{"id":200,"date":"2025-06-03T21:27:51","date_gmt":"2025-06-03T21:27:51","guid":{"rendered":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=200"},"modified":"2025-06-30T10:22:00","modified_gmt":"2025-06-30T18:22:00","slug":"case-11","status":"publish","type":"post","link":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=200","title":{"rendered":"Case 9"},"content":{"rendered":"

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

\n

Question 1<\/h2>\n
\n

A 63-year-old woman presents for a screening mammogram. She has a history of right breast cancer 10 years ago with treatment that included lumpectomy. The right breast is shown here:<\/p>\n

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

What is the best description for the most concerning abnormality found on this exam?<\/p>\n

A. Mass
B. Architectural Distortion
C. Focal Asymmetry
D. Asymmetry<\/p>\n

\n

Answer<\/h3>\n
\n

D. Asymmetry<\/strong><\/p>\n

\"\"<\/figure>\n

Explanation: <\/strong>There is an asymmetry in the medial right breast which is seen only on the CC projection, with no MLO view correlate. According to the ACR BI-RADS Atlas, an asymmetry is a unilateral deposit of fibroglandular tissue that does not meet the definition of a mass and is seen on only one mammographic projection (this is in contrast to a focal asymmetry, which is seen on two projections).<\/p>\n

There are findings related to prior lumpectomy and radiation in the posterior right breast. With the exception of a slight increase in several benign-appearing dystrophic calcifications, these post-treatment findings are stable compared to last year\u2019s mammogram and not worrisome.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

\n

Question 2<\/h2>\n
\n

After identifying the asymmetry, what is your assessment and recommendation for this screening mammogram (assume the left breast appears normal)?<\/p>\n

A. BI-RADS 0 (Incomplete); Recommend diagnostic mammogram and ultrasound
B. BI-RADS 1 (Negative); Recommend one-year follow-up
C. BI-RADS 2 (Benign); Recommend one-year follow-up
D. BI-RADS 3 (Probably Benign); Recommend six-month follow-up
E. BI-RADS 4 (Suspicious); Recommend biopsy<\/p>\n

\n

Answer<\/h3>\n
\n

A. BI-RADS 0 (Incomplete); Recommend diagnostic mammogram and ultrasound<\/strong><\/p>\n

Explanation: <\/strong>The appropriate next step is a diagnostic work-up, starting with a diagnostic mammogram, and following with an ultrasound if the asymmetry persists on the spot diagnostic images. Although a new asymmetry is worrisome, there is a possibility that it represents superimposition of normal fibroglandular tissue, and so it would not be appropriate to jump straight to biopsy.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

\n

Question 3<\/h2>\n
\n

The asymmetry persisted on the diagnostic mammogram and an ultrasound looking for the abnormality in the medial half of the right breast was performed. This is a representative image from the diagnostic ultrasound.<\/p>\n

\"\"<\/figure>\n

What is your assessment and recommendation?<\/p>\n

A. BI-RADS 0 (Incomplete); Recommend MRI
B. BI-RADS 3 (Probably Benign); Recommend six-month follow-up
C. BI-RADS 4 (Suspicious); Recommend stereotactic biopsy
D. BI-RADS 4 (Suspicious); Recommend ultrasound-guided biopsy<\/p>\n

\n

Answer<\/h3>\n
\n

D. BI-RADS 4 (Suspicious); Recommend ultrasound-guided biopsy<\/strong><\/p>\n

Explanation: <\/strong>This irregular mass is suspicious and should be biopsied (BI-RADS 4). When a mass is visible on both ultrasound and mammogram, an ultrasound-guided biopsy is usually preferred over a stereotactic biopsy, as the former option is usually more comfortable for the patient and allows for real-time visualization of the target by the performing physician. Additionally, there may be technical challenges in performing stereotactic biopsy on a far posterior mass such as this one.<\/p>\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-200","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\/200","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=200"}],"version-history":[{"count":4,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/200\/revisions"}],"predecessor-version":[{"id":723,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/200\/revisions\/723"}],"wp:attachment":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=200"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=200"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=200"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}