Infiltrating ductal breast cancer - temporal progression

Case contributed by Garth Kruger

Presentation

A 65 year old client returns for follow up mammography after two years.

Patient Data

Age: 65 years
Gender: Female

Left breast

mammography

A very faint shadow high up in the left breast seen retrospectively but not the initial read. 

Left breast

Annotated image

A very faint shadow high up in the left breast seen retrospectively (arrow) but not on the intial read.

Two years later

mammography

A very subtle developing density high up in the left breast is just slightly more prominent than previous. The projection is just slightly different from the previous study and this aids diagnosis.

A 4 x 6 mm mass with posterior shadowing with spiculations. 

Case Discussion

Infiltrating ductal carcinoma (IDC) was confirmed by needle biopsy.

This case illustrates the value of regular routine mammography, the value of comparison with previous images and lastly the value of reading batches of screening mammograms in an isolated environment free of interruptions, cellphones and Facebook.

Just as an aside, small lesions deep in the breast lying on the pectoral fascia like this one can be quite challenging to reach with the biopsy needle. You don't want a biopsy of the pectoral muscle so the "throw" of the needle on firing needs to throw almost parallel to the muscle, not perpendicular... you will have to make the skin puncture site in a place where you can tunnel along obliquely for quite a distance in order to 'fire' parallel to the muscle... always look at the images and plan your approach before going into the room.

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