Carcinoma right breast

Case contributed by Dr Garth Kruger

Presentation

Screening mammogram

Patient Data

Age: 53 years
Gender: Female

Another in the series of cases to illustrate potential pitfalls in workup of a mammographic abnormality.

Modality: Mammography

CC view right breast 2012. No abnormality. Dense breast.

Modality: Mammography

Two years later an abnormal new density centrally medial.

Modality: Mammography

The radiologist working up the case chooses to do a mag view instead of rolled CC and ML views. Look at this image carefully. Thoughts ?

Modality: Ultrasound

This is the later to be confirmed IDC of the right breast. Tall as broad, sharp angles, short lobulated margins. Its not a benign lesion in anyone's book. You will always sample this lesion.

Case Discussion

In general, as a personal preference, I prefer to keep mag views for microcalcifications and additional mammographic views (ML and rolled CC) for parenchymal asymmetries. Many will differ I know.

This case illustrates why.

I am never sure on the mag view if I actually see the lesion or if it is/ not in the field of view. This is specially true of dense breasts; its sometimes very difficult to orientate yourself exactly as to position. This is a big problem in larger breasts. Looking at the mag view above, I think the tech is about right in the positioning. I am no nearer an answer after the trouble of the mag view than before. If so, why do it .. ?

Old school radiologists used to say anecdotally that you could compress a cancer "away". There is not proof of this as far as I know. But look at the mag view again: note how much relatively denser the surrounding tissue is compared with the compressed tissue centrally ....

If you are going to use mag views for parenchymal asymmetry, do so thoughtfully and carefully. In my experience its simpler quicker and easier all round to simply do rolled CC and ML views in these cases and then go on to the ultrasound.

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Case Information

rID: 29485
Case created: 30th May 2014
Last edited: 13th Sep 2016
System: Breast
Inclusion in quiz mode: Included

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