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Answer: Biopsy.

An ultrasound-guided breast biopsy was performed.

(Click on images to view larger versions.)

Findings:

  • MLO and CC views of the right breast show a 1.9 x 1.2 x 0.8 cm lobulated mass in the upper outer quadrant (yellow arrows)

  • Magnification compression view of the right breast confirms the presence of mass and demonstrates tiny microcalcifications (green arrows)

  • Targeted ultrasound of the right breast shows a 1.3 x 0.7 x 1.2 cm irregularly shaped hypoechoic mass that is poorly defined (red arrows). The mass is located at the 10:30 position.

Diagnosis: Invasive (infiltrating) ductal carcinoma.

Discussion:
  • Invasive (Infiltrating) ductal carcinoma is the most common invasive breast cancer, accounting for 65%-80% of cases.

  • Often incites a strong desmoplastic response.

  • Often asymptomatic; therefore annual screening mammography advised for women 40 and older (earlier if first degree relative with breast cancer).

  • Risk factors for breast cancer include age (more common in older women), family history (first degree relative), postmenopausal obesity, hormone replacement therapy, radiation to chest.

  • Mammographically, almost any density, with or without suspicious calcifications, can be infiltrating ductal carcinoma. The more irregular, lobulated, or spiculated the border, the more likely the lesion is malignant. An irregular mass with spiculated margins is highly suggestive of malignancy.  

  • Sonographically, infiltrating carcinomas tend to be hypoechoic or isoechoic relative to normal fibrous breast tissue. These lesions often demonstrate internal echoes and posterior acoustic shadowing. Irregular borders are suspicious for malignancy and lesions that are taller than they are wide are also worrisome.

  • Surgical removal of the tumor is the mainstay of treatment. Postsurgical radiation limits recurrence. Chemotherapy may be given before surgery if necessary to shrink the tumor (neo-adjuvant chemotherapy) or after surgery to limit recurrence (adjuvant chemotherapy).

References:
  • Bassett LW. Imaging of breast masses. Radiol Clin North Am. 2000;38:669-691, vii-viii.

  • Korans DB. Breast Imaging, 2nd ed. Philadelphia: Lippincott-Raven; 1998.

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