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e-CASES: Intermediate grade ductal carcinoma in situ

History

81-year-old patient who had had no screening for around ten years.

Hardened retroareolar plaque and of the junction of the upper quadrants on examination of the right breast.

Findings

Voluminous, spiculated mass with ACR 5 architectural distortion, predominating in the upper lateral quadrant of the right breast, but spilling over into the adjacent quadrants. Its large size can be better appreciated with tomosynthesis because of the significant breast density.
The ultrasound revealed an adjacent mass that was biopsied: intermediate grade ductal carcinoma in situ.
The surgeon, using the standard images as the basis, simply wanted to perform a quadrantectomy. The tomosynthesis, the results of which were confirmed by a work-up extension with MRI, was one argument in favour of a mastectomy.


Diagnosis

Intermediate grade ductal carcinoma in situ


Discussion

DCIS of intermediate grade treated by means of mastectomy even though the surgeon initially wanted to perform a simple tumorectomy (edges of the lesion poorly identified on the mammogram images)


Key points

Here, the tomosynthesis was of no use in the characterisation of the lesion, which was very easily classified ACR 5.
On the other hand, this case makes it possible to illustrate how tomosynthesis can help both quickly and easily in the work-up extension, by showing where the precise edges of a lesion are, including in dense breast tissue.



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