Tomosynthesis in fatty breasts

Case contribution: Dr Radhiana Hassan


  • A 42 years old lady
  • Came for screening mammogram
  • No family history of breast cancer

Mammogram findings:

  • The breasts are almost entirely fatty
  • There is a focal density at right upper outer quadrant
  • No obvious border to suggest mass lesion
  • No obvious stromal distortion
  • However, on tomosynthesis images, a mass with speculated margin is demonstrated.
  • No skin thickening. No nipple retraction. No abnormal axillary enlargement.

Ultrasound findings:

  • A lobulated hypoechoic lesion is seen at Rt9H, 5 cm from nipple
  • It measures about 9x9x11 mm
  • It is taller than its width
  • No posterior shadowing seen
  • No penetrating vessels
  • No abnormal axillary node

Progress of patient:

  • A tru-cut biopsy of right breast consistent with invasive carcinoma
  • Right mastectomy done
  • HPE: invasive carcinoma with no special type, Grade 2
  • 12 lymph nodes with no evidence of malignancy
  • TNM stage (pTNM) pT1bN0
  • ER/Pr +ve and HER2 –ve
  • CT scan thorax, abdomen and pelvis show no distant metastasis

Diagnosis: Invasive carcinoma of no special type


  • Studies showed DBT has the advantages over FFDM including increased cancer detection
  • One of the study reported cancer detection rate in 6 per 1000 DBT compared with 5.1 per 1000 for FFDM alone.
  • Screening recall rates were 8% for DBT and 10.4% for FFDM alone


Author: radhianahassan