Home / Training / Manuals / Atlas of breast cancer early detection / Cases

Atlas of breast cancer early detection

Filter by language: English / Русский
                                                                                                                         Go back to the list of case studies
                                                                                                                         Click on the pictures to magnify and display the legends
Case number:106
Age:49
Clinical presentation:Premenopausal woman presented with increased risk of developing breast cancer because of family history of endometrial and breast cancer. She presented for follow-up screening. Examination did not reveal any lumps in the breasts or axillae.


Mammography:


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:2013: Right breast, central portion of the breast, central zone, anterior third
 ‣ Mass:
   • Number:1
   • Size:None
   • Shape:Irregular
   • Margins:Indistinct
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:Present
 ‣ Associated features:None


Breast composition:ACR category b (there are scattered areas of fibroglandular density)
Mammography features:

 ‣ Location of the lesion:2017: Right breast, central portion of the breast, central zone, anterior third
 ‣ Mass:
   • Number:1
   • Size:0.6 cm
   • Shape:Round
   • Margins:Circumscribed
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:Present
 ‣ Associated features:None


Breast composition:ACR category b (there are scattered areas of fibroglandular density)
Mammography features:

 ‣ Location of the lesion:2018: Right breast, central portion of the breast, central zone, anterior third
 ‣ Mass:
   • Number:0
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:Present
 ‣ Associated features:None

Ultrasound:


Ultrasound features: 2013: Right breast, upper outer quadrant at 10 o'clock

 ‣ Mass
   • Location:2013: Right breast, upper outer quadrant at 10 o'clock
   • Number:1
   • Size:None
   • Shape:None
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Hypoechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Solitary dilated duct with bulbous terminal end and internal echoes
 ‣ Special cases:Solitary dilated duct


Ultrasound features: 2016: Right breast, upper outer quadrant at 10 o'clock

 ‣ Mass
   • Location:2016: Right breast, upper outer quadrant at 10 o'clock
   • Number:1
   • Size:None
   • Shape:None
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Hypoechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Stable solitary dilated duct with bulbous terminal end and internal echoes
 ‣ Special cases:Solitary dilated duct


Ultrasound features: 2017: Right breast, outer quadrants at 9 o'clock

 ‣ Mass
   • Location:2017: Right breast, outer quadrants at 9 o'clock
   • Number:1
   • Size:None
   • Shape:None
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Hypoechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Stable solitary dilated duct with bulbous terminal end and internal echoes
 ‣ Special cases:Solitary dilated duct

BI-RADS:

BI-RADS Category (2013): 3 (probably benign)
BI-RADS Category (MRI 2014): 3 (probably benign)
BI-RADS Category (MRI 2017 and Mammography 2018): 2 (benign)

Further assessment:

Further assessment advised: Further imaging with breast MRI

MRI:


MRI features:
 ‣ MRI features:MRI 2014: Amount of fibroglandular tissue: ACR category a (the breasts are almost entirely fatty). Background parenchymal enhancement: Minimal (< 25%), symmetrical

 ‣ Location:Right breast, upper quadrant
 ‣ Focus:No
 ‣ Mass:
   • Shape:Irregular
   • Margin:Indistinct
   • Internal enhancement:Heterogeneous
   • Kinetic curve:No
 ‣ Non-mass enhancement:
   • Distribution:No
   • Internal enhancement:No
 ‣ Non-enhancing findings:No
 ‣ Associated features:No
 ‣ Axillary nodes:No


Cytology:

Cytology features:

 ‣ Type of sample:FNAC
 ‣ Site of biopsy:
   • Laterality:Right
   • Quadrant:Non-palpable lesion seen on ultrasound at 9 o’clock
   • Localization technique:Ultrasound-guided
   • Nature of aspirate:Fatty material
 ‣ Cytological description:Smear reveals blood, a single cluster of benign ductal cells, and a few fragments of adipose tissue
 ‣ Reporting category:Insufficient material
 ‣ Diagnosis:Insufficient. Core biopsy advised
 ‣ Comments:None


Case summary:

Premenopausal woman with increased risk of developing breast cancer presented for routine screening, diagnosed as solitary dilated duct in right breast of suspicious morphology on initial assessment, BI-RADS category 3 on imaging. Regular follow-up for more than 5 years in view of family risk in many relatives, diagnosed as stable unchanged solitary dilated duct in right breast, BI-RADS category 2 on imaging.

Learning points:


  • If uncomplicated and in the absence of nipple discharge, solitary dilated duct is categorized as BI-RADS 2 (benign) or BI-RADS 3 (probably benign).
  • In this case, with a high family risk and more than one relative with carcinoma of the breast and uterus, BI-RADS 3 assessment protocol was followed. Short interval follow-up ultrasound at 6 months showed stability; after another 6 months (i.e. annual follow-up), mammogram also revealed no interval change. The finding has further remained stable on 5 years follow-up. The assessment category is BI-RADS 2.
  • Breast MRI has been performed for high-risk screening. BI-RADS 2 assessment category.

25 avenue Tony Garnier CS 90627 69366, LYON CEDEX 07 France - Tel: +33 (0)4 72 73 84 85
© IARC 2024 - Terms of use  -  Privacy Policy.