A 65-year-old female presented with a palpable right breast nodule. Mammography showed a poorly marginated, high attenuating nodule in the right breast. Ultrasound revealed a poorly marginated, hypoechoic nodule infiltrating the chest wall. Both findings were compatible with mammary malignancy. A core biopsy was suggested due to a BIRADS category of 4 (suspicious abnormality).

1. Dr Faiza Rahman
MCPS trainee
Al-Noor Diagnostics

2.  Patient 65years old female presented at
Al.Noor diagnostics on 6th Feb. 2016 with
complain of palpable right mammary nodule
for 1 month.
 No associated complains of pain or discharge
 Family history of ca breast was also present
 No other positive family history.

3.  She was advised B/L mammography

4. RCC Shows
Partial view of
A poorly
marginated,
high
attenuating
nodule,
causing focal
distortion of
mammary
architecture.

5.  Mammography of the patient shows a
predominantly fatty parenchyma. Right breast
shows partial view of poorly marginated,high
attenuating nodule, causing focal distortion of
mammary architecture in its medial aspect. The
nodule could not be included in the MLO view
because of its peripheral location and proximity
to the chest wall. No evidence of clustered micro
calcifications or skin changes noticed. Nipple and
areola are also spared.
 Left breast essentially appears unremarkable.
 Small bilateral auxiliary nodes are also noticed.

6.  Here USG plays a significant role for
evaluation of the lesions which are located at
relatively difficult location which can not be
optimally included in Mammography
evaluation.

7. A poorly marginated, hypoechoic
nodule, infiltrating the posterior
chest wall, at periphery of 04-05
o’clock location of the right breast.

8.  Right mammary sonography shows a poorly marginated hypo
echoic nodule at periphery of 4-5 o’ clock position of the right
breast. The nodule measures 12x12x11mm and is infiltrating the
posterior chest wall. Another poorly marginated nodule
measuring 8x5mm also noticed within the subcutaneous location
overlying the mammary nodule.
 Left breast and bilateral axillary lymph nodes appear
unremarkable.
 Both the mammographic and sonographic features of the right
mammary nodule are compatible with the mammary malignancy.
(as it is high attenuating, poorly marginated causing focal
distortion of mammary architecture on mammogram and is
poorly marginated, hypo echoic with heterogeneous echo
distribution, infiltrating posterior chest wall on ultrasonography)
 BIRADS IV
 Suggestion: Core Biopsy

9.  There are 7 ACR BI-RADS standardized categories:
 Category 0, or “need additional imaging evaluation” (i.e. spot
compression and magnification views, along with other tailored
mammographic views.), is almost always used in screening
situation.
 Category 1, or “negative”, is used if there are no findings to
comment on.
 Category 2, or “benign findings”.(i.e lesion with well defined
margins, homogenous echodistribution, no lymph node
involvement)
 Category 3, or “probably benign findings” (initial short – interval
follow-up is suggested)
 Category 4, or “suspicious abnormality”, is used when a finding
has a definite probability of being malignant (biopsy advised).
 Category 5, or “highly suggestive of malignancy”.(i.e clustered
microcalcifications, skin changes or malignant lymph nodes)
 Category 6, or “known biopsy–proven malignancy”.

10. Malignant lesion
appears poorly
marginated,
hypo echoic with
heterogeneous
echo
distribution.
While benign
lesion shows well
defined margins
with
homogenous
internal echoes.