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e-CASES: Discordance in imaging with macro-biopsy and no tumoral elements: decision taken for monitoring

History

Pre-menopausal.
Had 4 children (the first at the age of 20), all breastfed.
Puberty around the age of 15 years.
No personal or family history of breast or ovarian cancer.
Clinical examination without particularity: breasts soft, axillae free.

Findings

Asymmetry in the infracentimetric density, seen only from the cranio-caudal position, profoundly retroareolar, persistent after localised compression.
On the other hand, the tomosynthesis was in favour of an image constructed from several projecting structures.
Ultrasound did not play a part in this (difficult on large breasts).
Given the discordance between the tomosynthesis and the standard images, and the lack of distance from this first examination, a stereotactic macro-biopsy was performed, with a good result with regard to the positioning: it revealed fatty, glandular tissue with no tumoral lesions.
The patient should be seen again at 6 months.


Diagnosis

Discordance in imaging with macro-biopsy and no tumoral elements: decision taken for monitoring


Discussion

As in the previous case, here the tomosynthesis was of use in the characterisation of the density asymmetry, making it possible to reveal the relationships between the different structures within the breast and thus to understand how these structures are superimposed to finally produce a worrying image.



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