Question 1665
{"accessible":true,"alternatives":[{"id":8284,"text":"bilateral breast MRI"},{"id":8286,"text":"digital breast tomosynthesis"},{"id":8288,"text":"staging CT scan of the chest, abdomen and pelvis"},{"id":8287,"text":"standard digital mammogram"},{"id":8285,"text":"targeted breast ultrasound"}],"archived":false,"correctAlternativeId":8285,"explanation":"\u003cp\u003eTargeted ultrasound is the most appropriate next step – to confirm the presence of a solid mass, and facilitate image-guided biopsy.\u0026nbsp; The axilla can also be assessed at the same time.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003eThere is no need to perform breast MRI for staging where the CESM is diagnostic – the sensitivity of CESM and MRI are comparable.\u0026nbsp;\u003c/p\u003e\u003cp\u003eTomosynthesis is indicated in the assessment of possible distortions and soft-tissue masses, to confirm or exclude their presence and is most often utilized in screening assessment.\u0026nbsp;\u003c/p\u003e\u003cp\u003eThe low energy component of a CESM is equivalent to a standard digital mammogram – there is no need to perform both.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003eMetastatic disease at diagnosis is rare in primary breast cancer - CT is appropriate in some cases (e.g. locally advanced disease), but only following a confirmed diagnosis.\u003c/p\u003e","id":1665,"imageUrl":"https://prod-images-static.radiopaedia.org/images/52956452/30c0d3e1cc9cf2b3c3881a72778bb5_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":79131},"imageAttributionCaseInfo":{"title":"Breast cancer on contrast mammogram","contributor_name":"Sarah Tennant","contributor_param":"dr-sarah-tennant","case_rid":79131,"case_param":"breast-cancer-on-contrast-mammogram"},"firstQuestionPath":"/questions/1665","nextQuestionPath":null,"relatedArticles":[{"id":1644,"title":"Mammography","link":"/articles/mammography?lang=us"},{"id":12182,"title":"Breast MRI","link":"/articles/breast-mri?lang=us"},{"id":15406,"title":"Contrast-enhanced mammography","link":"/articles/contrast-enhanced-mammography-2?lang=us"},{"id":2681,"title":"Breast ultrasound","link":"/articles/breast-ultrasound-1?lang=us"}],"alsoUsedIn":[{"id":648,"kind":"Course","title":"Radiopaedia 2020 - Lectures Only - page 648","link":"https://radiopaedia.org/courses/radiopaedia-2020-exclusive/pages/648"},{"id":648,"kind":"Course","title":"2020 Virtual Conference Private Use - page 648","link":"https://radiopaedia.org/courses/2020-virtual-conference-private-use/pages/648"}],"stem":"\u003cp\u003eA 50 year old female presents with a new lump in the left breast and undergoes contrast mammography.\u0026nbsp; The left CC recombined image is shown.\u0026nbsp; The low energy image showed no additional finding.\u0026nbsp;\u003c/p\u003e\u003cp\u003eThe most appropriate next step would be:\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1665"}],"attemptsPercentages":[{"alternativeId":"8286","percentage":6},{"alternativeId":"8284","percentage":11},{"alternativeId":"8287","percentage":7},{"alternativeId":"8285","percentage":70},{"alternativeId":"8288","percentage":6}],"promptToLogin":false,"questionManager":false,"articleId":"digital-breast-tomosynthesis"}