It has, 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 sonologists will tell you. Patients regularly do feel lesions that are clinically significant in spite of the meta-analyzes which are now vogue. This patient had done diligent clinical examinations for years and was adamant the lesion was new and wanted it worked up. It turned out 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.