Invasive ductal carcinoma in 49-year-old patient

Prof. Dr. Katja C. Siegmann-Luz, Diagnostic Breast Cancer Centre in Königs Wusterhausen, Germany.

Case description

The patient presented with a new, 3-week old palpable finding in the right breast. Normal findings in screening of dense glandular tissue and for macromastia. Sonography shows 24 mm diameter malignoma-typical lesion top right at 12 o’clock, BI-RADS 5. Poorly differentiated triple-negative breast cancer NST G3 confirmed by ultrasound-guided punch biopsy.

Lesion is marked with Tumark Vision (Image 1) with ultrasound guidance prior to neo-adjuvant chemotherapy. A tumor with 26 mm diameter surrounding the clip is differentiated in post-intervention breast tomosynthesis (Image 2).

Course of treatment

Sonographic check-up after 6 months of neo-adjuvant therapy shows partial remission of the tumor and an unchanged position of Tumark Vision (Image 3). Ultrasound-guided, pre-operative wire marking of the clip (Image 4), clearly visible in segment resectate (Image 5). Tissue margins are tumor-free (R0).

Conclusion

Long-term ultrasound visibility of the placed clip is helpful in planned breast-conserving surgery (BET) after neo-adjuvant therapy especially in case of tumor remissions and if tumor delimitation is limited. Thanks to its geometry, Tumark Vision can easily be delimited as hyperechoic ring-shaped structure.

Pictures

Image 1
Sonographic depiction of Tumark Vision within the cancer lesion measuring 24 mm prior to planned neo-adjuvant therapy.

Breast tomosynthesis right CC (left) and right ML (right) showing the clip (Tumark Vision) within the cancer lesion measuring 26 mm right top.

Image 2
Breast tomosynthesis right CC (left) and right ML (right) showing the clip (Tumark Vision) within the cancer lesion measuring 26 mm right top.

Breast sonography after 6-month neo-adjuvant chemotherapy showing Tumark Vision within the residual cancer measuring 10 mm after partial remission.

Image 3
Breast sonography after 6-month neo-adjuvant chemotherapy showing Tumark Vision within the residual cancer measuring 10 mm after partial remission.

Mammography right ML (left) and CC (right) images to monitor wire positioning after ultrasound-guided marking of Tumark Vision.

Image 4
Mammography right ML (left) and CC (right) images to monitor wire positioning after ultrasound-guided marking of Tumark Vision.

Sample radiography. Diagnostic exposure (left), magnification of raw image to show Tumark Vision (right).

Image 5
Sample radiography. Diagnostic exposure (left), magnification of raw image to show Tumark Vision (right).