Breast lesion referred for biopsy

Case contributed by Dr Garth Kruger

Presentation

This patient was referred for biopsy of a small lesion in the right breast

Patient Data

Age: 65
Gender: Female
Ultrasound

There are very few areas of radiology where the actual management of a lesion plays such a large part of arriving at a diagnosis as in breast imaging . This case will form part of a series of cases submitted to illustrate a management teaching point. Look at the first image and answer the question before you move on.

The lesion justifies biopsy. It is apparently solid and is taller than broad and very slightly lobulated.

Ultrasound

The lesion now looks like an intramammary lymph node. Well defined, hypoechoic, with a fatty hilum and clearly circumscribed. Believe it or not, this is the same lesion as is imaged above!

Case Discussion

  • The teaching point of this case is that every single lesion that is found on ultrasound and is potentially sent for biopsy should be reviewed in real time by the radiologist reading the study. Without exception.

You can virtually create concerning characteristics on ultrasound on any lesion that is visible. It is essential that the radiologist is comfortable that the static images presented to him are in fact representative of the real time appearance of the lesion.

Patients that are unnecessarily recalled in general or sent for intervention for innocuous lesions degrade the quality of the work we do. It unnecessarily upsets patients and their physicians. This case illustrates this point very well. In the practice where I work it is policy that any lesion sent for intervention is reviewed in real time before a second opinion is sought.

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Case information

rID: 21508
Case created: 27th Jan 2013
Last edited: 7th Nov 2017
System: Breast
Inclusion in quiz mode: Included

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