79-year-old woman recalled for developing asymmetry in anterior right breast
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Our next patient is a 79-year-old woman recalled
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from screening for evaluation of a developing
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asymmetry in the anterior right breast.
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So here's the screening mammogram for this
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patient, bilateral CCs and MLO views, and
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she has heterogeneously dense breast tissue.
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Breast tissue, you can see in the right breast,
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there's an area of asymmetry here with a
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suggestion of some calcifications there as well.
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This was the asymmetric area.
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So that was what was being recalled.
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And when we looked back for several prior
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mammograms, it looked like there was some
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developing asymmetry in that location.
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So when we brought the patient back in, we did
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our usual evaluation, which was CC
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and MLO spot compression views and a lateral view.
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So here's our right CC spot compression view
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and you can see that there's some sort of an
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asymmetry there with some central calcification.
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And these were the tomosynthesis
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images, again showing central
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calcification and this asymmetry or mass.
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Thanks.
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This is the MLO spot compression
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view with tomosynthesis.
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On this view, it's a little harder to see.
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There's some density or
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asymmetric density in this area.
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It's a little harder to make out.
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And then we also did a lateral view.
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So here's our lateral projection.
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We see some calcifications.
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But just dense tissue there, and then this
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was the tomosynthesis series, and it does
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look like there's a more mass-like area with
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calcification here, just above the nipple.
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So our next step was to do
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ultrasounds, which we did.
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So here was the ultrasound of this patient
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and ultrasound was a lot more obvious.
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There's a large hypoechoic mass with an echogenic
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rim in the right breast at the nine o'clock
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position, three centimeters from the nipple.
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So a little bit out from the
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nipple and you can see that it's 3.6 centimeters.
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48 00:02:25,150 --> 00:02:26,750 So quite a large mass
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and we can see some of that calcification
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or echogenic material within.
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The center, so that was it in the radial
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plane and then in antiradial, we could also
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see it with the central calcifications.
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And because of the size of this
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over three centimeters, we went
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ahead and looked at the axilla.
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We see some little lymph nodes with thin cortex.
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Here's another lymph node with a thin cortex.
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Really, nothing suspicious there.
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The largest one, the cortex
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was under two millimeters.
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So this is suspicious for malignancy.
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We would consider this a BI RADS
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5, highly suggestive of malignancy.
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And we went ahead and recommended an ultrasound
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guided biopsy of this, lobular carcinoma.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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