Breast cancer - temporal evolution

Case contributed by Dr Garth Kruger


Routine mammography form 2009 to 2013.

Patient Data

Age: 60
Gender: Female

"Time lapse" mammography to illustrate the development of an infiltrating ductal carcinoma over a period of 4 years. Not all IDC present as a mass lesion. This case presents with progressive parenchymal symmetry with long slender "runners". This lesion is differentiated form a radial scar by the density centrally and with the appearance on ultraound. Contrast this case with the appearance of the radial scar

No abnormalities in 2009.

MLO view left breast 2010 with a second annotated view.


Very subtle asymmetry with "runners' developing. Seen on the MLO view not the CC view. Note the development of slender "runners" radiating form the small mass lesion?

2013 images of the left breast with an annotated CC view.


The central density is visible in 2013 again with the spiculated periphery.  strangely best seen on the CC view this time.  Contrast the dense mass in the center with the appearnce of a radial scar on mammography.


Solid IDC with all the hallmarks of malignancy. BIRADS V lesion.

Case Discussion

The object of this case is not the unthinking use of the all-seeing "retrospectroscope", an instrument has 6/6 vision on hindsight. The teaching point here is to allow you to look at a case and train your eye to observe and recall the spiculated "runners" that radiate from a small solid lesion. You can train your eye to spot the "runners" and lead it to the mass even in a dense breast. This is a skill that you can acquire with practice and effort.

If you are reading mammograms in a busy noisy, distracting, overlit environment, you will miss these lesions most of the time. You need to review mammograms in an environment that allows you to concentrate on what you are doing. No phone.

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