{"id":79,"date":"2025-05-29T15:35:45","date_gmt":"2025-05-29T15:35:45","guid":{"rendered":"https:\/\/depts.washington.edu\/breast-imaging-teach\/wordpress\/?p=79"},"modified":"2025-06-30T17:20:20","modified_gmt":"2025-06-30T17:20:20","slug":"case-1","status":"publish","type":"post","link":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=79","title":{"rendered":"Case 1"},"content":{"rendered":"

Contributed by: Steven J. Rockoff, MD and Diana L. Lam, MD \u2013 June 1, 2020<\/p>\n

\n

Question 1<\/h2>\n
\n

An 82-year-old woman presents for a screening mammogram:<\/p>\n

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

What is the dominant abnormality?<\/p>\n

A. Mass in the right breast
B. Mass in the left breast
C. Focal asymmetry in the right breast
D. Focal asymmetry in the left breast
E. No abnormality<\/p>\n

\n

Answer<\/h4>\n
\n

B. Mass in the left breast<\/strong><\/p>\n

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

Explanation: <\/strong>According to the ACR BI-RADS Atlas, a mass is a three dimensional, space-occupying finding that is seen on two different mammographic projections. It has convex-outward borders and is usually dense in the center compared to its periphery.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Question 2<\/h2>\n
\n

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

A. BI-RADS 4 (Suspicious); Ultrasound-guided biopsy
B. BI-RADS 4 (Suspicious); Stereotactic biopsy
C. BI-RADS 0 (Incomplete); Diagnostic MRI
D. BI-RADS 0 (Incomplete); Diagnostic mammogram and ultrasound<\/p>\n

\n

Answer<\/h4>\n
\n

D. BI-RADS 0 (Incomplete); Diagnostic mammogram and ultrasound<\/strong><\/p>\n

Explanation: <\/strong>One must become familiar with the BI-RADS Assessment Categories and their corresponding management recommendations. The next step in the work-up of a screen-detected, potentially suspicious mass is diagnostic mammography and ultrasound. In this situation, BI-RADS Assessment Category 0 (\u201cNeed Additional Imaging Evaluation\u201d) should be assigned and the patient is recalled for dedicated imaging of the finding.<\/p>\n

Left breast diagnostic mammogram performed with spot compression confirmed the presence of an irregular mass with obscured margins:<\/p>\n

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

Question 3<\/h2>\n
\n

Targeted ultrasound at the 12:00 position revealed:<\/p>\n

\"\"<\/figure>\n

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

A. Circumscribed
B. Angular
C. Microlobulated
D. Indistinct
E. Spiculated<\/p>\n

\n

Answer<\/h4>\n
\n

C. Microlobulated<\/strong><\/p>\n

Explanation:<\/strong> A mass\u2019s margins can appear different between the mammographic and sonographic modalities. When assessing sonographic mass margins, the first step is to determine if this mass is circumscribed (sharply-defined around the entire circumference with an abrupt transition between the mass and surrounding normal tissue) or not circumscribed. \u201cNot circumscribed\u201d is further subdivided into:<\/p>\n

    \n
  1. A<\/strong>ngular<\/li>\n
  2. I<\/strong>ndistinct<\/li>\n
  3. M<\/strong>icrolobulated<\/li>\n
  4. S<\/strong>piculated<\/li>\n<\/ol>\n

    The ultrasound margins of this mass are best described as microlobulated, meaning that the dominant feature is multiple small undulations.<\/p>\n

    A helpful mnemonic to remember the non-circumscribed types of margins is \u201cAIMS<\/strong>\u201c.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

    \n

    Question 4<\/h2>\n
    \n

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

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

    \n

    Answer<\/h4>\n
    \n

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

    Explanation:<\/strong> Diagnostic mammogram and ultrasound has confirmed the presence of a suspicious mass. BI-RADS Assessment Category 4 (\u201cSuspicious\u201d) is assigned and tissue sampling with biopsy is recommended in order to arrive at the final diagnosis. When technically feasible, ultrasound-guided biopsy is preferred over stereotactic biopsy due to the ability to see the target in real time while acquiring samples.<\/p>\n

    \"\"<\/figure>\n

    Ultrasound-guided biopsy revealed invasive ductal carcinoma.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

    \n","protected":false},"excerpt":{"rendered":"

    Contributed by: Steven J. Rockoff, MD and Diana L. Lam, MD \u2013 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-79","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\/79","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=79"}],"version-history":[{"count":8,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/79\/revisions"}],"predecessor-version":[{"id":658,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/79\/revisions\/658"}],"wp:attachment":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=79"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=79"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=79"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}