BIRADS IV lesion
This 80 year old lady presents with a solid lump in her left breast. She has never had breast imaging. The patient refuses mammography. This lesion is found on ultrasound in her left breast at 8 o' clock..
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Ultrasound shows a solid lesion which is tall as broad and is not compressible. The lesion has no pseudocapsule and has multiple microlobulations and even some micrcalcification.
The lesion has all the hallmarks of malignancy on ultrasound. The sharp lobulations with acute angles and the poorly circumscribed margin are typically those of a malignant lesion. This is neber ever a benign lesion.
1. Do you routinely include axilla ultrasound if you find a lesion in the breast?
2. In this case (patient permitting) would you do bilateral diagnostic mammograms or ipsilateral imaging only? Why would you do the contralateral side as well?
3. The patient is afraid that biopsy will cause the cancer to spread? is this a valid concern in breast pathology? is this a valid concern with pancreas malignancy? What is "seeding" and is it important in the context of survival or recurrence of mailgnancy?
4. If any post menopausal woman develops a non- specific breast imaging abnormaility always be suspicious. Its a red flag and deserves your attention.