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Case number:167
Age:63
Clinical presentation:Postmenopausal woman who had undergone breast-conserving surgery in 2003 for right breast cancer presented for regular surveillance check-up. On clinical examination, a firm nodularity was noted at the scar site in the right breast.



Mammography:


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

 ‣ Location of the lesion:2012: Right breast, upper outer quadrant at 12 o’clock, posterior third, beneath surgical scar
 ‣ Mass:
   • Number:1
   • Size:
   • Shape:Irregular
   • Margins:Spiculated
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:Present
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Scar tissue with skin thickening


Mammography features:

 ‣ Location of the lesion:2017: Right breast, upper outer quadrant at 12 o’clock, posterior third, beneath surgical scar
 ‣ Mass:
   • Number:1
   • Size:
   • Shape:Irregular
   • Margins:Spiculated
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:Fat necrosis calcifications
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:Minimal
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Scar tissue with skin thickening


Mammography features:

 ‣ Location of the lesion:2018: Right breast, upper outer quadrant at 12 o’clock, posterior third, beneath surgical scar
 ‣ Mass:
   • Number:1
   • Size:
   • Shape:Irregular
   • Margins:Spiculated
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:Round, fat necrosis calcifications
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:Minimal
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Organized scar with fat necrosis calcifications

Ultrasound:


Ultrasound features: 2018: Right breast, upper quadrants at 12 o'clock

 ‣ Mass
   • Location:2018: Right breast, upper quadrants at 12 o'clock
   • Number:None
   • Size:None
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Angular
   • Echo pattern:Hypoechoic
   • Posterior features:Strong posterior shadowing
 ‣ Calcifications:Surgical scar macrocalcification
 ‣ Associated features:Architectural distortion
 ‣ Special cases:None

BI-RADS:

BI-RADS Category (Right BCS, post operative breast): 2 (benign)

Case summary:

Postmenopausal woman who underwent breast-conserving surgery in 2003 for right breast carcinoma presented with firm nodularity along the scar tissue. Diagnosed as organized scar with typically benign calcifications at surgical site, BI-RADS 2 on imaging.

Learning points:



  • In patients on annual surveillance after breast-conserving surgery, mammography is challenging because the normal breast architecture is altered after surgery.
  • The surgical scar usually decreases in density and/or size on serial imaging as is seen in this case. However, an increase in size or density on serial mammogram is suspicious for recurrence.

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