Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Video Case Studies


Note: Tomosynthesis video files are included in the e-book version.

Chapter 1

Case Study 1.1, Bilateral screening mammogram in a 48 year-old woman. (A) Extremely dense breast tissue is noted, although no suspicious abnormality is seen on the 2D images. (B) However, tomosynthesis reveals an architectural distortion in the left posterior outer breast at the 3-o’clock position (arrows) . (C) Close-up MLO and CC views plus AVI better depict the architectural distortion (circles) . (D) Targeted ultrasound reveals a corresponding hypoechoic irregular mass with posterior acoustic shadowing, as well as a second focal irregular hypoechoic mass with indistinct margins and posterior acoustic shadowing in the left lateral breast. Diagnosis: Ultrasound-guided CNB = infiltrating lobular carcinoma, moderately differentiated at both sites, ER/PR+, Her–, 0/1 SLN. Tumor size was 6 cm at excision/partial mastectomy .

Chapter 3

Case Study 3.1, (A) A coarse calcification in the right central breast is noted to have a straight slinky artifact on the out of plane MLO tomosynthesis view (arrow) . (B) This calcification appears serpiginous on the CC tomosynthesis view (arrow) . Note that the Cooper ligaments are not as sharp on the CC view. Conclusion: CC motion artifact.

Case Study 3.2, (A) 2D MLO demonstrates scattered fibroglandular tissue and no abnormalities. (B) Tomosynthesis MLO reveals a foggy ground-glass appearance along the posterior breast. Because the 2D portion of the exam is normal, the possibility of a detector abnormality is excluded. Conclusion: Tomosynthesis processing artifact.

Case Study 3.3, This screening mammogram reveals predominately fatty breast tissue. (A) On the 2D CC view, an oval asymmetry is noted in the anterior breast, most likely the nipple. (B) On tomosynthesis, the asymmetry is best seen on the first slice. Conclusion: Although for optimal positioning nipples should be in profile, it is not always possible, and some technical repeats can be avoided as tomosynthesis permits visualization of the underlying tissue.

Chapter 5

Case Study 5.1, (A) A focal asymmetry is noted on the left breast 2D MLO view only of a screening exam on a 44-year-old woman with scattered fibroglandular tissue. (B) Tomosynthesis images show that the asymmetry is caused by superimposed normal tissue because no underlying mass is seen when scrolling through the entire stack of images. Diagnosis: Normal tissue. No recall necessary.

Case Study 5.2, (A) Screening mammogram of a 64-year-old woman shows several masses in the posterior left breast that appear ill-defined on the 2D image. (B) Tomosynthesis slice and movie images demonstrate the reniform shape, circumscribed margins, and fatty hilum of benign-appearing lymph nodes. Diagnosis: Benign lymph nodes. No recall necessary.

Case Study 5.3, A 67-year-old woman with heterogeneously dense breasts was recalled from screening for architectural distortion in the left breast, better seen on tomosynthesis images. (B) The spiculations are well demonstrated on the tomosynthesis movie images. (C) Ultrasound shows an isoechoic, taller-than-wide mass. Diagnosis: Ultrasound-guided core needle biopsy was performed, with concordant pathology of radial scar.

Case Study 5.4, (A) A baseline screening mammogram of a 43-year-old with nondense tissue showed a small subtle mass in the right breast. (B) Associated spiculations are better seen on tomosynthesis slice and (C) movie images. (D) US showed a small, taller-than-wide hypoechoic mass. Diagnosis: Final pathology invasive ductal carcinoma, T1cN0, ER/PR+, Her2–.

Case Study 5.5, (A) A 54-year-old woman with heterogeneously dense breasts was recalled for a mass (circle) in the lateral right breast, identified on the tomosynthesis images. (B) The spiculations highlight the mass and are much better appreciated on the tomosynthesis movie images. (C) Ultrasound confirmed a hypoechoic spiculated, shadowing mass. Diagnosis: Ultrasound-guided core needle biopsy yielded invasive ductal carcinoma, T1c N2a, ER+, PR–, Her2+.

Case Study 5.6, (A) A 62-year-old with right breast upper-outer quadrant mass obscured by superimposed tissue on 2D images, but more definite on tomosynthesis images (circle) . (B) Tomosynthesis movie images highlight the associated architectural distortion. (C) An ill-defined hypoechoic mass was found on US and core needle biopsy performed. Diagnosis: Invasive ductal carcinoma, T2N0 , ER/PR+, Her2–.

Case Study 5.7, (A) A 53-year-old with left breast mass seen on screening mammogram. The spicules on the 2D image could be dismissed as adjacent fibroglandular tissue. (B) Tomosynthesis slice and movie images demonstrate that the spicules radiate distantly from the mass. (C) Ultrasound shows an irregular mass with angular and spiculated margins. Diagnosis: Final pathology invasive ductal carcinoma, T1c N0, ER/PR+, Her2–.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here