Seven cases of difficult subtle lesions are presented in which DBT has been used as an adjunct to standard 2DM during the localization process. DBT in cranio-caudal and medio-lateral projections was used to check the position of the needle during the procedure allowing 3D localization of the wire. DBT of the specimen was performed after surgery to demonstrate the mammographic abnormality.
CASE 1
Soft Tissue Density:
Fig.: FIRST CASE: DBT
Post wire 2D mammogram:
Fig.: 2D post wire
Is the tip of the wire within the lesion?
Post wire DBT:
Fig.: DBT post wire
Yes it is!
(G2 Invasive Ductal Carcinoma)
CASE 2
Distortion:
Fig.: SECOND CASE: 2D Mag
Post wire 2D mammogram:
Fig.: 2D post wire
Post wire DBT:
Fig.: DBT post wire
DBT clearly shows the wire within the lesion.
Specimen DBT:
Fig.: DBT specimen
The distortion has been removed (Radial Scar/ Complex Sclerosing Lesion and Lobular In Situ Neoplasia).
CASE 3
Anterior Distortion:
Fig.: THIRD CASE: 2D
(Radial Scar/ Complex Sclerosing Lesion)
DBT:
Fig.: DBT
There is another distortion posteriorly!
2D mammogram post wire localization of the posterior lesion:
Fig.: 2D post wire
DBT:
Fig.: DBT post wire
DBT allows a better visualization of the wire through the subtle second distortion. (Radial Scar with low grade DCIS)
CASE 4
Possible Distortion in a dense parenchyma:
Fig.: FOURTH CASE: 2D
DBT was performed and confirmed the distortion:
Fig.: DBT
Post wire DBT demonstrates the correct localization:
Fig.: DBT post wire
Surgical excision: Radial Scar/ Complex Sclerosing Lesion
CASE 5
Asymmetric Density:
Fig.: FIFTH CASE 2D Mag
Post wire DBT shows the wire within the lesion:
Fig.: DBT post wire
The lesion is visualized at the specimen DBT:
Fig.: DBT specimen
G2 Invasive Ductal Carcinoma.
CASE 6
Subtle Lesion:
Fig.: SIXTH CASE: DBT
DBT post wire:
Fig.: DBT post wire
Grade 1 Invasive Ductal Carcinoma.
CASE 7
Distortion:
Fig.: SEVENTH CASE: 2D
Specimen DBT shows that the distortion has been removed:
Fig.: DBT specimen
Grade 1 Invasive Ductal Carcinoma and low grade DCIS.