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Atlas of breast cancer early detection

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Case number:161
Age:44
Clinical presentation:Premenopausal woman with increased risk of breast carcinoma because of family history of breast cancer presented in 2012 for screening. CBE did not reveal any abnormality.


Mammography:


Breast composition:ACR category c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:

 ‣ Location of the lesion:2012: Right breast, upper inner quadrant at 1 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:1.8 × 1.0 cm
   • Shape:Oval
   • Margins:Partly circumscribed and partly indistinct
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:Suspicious calcifications
   • Distribution:Grouped, > 5 in number, in < 2.0 cm of breast tissue
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


Mammography features:

 ‣ Location of the lesion:2012: Left breast, upper inner quadrant at 10 o’clock, posterior third
 ‣ Mass:
   • Number:0
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:Single macrocalcification focus
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


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

 ‣ Location of the lesion:2017: Follow-up at year 5: Right breast, upper inner quadrant at 1 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:1.7 × 1.0 cm
   • Shape:Oval
   • Margins:Partly circumscribed and partly indistinct
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:Coarse macrocalcifications
   • Suspicious:None
   • Distribution:In mass
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


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

 ‣ Location of the lesion:2017: Follow-up at year 5: Left breast, upper inner quadrant at 10 o’clock, posterior third
 ‣ Mass:
   • Number:0
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:Single macrocalcification focus
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


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

 ‣ Location of the lesion:2018: Follow-up at year 6: Right breast, upper inner quadrant, 1 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:1.7 × 1.0 cm
   • Shape:Oval
   • Margins:Partly circumscribed and partly indistinct
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:Coarse macrocalcifications
   • Suspicious:None
   • Distribution:In mass
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


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

 ‣ Location of the lesion:2018: Follow-up at year 6: Left breast, upper inner quadrant at 10 o’clock, posterior third
 ‣ Mass:
   • Number:0
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:Single macrocalcification focus
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None

Ultrasound:


Ultrasound features: 2012: Right breast, upper quadrants at 12 o’clock

 ‣ Mass
   • Location:2012: Right breast, upper quadrants at 12 o’clock
   • Number:1
   • Size:1.0 × 0.8 cm
   • Shape:Oval
   • Orientation:Not parallel
   • Margins:Circumscribed, 2–3 lobulations present
   • Echo pattern:Hypoechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:None
 ‣ Special cases:None

BI-RADS:

BI-RADS Category (2012): 3 (probably benign)
BI-RADS Category (at follow-up (2017)): 2 (benign)
BI-RADS Category (at follow-up (2018)): 2 (benign)

Case summary:

Premenopausal woman with increased risk of breast cancer because of family history of breast cancer in a first-degree relative presented for mammography screening. She attended for regular annual follow-up for 6 years. On initial assessment, diagnosed as grouped calcifications of suspicious morphology in right breast, BI-RADS 3 on imaging. At 6 year follow-up, diagnosed with involuting (partially calcified) fibroadenoma in right breast, BI-RADS 2 on imaging, and stable, typically benign calcifications in left breast, BI-RADS 2 on imaging.

Learning points:


  • BI-RADS 3 finding has < 2% risk of malignancy.
  • In this case a faint, probably benign, non-palpable mass with grouped calcifications is seen in the right breast.
  • Follow-up was done to ascertain stability and the mass was confirmed as showing morphological features of involuting fibroadenoma. The final BI-RADS assessment was downgraded to BI-RADS 2 (benign).

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