Intended for healthcare professionals

Endgames Picture Quiz

Breast imaging

BMJ 2008; 337 doi: (Published 17 September 2008) Cite this as: BMJ 2008;337:a1313
  1. Peter D Britton, consultant radiologist
  1. 1Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge CB2 2QQ
  1. peter.britton{at}

    Case history

    The figure shows the left and right mammograms of an 81 year old woman with a short history of a lump in the right breast. Clinical examination showed a mass in the upper outer quadrant, which felt as if it might be a breast carcinoma.


    • 1. What is shown in the right breast?

    • 2. What is shown in the left breast?

    • 3. What would be the next step in investigating this patient?


    Short answers

    • 1. An asymmetric density superiorly with some parenchymal deformity. Core biopsy showed an invasive lobular breast carcinoma.

    • 2. A partially well defined mass inferiorly. In a patient of this age even a well defined mass suggests malignancy. Core biopsy showed an invasive ductal carcinoma.

    • 3. Such patients undergo “triple” assessment—clinical examination, imaging, and, if necessary, needle biopsy in a multidisciplinary breast clinic.

    Long answer

    Any patient with a new breast lump should be referred to a specialist multidisciplinary breast clinic. Modern breast assessment consists of triple assessment—expert clinical examination, imaging (usually mammography and ultrasonography), and, if necessary, needle biopsy.1 The single most important risk factor for breast cancer is age, with the incidence of breast cancer rising throughout life. A patient presenting with a new discrete lump at the age of 81 years is at substantial risk of having a malignancy.2 Mammography is the first line imaging investigation for women over the age of 35 years.3 The mammographic features …

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