Invasive Breast Carcinoma

Fig. 12.8a This large lesion (left) has changed the architecture of the neighboring breast tissue. The magnified view in another projection (right) displays the scirrhous extensions of the tumor into the glandular parenchyma. b This tumor does not visibly invade the surrounding tissue. Mammographically it could also be a cyst or a fibroadenoma. An ultrasound examination should definitely be performed for further characterization. c The ultrasound examination yields crucial additional information: There is definite distal echo shadowing. Cysts fall off the list of differential diagnoses. A core needle biopsy is performed right away under ultrasound guidance. The histological result was an invasive ductal carcinoma.

Hilar RetractionUltrasound Cyst Fibroadenoma CancerBreast Fibroadenoma After
Fig. 12.9 Lymph nodes typically show a little hilar retraction and a fine lobulation.

• Diagnosis: After some consideration Hannah has little doubt that this lesion is a breast cancer. On the magnified views she has also detected a little calcification, which is the case in up to 40% of all carcinomas (Fig. 12.10a). Dr. Skywang asks her to perform an ultrasound of the lesion, which also points towards a malignant character of the lesion (Fig. 12.10b). Dr. Skywang advises the patient to have an ultrasound-guided core needle biopsy done. Mrs. Rimzky agrees right away. The final result is available two days later: it is an invasive breast cancer. MRI of both breasts is then performed, which demonstrates several other lesions in close vicinity to the dominant lesion (Fig. 12.10c).

f In more than 40% of mastectomy specimens, pathologists i find additional foci of cancer that went undetected by mammography and/or ultrasound. Contrast-enhanced magnetic resonance tomography of the breast can find many of these lesions with great accuracy and reliability.

Mrs. Rimzky undergoes surgery only a few days later. Instead of the initially planned quadrantectomy, a complete mastectomy and axillary lymph node dissection is done. Fortunately the lymph nodes prove to be unaffected.

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