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Fig. 2D —Malignancy detected by human second reviewer: 73-year-old
woman with ductal carcinoma who was called back by human second reviewer for
possible architectural distortion versus summation shadows. Abnormality was
suspected on only mediolateral oblique projection of screening mammographic
images. Of note is that computer-aided detection (CAD) system had marked this
same image, but mark had been dismissed by "CAD reviewer." At time
of diagnostic evaluation, many additional views were obtained, and finding was
considered to be superimposition of shadows. However, short-term follow-up was
recommended in 6 months based only on radiologist's "gut" feeling,
even though mammogram was considered to be negative for abnormal findings. At
that follow-up, finding was now thought to be architectural distortion in two
views but was best seen in craniocaudal projection. Whether this change
represented progression in malignancy versus differences in projection is not
known. Pathology showed ductal carcinoma in situ. Craniocaudal (C) and
mediolateral oblique (D) mammograms (magnification, x1.8) 6
months later show architectural distortion (arrows) that prompted the
radiologist to recommend surgical biopsy.
