Ductal carcinoma in situ - palpable abnormality without calcification

Case contributed by Garth Kruger


Palpable abnormality right breast 4 o'clock.

Patient Data

Age: 40 years
Gender: Female

The mammogram showed no abnormality.

At the 4 o'clock radian of the right breast a subtle parenchymal abnormality was found. Poorly defined and heterogeneous. No microcalcifications or distortion of the surrounding breast tissue.

Images obtained during ultrasound-guided core biopsy showing the position of the needle post-fire. The histology returns as DCIS. Segmental resection followed. There was no evidence of an IDC on histology.

Case Discussion

Not all DCIS calcifies.

The diagnosis of breast pathology is made on imaging, cytology/histology and clinical exam. All three have to be clearly benign before you can pass off the "palpable mass". Unless you identify a definite benign etiology, the "palpable mass" deserves being sampled.

In general terms, if something worries you on imaging grounds, short-term follow-up rarely serves a purpose. If it worries you now it's going to still worry you in 6 months.

In everyday breast practice, the patient who finds an abnormality that turns out to be significant is quite common. Which makes it such a pity that it has become fashion to blow off breast self-exam as not statistically helpful. The contrary is true in the trenches of everyday imaging life. The value of breast self exam is shown by cases like this with regular frequency.

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