{"id":115,"date":"2025-05-29T16:52:34","date_gmt":"2025-05-29T16:52:34","guid":{"rendered":"https:\/\/depts.washington.edu\/breast-imaging-teach\/wordpress\/?p=115"},"modified":"2025-06-30T17:02:11","modified_gmt":"2025-06-30T17:02:11","slug":"case-4","status":"publish","type":"post","link":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=115","title":{"rendered":"Case 4"},"content":{"rendered":"

Contributed by: Steven J. Rockoff, MD and Diana L. Lam, MD – June 1, 2020<\/p>\n

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Question 1<\/h2>\n
\n

A 56-year-old woman presents for a screening mammogram:<\/p>\n

\"\"<\/figure>\n
\"\"<\/figure>\n

How do you best describe the patient\u2019s breast density?<\/p>\n

A. The breasts are almost entirely fatty<\/p>\n

B. There are scattered areas of fibroglandular density<\/p>\n

C. The breasts are heterogeneously dense<\/p>\n

D. The breasts are extremely dense<\/p>\n

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Answer<\/h4>\n
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C. The breasts are heterogeneously dense<\/strong><\/p>\n

Explanation: <\/strong>One of the first steps in interpreting a mammogram is assessing the breast composition, also known as breast density. There are four acceptable categories described in the ACR BI-RADS manual, which are listed above. This patient\u2019s breasts are heterogeneously dense on mammogram, which may obscure small masses.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Question 2<\/h2>\n
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A representative zoomed in image is shown here:<\/p>\n

\"\"<\/figure>\n

What is the dominant type of calcification that is present?<\/p>\n

A. Fine pleomorphic calcifications<\/p>\n

B. Large rod-like calcifications<\/p>\n

C. Vascular calcifications<\/p>\n

D. Linear calcifications<\/p>\n

\n

Answer<\/h4>\n
\n

C. Vascular calcifications<\/strong><\/p>\n

Explanation: <\/strong>These are benign vascular calcifications, present in a diffuse distribution bilaterally. These have the characteristic \u201ctram-track\u201d appearance.<\/p>\n

Note that \u201clinear\u201d is not a type of calcification like the other answer choices, but rather is a descriptor for the distribution of calcifications.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

\n

Question 3<\/h2>\n
\n

Although difficult to appreciate on the 2-D whole breast images provided above, there was a screen-detected mass in the lower inner quadrant of the right breast. Here is the mass noted on MLO and spot tomosynthesis CC images:<\/p>\n

\"\"<\/figure>\n
\"\"<\/figure>\n

What is the best descriptor for the margins of this mass on mammogram?<\/p>\n

A. Circumscribed<\/p>\n

B. Obscured<\/p>\n

C. Microlobulated<\/p>\n

D. Indistinct<\/p>\n

E. Spiculated<\/p>\n

\n

Answer<\/h4>\n
\n

E. Spiculated<\/strong><\/p>\n

Explanation: <\/strong>The numerous thin lines radiating outward from the mass are indicative of spiculated margins, which is a suspicious finding.<\/p>\n

A mass with circumscribed margins has at least 75% of its margins sharply demarcated and separable from the surrounding tissue.<\/p>\n

A mass with obscured margins has at least 25% of its margin hidden by superimposed or adjacent breast tissue.<\/p>\n

A mass with microlobulated margins has multiple small outward undulations.<\/p>\n

A mass with indistinct margins has no clear demarcation of its margin from the surrounding tissue.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Question 4<\/h2>\n
\n

Targeted ultrasound was performed, with a representative image of the mass shown here:<\/p>\n

\"\"<\/figure>\n

What is the best descriptor for the margins of this mass on ultrasound?<\/p>\n

A. Indistinct<\/p>\n

B. Angular<\/p>\n

C. Microlobulated<\/p>\n

D. Spiculated<\/p>\n

\n

Answer<\/h4>\n
\n

A. Indistinct<\/strong><\/p>\n

Explanation: <\/strong>This mass is not circumscribed on ultrasound. The margin between the majority of the mass and surrounding tissue is not clearly defined, and there is a lack of other features that would be seen with the other margin descriptors. This mass\u2019s sonographic margin is best described as indistinct.<\/p>\n

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Ultrasound-guided biopsy was performed, which yielded invasive ductal carcinoma.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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