49-year-old patient presented for a bilateral screening mammogram as well as a bilateral screening ultrasound due to dense breast tissue. On mammography, dense breast tissue was noted and no suspicious masses or calcification were seen in either breast.

Screening ultrasound demonstrated a 10 mm irregular, hypoechoic mass in the 2:00 position of the left breast.  An ultrasound guided needle core biopsy of the mass was performed.

Needle core biopsy of the left breast lesion was performed under ultrasound guidance revealing invasive lobular carcinoma. An MRI for extent of disease evaluation was performed which demonstrated an enhancing mass in the right breast, which was not previously detected. An MRI guided needle core biopsy was performed of the contralateral breast MRI finding revealing a complex sclerosing lesion. Both lesions biopsied were mammographically occult in this patient with dense breast tissue.

Mammography is still the gold standard for detecting breast cancers. It can detect up to 98% of breast cancers in fatty replaced and scattered tissue, however only 48% of cancers are detected in dense breast tissue utilizing mammography only. Ultrasound, when used as a screening tool, can detect breast cancers that are not visualized on mammography. In one study, ultrasound was shown to yield 3.25 per 1,000 cancers in women with dense breast tissue and normal mammograms.

Weigert J, Steenbergen S. The Connecticut Experiment: The role of ultrasound in the Screening of Women With Dense Breasts. 

Image IQ

Mammography

49-year-old patient presented for bilateral screening mammogram as well as bilateral screening ultrasound due to dense breast tissue.

Image IQ: Ultrasound Screening of Dense Breasts