Carcinoma right breast

Case contributed by Dr Garth Kruger

Presentation

The patient complained of a very small palpable lesion just adjacent to the right areola.

Patient Data

Age: 54 years
Gender: Female
Modality: Mammography

The images show a small IDC which the patient has palpated and which was confirmed on ultrasound and subsequent biopsy.

Annotated image of the current study

Modality: Annotated image

Annotated image of there 2014 image showing a minute spiculated lesion.

Previous examination (three years prior)

Modality: Mammography

No convincing mass lesion identified. 

Modality: Ultrasound

Small solid lesion 4 mm diameter as indicated by the patient. Note the technologist annotations at the bottom of the images. Its small solid and has shaggy margins. And you can see why she felt it; its under the skin.

Case Discussion

It is unfortunately become common knowledge in the breast literature and recommendations that clinical exam has supposedly limited value. We do women a disservice by propagating this myth. The converse is true in everyday breast practice as many senologists will tell you. Patients regularly do feel lesions that are clinically significant in spite of the meta analyses which are now vogue. This patient had done diligent clinical exam for years and was adamant the lesion was new and wanted it worked up. It turned out be be a small malignancy.

This case is no exception.

The moral here is not all you read is necessarily applicable/of value to your clinical breast imaging practice. I always take notice if a patient insists that something has changed in her breast. Get up and go and review the ultrasound images in real time. Talk to the patient and ask her to show you what she feels.

I challenge anyone even with hindsight to have picked up that lesion in a batch of screening mammograms. The patient found it.

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Case Information

rID: 29472
Case created: 28th May 2014
Last edited: 15th Sep 2016
System: Breast
Inclusion in quiz mode: Included

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