Changing left mammogram

Case contributed by Dr Garth Kruger

Presentation

A 60 year old woman comes for annual mammograms.

Patient Data

Age: 60
Gender: Female
Mammography

Another in the series of "time lapse mammography" of the same patient to illustrate a teaching point. As with previous cases this only serves a purpose if you thoughtfully look at the individual images as presented before moving on.

The small density centrally in the left breast is noted in 2009 and called "well defined well circumscribed and likely benign".

Its called Birads II and follow up is suggested in one year. Are you happy with that?

No you are not unless you have previous for comparison which in this case were not available. You may get away with tis in a premenopausal woman but in someone who is 62 you better be brave.

Mammography

The patient duly comes back a year later and the lesion is called "unchanged" in 2010.

Are you happy with that ?

No, you are not. The lesion now has fuzzy margins and she is post menopausal. Remember what Felson said about " honeycombing" in the lung? A honeycomb should at least look like a honeycomb. An unchanged lesion should at least be unchanged.

What should be done at this stage? Full work up with additional images and ultrasound.

Mammography

In 2011 the lesion is now both larger and poorly defined. 

What lesions do you know of that enlarge in post menopausal women and what would your primary concern be now ?

Your primary concern would be that this patient who comes back has in fact a carcinoma of the left breast.?

Ultrasound

The patient is finally worked up and this little lesion is an IDC.

Case Discussion

Breast imaging is best performed by breast imagers regardless of where you work..

The upside of this case is that the lesion is possibly biologically relatively innocuous given its slow pace of growth and initial imaging. Unfortunately the patient had metastatic nodes on sentinel node imaging.

Related articles

- breast neoplasms

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Case information

rID: 23840
Case created: 12th Jul 2013
Last edited: 26th Feb 2016
System: Breast
Inclusion in quiz mode: Included

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