2:29

from the nipple all the way out to 5 centimeters.

2:32

But there really wasn't any obvious finding there.

2:37

So we went ahead and recommended, since this is

2:39

a developing asymmetry, we know that even with no

2:42

ultrasound correlate, recent literature suggests

2:45

up to 20 percent malignancy rate for these.

2:48

So, you know, we recommended a tomosynthesis

2:51

guided biopsy, and that

2:54

was performed, and it showed fibrocystic

2:57

change and PASH, so pseudoangiomatous

2:59

stromal hyperplasia, or PASH.

3:02

So we thought that was a concordant

3:04

result, benign and concordant.

69-year-old woman recalled for developing asymmetry in right breast

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0:00

Our next patient is a 69-year-old woman

0:03

who was recalled from her screening

0:05

mammogram for evaluation of a developing

0:07

asymmetry in the right breast.

0:10

So here's our screening mammogram on this patient

0:14

and she was being recalled for an asymmetry in the

0:18

right upper outer breast at anterior depth and it

0:21

was actually right in here and here and then if we

0:26

look back to mammograms a few years before this.

0:31

You can see that there's tissue in this

0:33

area, lateral to the nipple on the right,

0:37

but it's not as dense as it is now.

0:40

So there's an increasing asymmetric density here.

0:44

It's a little bit harder to see on the MLO (mediolateral oblique)

0:46

views, but you can really see it on the CC (craniocaudal) view.

0:49

So, when we brought her back, we did additional

0:54

views, and for focal asymmetry, which this was, or

0:57

developing asymmetry, our protocol is CC and MLO

1:02

spot compression views and a full lateral view.

1:05

So that's what we did.

1:08

So here's the MLO spot compression view.

1:11

You can still see that almost like

1:13

a little triangle of density here.

1:17

And then this is the tomosynthesis

1:20

imaging through that area.

1:25

You can see that it almost looks like

1:26

a little triangle sticking out there.

1:33

And then we did a CC spot compression view.

1:39

With tomosynthesis.

1:43

You can see again almost like a little

1:45

triangular area of tissue density there.

1:48

So it persisted with spot compression.

1:52

We also did a lateral view and you can see

1:55

that little triangle poking out there and

1:59

the lateral view also had tomosynthesis.

2:02

So we can show those images and we get

2:05

to that little triangular place there.

2:08

So because this looked like a real finding,

2:11

we went ahead and did ultrasound to see

2:13

if we could find it with ultrasound.

2:16

And we imaged in the upper outer breast centered

2:23

at the 10 o'clock position, but this says

2:27

5 centimeters from the nipple, but I know we covered

2:29

from the nipple all the way out to 5 centimeters.

2:32

But there really wasn't any obvious finding there.

2:37

So we went ahead and recommended, since this is

2:39

a developing asymmetry, we know that even with no

2:42

ultrasound correlate, recent literature suggests

2:45

up to 20 percent malignancy rate for these.

2:48

So, you know, we recommended a tomosynthesis

2:51

guided biopsy, and that

2:54

was performed, and it showed fibrocystic

2:57

change and PASH, so pseudoangiomatous

2:59

stromal hyperplasia, or PASH.

3:02

So we thought that was a concordant

3:04

result, benign and concordant.

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 developing asymmetry in right breast