Breast Masses with Dr. Shannon Falcon

Shannon Falcon, MD

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Breast Masses

Introduction

Hi, I am Dr. Shannon Falcon. I'm going to be presenting on breast masses today. I have no financial relationships or conflicts of interest to disclose.

Objectives

  • Define a mass on breast imaging and understand the BI-RADS Atlas fifth edition lexicon of mass descriptors for mammogram and ultrasound.
  • Confidently apply the lexicon to breast cases.
  • Review the clinical implications of characterizing masses using these descriptors.

Topics

  • Definition and criteria of a breast mass
  • Mass descriptors for mammography and ultrasound
  • Clinical implications and management decisions
  • Case studies and application of descriptors

Case Summaries

Case 1: 68-year-old Female

Presented for a screening mammogram. Identified an uncommon anatomic variant resembling a mass, but it was located at the medial aspect of the pectoral major muscle.

Case 2: 62-year-old Female

History of DCIS. Presented for screening. Identified a well-circumscribed mixed density mass, classic hamartoma.

Case 3: 47-year-old Female

Presented for annual screening. Identified an oval mass with circumscribed margins. Biopsy revealed PASH (pseudoangiomatous stromal hyperplasia).

Case 4: 36-year-old Female

History of thyroid cancer. Identified an oval hypoechoic mass with angular margins on ultrasound. Biopsy revealed a tubular adenoma.

Case 5: 57-year-old Female

Presented for annual screening. Identified multiple bilateral skin-based masses consistent with neurofibromatosis.

Case 6: 34-year-old Female

Presented with a palpable abnormality. Identified an oval hypoechoic mass with circumscribed margins. Follow-up showed significant growth. Biopsy revealed a malignant phyllodes tumor.

Case 7: 31-year-old Female

Presented with a palpable abnormality. Initial ultrasound showed a hypoechoic mass with circumscribed margins. Follow-up showed significant growth. Biopsy revealed a malignant phyllodes tumor.

Case 8: 57-year-old Female

Presented with right bloody nipple discharge. Identified an intraductal mass with marked internal vascularity, consistent with an intraductal papilloma.

Case 9: 68-year-old Female

Presented for screening. Identified an irregular mass inseparable from the nipple areolar complex. Biopsy revealed a subareolar malignancy.

Case 10: 47-year-old Female

Presented for annual screening. Identified a subtle asymmetry on tomosynthesis. Biopsy revealed a mucinous or colloid carcinoma.

Case 11: 58-year-old Female

Presented with a left palpable abnormality. Identified a hypoechoic mass with indistinct margins on ultrasound. Biopsy revealed a metaplastic carcinoma.

Case 12: 31-year-old Female

Presented with a right palpable mass. Initial ultrasound showed a circumscribed mass. Biopsy revealed a medullary carcinoma.

Conclusion

Thank you so much for listening. I hope you learned more about using the BI-RADS descriptors, how to use them appropriately, and what they mean when you use them. Be thoughtful with your words, always choose the most suspicious margin, and don't hesitate to biopsy if something doesn't feel right. Use BI-RADS 5 appropriately to guide patient management effectively.