PMC9096758_01
A millimetric density was observed in the upper quadrant of the right breast in annual serial mammograms. a A small nodular density mimics an IMLN. b Minor difference in size and density. c Increase in density and partially obscured margins. d Significant increase in size and density, indistinct margins, particularly at the anterior part of the lesion
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Fig1
A 3 mm in size nodular opacity with smooth borders was observed in the upper part of the right mediolateral oblique (MLO) radiograph for the first time in 2016 (Fig. 1a). For the following three years, this density was accepted as an intramammary lymph node (IMLN) due to its localization by different radiology residents because of the lack of an expert breast radiologist (Fig. 1b, c). However, when 2018 was accepted as the breaking point, it was observed that the density of the lesion slightly increased, and the edges of the lesion were no longer smooth but partially obscured (Fig. 1c). When the patient, who did not participate in the screening program because of the COVID-19 pandemic, finally applied in late 2020, it was noted that the lesion became completely hyperdense in addition to enlargement (Fig. 1d).
Sonographic findings. a The vertically oriented hypoechoic lesion, irregular in shape with indistinct margins. b No vascular coding in color Doppler image. c High elasticity features with shear wave elastography
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Fig2
Toshiba Medical Systems Corporation, Canon Inc, Japan) (Fig. 2a). No significant vascularization was observed in the lesion on color Doppler images (Fig. 2b). High elasticity values were obtained simultaneously (Fig. 2c).
Illustration of volumetric increase relative to serial mammograms. First line: The largest diameter of the density on mammography (mm) Second line: The volumetric measurement of the density (mm3)
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Fig3
While the lesion continued to grow quite insidiously over the years in the two-dimensional plane, we calculated how much the lesion enlarged in three dimensions retrospectively (Fig. 3).