{"id":128,"date":"2025-05-29T17:10:08","date_gmt":"2025-05-29T17:10:08","guid":{"rendered":"https:\/\/depts.washington.edu\/breast-imaging-teach\/wordpress\/?p=128"},"modified":"2025-06-30T17:29:59","modified_gmt":"2025-06-30T17:29:59","slug":"case-5","status":"publish","type":"post","link":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=128","title":{"rendered":"Case 5"},"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
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A 48-year-old woman presents for 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
B. There are scattered areas of fibroglandular density
C. The breasts are heterogeneously dense
D. The breasts are extremely dense<\/p>\n

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Answer<\/h3>\n
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Either B. There are scattered areas of fibroglandular density, or 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 BI-RADS manual, which are listed above. Breast density is a subjective assessment of how much fibroglandular tissue compared to fat tissue is present in the breast, and also has a correlation to how difficult it may be to interpret a patient\u2019s mammogram. Woman who have \u201cdense\u201d breasts (heterogeneously or extremely dense) have a slightly increased risk of developing breast cancer compared to women with non-dense breasts. This patient\u2019s breasts were reported as being composed of scattered areas of fibroglandular density. Since this is a subjective determination, describing them as heterogeneously dense could also be acceptable.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Question 2<\/h2>\n
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A mass is present in the upper outer quadrant of the left breast:<\/p>\n

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

How is this mass best described?<\/p>\n

A. BI-RADS 0 (Incomplete); Recommend diagnostic mammogram and ultrasound
B. BI-RADS 2 (Benign); Recommend one year follow-up
C. BI-RADS 3 (Probably Benign); Recommend six month follow-up
D. BI-RADS 4 (Suspicious); Recommend biopsy<\/p>\n

\n

Answer<\/h3>\n
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B. BI-RADS 2 (Benign); Recommend one year follow-up<\/strong><\/p>\n

Explanation: <\/strong>This is the classic appearance of an intramammary lymph node on mammography. This is a normal breast structure, typically appearing as a circumscribed small mass on the mammogram with a lucent notch that corresponds to the anatomic fatty hilum. The most common location is in the upper outer quadrant. If the appearance is not quite classic, a history of stability on prior mammograms is reassuring that this is most likely a normal\/benign lymph node.<\/p>\n

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In this patient\u2019s case, her intramammary lymph node had been unchanged for many years and has the expected appearance of a lymph node on this post-contrast MRI image:<\/p>\n

\"\"<\/figure>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Contributed by: Steven J. Rockoff, MD and Diana L. Lam, MD – June 1, 2020<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-128","post","type-post","status-publish","format-standard","hentry","category-quiz"],"_links":{"self":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/128","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=128"}],"version-history":[{"count":6,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/128\/revisions"}],"predecessor-version":[{"id":667,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/128\/revisions\/667"}],"wp:attachment":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=128"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=128"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=128"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}