{"id":228,"date":"2025-06-03T21:55:38","date_gmt":"2025-06-03T21:55:38","guid":{"rendered":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=228"},"modified":"2025-06-30T10:22:53","modified_gmt":"2025-06-30T18:22:53","slug":"case-14","status":"publish","type":"post","link":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=228","title":{"rendered":"Case 12"},"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 40-year-old woman presents for a baseline screening mammogram:<\/p>\n

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

You note a large mass in the left breast. What is the best description for the location of this mass?
A. 1:00 (upper outer quadrant)
B. 1:00 (upper inner quadrant)
C. 5:00 (lower outer quadrant)
D. 5:00 (lower inner quadrant)
E. 11:00 (upper inner quadrant)
F. 11:00 (upper outer quadrant)<\/p>\n

\n

Answer<\/h3>\n
\n

A. 1:00 (upper outer quadrant)<\/strong><\/p>\n

Explanation:<\/strong> To interpret a mammogram, one must become familiar with the proper way to describe the location of a finding such as a mass or calcifications. Standard reporting should include the following:<\/p>\n

    \n
  • Laterality (left or right breast)<\/li>\n
  • Quadrant (upper outer, upper inner, lower outer, or lower inner)<\/li>\n
  • O\u2019clock face (i.e. 12:00, 1:00, 2:00, etc\u2026)<\/li>\n<\/ul>\n

    O\u2019clock face is determined by visualizing that you are standing in front of the patient, looking at the breast with a clock superimposed upon it. Note that any o\u2019clock position will not be in the same quadrant of each breast (i.e. a 2:00 mass in the right breast is upper inner quadrant, but a 2:00 mass in the left breast is upper outer quadrant).<\/p>\n

    As per the ACR BI-RADS manual, other location descriptors that can be used are:<\/p>\n

      \n
    • Depth (anterior third, middle third, or posterior third)<\/li>\n
    • Distance from the nipple<\/li>\n
    • A few terms that can be used in lieu of a quadrant: \u201ccentral\u201d, \u201cretroareolar\u201d, \u201caxillary tail\u201d<\/li>\n<\/ul>\n

      Determining the quadrant and o\u2019clock face of a finding requires being familiar with the standard display of a mammogram. If you are not yet familiar with the orientation of a mammogram, see the below annotations:<\/p>\n

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

      Question 2<\/h2>\n
      \n

      What is your assessment and recommendation after reading the screening mammogram?
      A. BI-RADS 0 (Incomplete); Recommend diagnostic 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 ultrasound<\/strong><\/p>\n

      Explanation:<\/strong> This is the patient\u2019s first (baseline) mammogram and there is a left breast mass in the upper outer quadrant that needs further characterization before deciding final management. Targeted diagnostic ultrasound is the correct next step.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

      \n

      Question 3<\/h2>\n
      \n

      The ultrasound of the expected position of the mass is performed. A representative image:<\/p>\n

      \"\"<\/figure>\n

      What is your assessment and recommendation?
      A. BI-RADS 0 (Incomplete); Recommend diagnostic MRI
      B. BI-RADS 1 (Negative); One year follow-up
      C. BI-RADS 2 (Benign); One year follow-up
      D. BI-RADS 3 (Probably Benign); Six month follow-up
      E. BI-RADS 4 (Suspicious); Ultrasound-guided biopsy
      F. BI-RADS 5 (Highly Suspicious); Ultrasound-guided biopsy<\/p>\n

      \n

      Answer<\/h3>\n
      \n

      D. BI-RADS 3 (Probably Benign); Six month follow-up<\/strong><\/p>\n

      \"\"<\/figure>\n

      Explanation:<\/strong> This non-palpable, solid, circumscribed oval mass can be assessed as \u201cProbably Benign\u201d, meaning that it has a less than a 2% chance of being malignant. The assessment of BI-RADS 3 can be given with a recommendation for short term follow-up (diagnostic ultrasound in six months). Once two years of stability has been documented for this mass, it can finally be designated benign with no specific follow-up needed.<\/p>\n

      As per the ACR BI-RADS manual 5th edition, there are three mammographic findings which can be designated as BI-RADS 3, Probably Benign:<\/p>\n

        \n
      1. A solid mass which is non-palpable, non-calcified, circumscribed, oval or round\u00a0(as seen in this case)<\/strong>.<\/li>\n
      2. A non-palpable focal asymmetry with no ultrasound correlate.<\/li>\n
      3. A solitary group of punctate calcifications.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
        \n

        Question 4<\/h2>\n
        \n

        Maybe you were wondering about the smaller mammographic mass that is posterior to the dominant mass. Here is the ultrasound of that second mass:<\/p>\n

        \"\"<\/figure>\n

        What is this mass?
        A. Cyst
        B. Hamartoma
        C. Lymph Node<\/p>\n

        \n

        Answer<\/h3>\n
        \n

        C. Lymph Node<\/strong><\/p>\n

        Explanation: <\/strong>This is the normal sonographic appearance of an intramammary lymph node, with a thin hypoechoic cortex and a hyperechoic fatty hilum.<\/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-228","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\/228","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=228"}],"version-history":[{"count":3,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/228\/revisions"}],"predecessor-version":[{"id":726,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/228\/revisions\/726"}],"wp:attachment":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=228"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=228"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=228"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}