Findings:Spiculated mass progressively increasing in size.

9/23/88
Asymmetry on right, but no dominant mass, pathologic calcifications, distortion or skin thickening.

6/26/91
Read as negative. No change.

10/20/92
Read as negative. No change.

5/16/94
Read as negative. No change. Stellate mass was thought to represent asymmetric normal tissue due to lack of progression from previous studies. Clinical follow-up was recommended due to a new palpable mass. Patient never received biopsy at this time.

10/18/95
Spiculated mass again identified, with new microcalcifications and now more dense. Read as highly suspicious for carcinoma. Biopsy recommended.

10/26/95
Biopsy after needle localization containing spiculated mass.

Diagnosis: Breast Cancer: infiltrating ductal carcinoma.

Discussion: Retrospectively, a dominant mass with spiculation can be recognized on the study of 6/26/91, with gradual increase in size and density. Although the mammogram of 5/16/94 was incorrectly read as no evidence of malignancy, the new palpability of the lesion should have prompted biopsy.

The spiculated appearance of this mass should always prompt biopsy, regardless of lack of change over time.

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