Role of tangential spot-compression view in assessment of a small palpable mass turned out to be a Multi-focal disease

Author / Copyright: Dr. Eman Ewais (Breast Imaging Specialist and Educator)

Clinical History

A 50 yrs old generally healthy female patient presented by a recently felt palpable lump in her left breast she has no personal history of breast cancer or breast surgery. Positive family history of breast cancer (sister at post-menopausal age).

Case Imaging Scenario

Patient was initially assessed by digital mammography standard views (bilateral mediolateral oblique (MLO) and craniocaudal (CC) views of the breasts), which showed a small focal asymmetry at the LOQ middle third of the left breast about 4 o’clock in position. [Figure 1]. Right breast mammogram was normal.

Targeted evaluation by hand held high resolution ultrasound was performed and showed a small papion-shaped, irregular, taller than wider, hypoechoic solid lesion at the left breast 4 o’clock corresponding to the mammographic focal asymmetry location and patient area of complaint. It measured about 8 x 6 x 5 mm in maximum dimensions. Doppler ultrasound showed an abnormal peripheral vessel. It was also surrounded by an echogenic halo. Findings were of high suspicion of malignancy. [Figure 2].

The initially noted mammographic findings were poorly characterized as a mass despite the low density of this ACR B breast, so, there was a need to confirm the concordance between mammography and ultrasound findings and It was notable in ultrasound that the lesion is superficial in location so an additional tangential spot-compression view was performed at 60o angle and showed an irregular bi-lobed mass of high density and irregular margin consistent with ultrasound suspicious findings [Figure 3].  The mass was given a BI-RADS category 4c and referred for biopsy which confirmed a diagnosis of invasive ductal carcinoma.