Case archive
Bilateral mammography is essential even if the complaint is unilateral
Author / Copyright: Dr. Shorouk Zaki (Banha University)
Clinical History
40 years old female with palpable painful left breast lump, no personal or family history of breast cancer.
Case Imaging Scenario
The patient underwent bilateral mammography and ultrasound despite having unilateral complaint as this is our policy in the breast imaging centre .Left breast palpable lesion was detected as an area of adenosis with no suspicious masses or cyts. Right breast highly suspicious multi-focal masses were detected on mammography (Figure a&b).
Complementary ultrasound at the upper inner quadrant near the chest wall given BI-RADS category 4c. (Figure 2).
Ultrasound guided biopsy was done that revealed IDC (invasive duct carcinoma).
Metallic clips was inserted within the largest mass upon the request of the oncologist and oncosurgeon prior to the neoadjuvant chemotherapy.
MRI was done for better staging of the case as well.
Figure 5: post contrast subtracted MRI images and MIP image: The right breast upper inner quadrant showed a deeply seated irregular speculated soft tissue mass lesion measuring about 12 mm in diameter showing intense post contrast enhancement and on plotting time intensity curve it showed type 3 washout curve (curve not shown). The mass is seen surrounded by few (3-4) sub-centimetric foci of similar enhancement and kinetic criteria.
Women over 30 with palpable breast masses are referred to diagnostic mammography which has in this context two roles, the first is to evaluate the palpable lesions and the second is to detect occult breast cancers in both breasts [1]. According to the ACR practice parameters revised 2018, a diagnostic mammogram may include full CC, MLO, and/or supplemental views to evaluate an area of
clinical or imaging concern [2]. This is done for both breasts at the same time and even digital breast tomosynthesis may be indicated [2].
In some clinical malpractice patient may be referred for unilateral mammography which is a wrong request as in this case if we followed the complaint of the patient the incidentally occult right breast cancer could not be diagnosed.
So, never to obey malpractice referral requests with unilateral mammography.
Teaching Points:
Diagnostic mammography is bilateral MLO and CC with or without additional views.
Never to obey the malpractice of some clinicians in referral of unilateral mammography.
Final Diagnosis:
Non palpable right breast UIQ multifocal invasive duct carcinoma.
Keywords:
Diagnostic mammography, bilateral examination, non-palpable breast cancer, IDC.
- Ability of mammography to reveal non palpable breast cancer in women with palpable breast masses, Eric L. Rosen, Edward Sickles, and Delia Keating, AJR 1999;172:309-312.
- ACR practice parameters for screening and diagnostic mammography, revised 2018
- Mammography and ultrasound were done at Samascan private center.
- MRI was done at Benha university hospitals.
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