Patient: Description of condition (onset, main symptoms, hospital visited, etc.): Mammogram at the end of September: ? Mammogram description: Both mammary glands are of mixed type, with lumpy and nodular hyperdense shadows and uneven glandular densities, and the deep right nipple appears to have small dotted high-density calcification shadows. The lymph nodes were seen in both axillae. Molybdenum palladium imaging diagnosis: lobular hyperplasia on both sides of the breast, small dot-like high-density calcification shadow in the deep right nipple, please combine with clinical, further examination if necessary. The results of this study are summarized below. MRI description: The scan and enhancement showed that both mammary glands showed abundant glands with uniform distribution, no obvious nodular shadow and enhancement focal shadow, the right nipple showed poorly, local enhancement shadow was seen behind the nipple, the surrounding small patch of areola skin thickening changes, the left breast skin showed smooth, no obvious enlarged lymph node shadow was seen in both axillae. The skin of the left breast was smooth, and there were no obvious enlarged lymph nodes in either axilla. MRI diagnosis: 1, no obvious abnormalities in both mammary glands. 2, the right nipple showed poor and posterior reinforcement shadow, please combine with the clinical examination. The ultrasound was done by Chen Mann in Ruijin on September 19: ? The left breast is 12mm thick, with dense glands, smooth and intact borders, enhanced internal echogenicity, disorganized structure, and leopard-like appearance. CDFI did not show any significant abnormal blood flow signal. 3D ultrasound did not show any signs of abnormal distribution of glands and Kuhnian ligament. There were two masses in the right breast at about 7-8 o’clock, one of which was about 7.1*3.6mm in size, and several masses in the left breast at 1-2 o’clock, one of which was about 6.6*4.1mm in size. There were multiple masses in the left breast at 107-11 o’clock, one of which was about 5.9*2.5mm in size, growing horizontally, oval in shape, with clear borders and blurred edges, and hypoechoic interior, with fair distribution. There was no obvious calcification foci, no obvious change in the posterior echogenicity of the mass, and no obvious blood flow signal was seen in the CDFI mass. There was no obvious enlarged lymph in the bilateral axillae. Ultrasound diagnosis: bilateral multiple substantial nodular lesions in the breast. grade 3 No ???? The problem is: the change of molybdenum palladium last year and this year, last year was scattered 2 calcification points, this year is concentrated in 7mm nodules with 5 calcification points, distribution like sand grains. ultrasound follow-up of this nodule this year is faster than the growth. The nodule is growing faster than this year. I have read other information that if there are no clusters of calcifications on previous mammograms and they are newly found, I should be more alert. 2, molybdenum palladium shows a concentration of 5 calcification points is very worried, is the possibility of malignancy is not large? 3. I don’t know what would be the best option if I have surgery. Thank you! Liu Jian, Breast Surgery Department, Hangzhou First People’s Hospital: Hello! It’s true that you should pay attention to the small calcifications. 5 small calcifications are more risky when they are concentrated together than when they are scattered. In your case, it is better to do a mammography biopsy for microcalcifications. Our hospital has a digital mammography and breast stereotactic system that can precisely locate microcalcifications. Intraoperatively there can be a quick section to determine the condition. If it is convenient, you’d better come and see us first, and we will decide which biopsy method according to your condition. Patient: Thank you for your reply, in that case I will come to you with the film first. Patient: I have already had an MRI, but the MRI report says that there is no abnormality in the gland, but there is a reinforcing shadow behind the nipple, so I don’t know if this reinforcing shadow is the same lesion as the molybdenum palladium calcification. Thank you. One more thing I would like to ask is what is the significance of the MRI that the doctor ordered? I feel that the MRI I had is not a very important diagnostic basis, what is the reason? I am confused about where my lesion is: 1. The molybdenum palladium calcification lesion is oblique and the cephalic calcification site is basically at 7-8 o’clock, and the ultrasound is consistent, this site should be in the gland, but the MRI conclusion says that no significant abnormalities are seen in both sides of the breast. This is not very consistent, is my understanding of this valid? 2. The MRI said that the right nipple was poorly displayed, and a localized enhancement shadow was seen behind the nipple, but I asked the radiologist to look at it and think that it was very close to the nipple. 3. I would like to ask again, if it is assumed that the MRI does not make intra-glandular lesions, does it mean that there are no lesions? What is the point of having an MRI? Under what circumstances can the premise that the mass seen by ultrasound is a mass containing a calcified foci be confirmed? Thank you, Dr. Liu, for your kind assistance. Liu Jian, Breast Surgery Department, Hangzhou First People’s Hospital: Hello! There are cases where MRI is inconsistent with ultrasound and mammogram. At present, in Zhejiang, if MRI finds lesions that cannot be localized, lesions found under ultrasound and mammography can be localized. Especially the lesions seen under the mammogram can be removed by a minimally invasive method after precise calculation by computer if the patient’s breast condition allows it. This kind of surgical scar is only 3mm and the trauma inside is small, which is the best choice. Patient: Thank you, Director Liu, for your reply. I really appreciate it because I have not even visited your hospital and I am really grateful to get a dialogue consultation from Director Liu. Secondly, I would like to get some pointers from Director Liu: 1. Is it possible that my case is malignant? I went to the hospital 2 days ago to do f palladium to the radiology department to find a doctor to look at the film on the computer, the doctor said that according to his diagnosis, this film up to give me a grade 3, so is the heart is more at ease. But after all, there are small calcified spots, and they are relatively concentrated in one place, so I still want to further track this lesion. 2, if the computer to remove this lesion is indeed more accurate, but the problem is that in case everything comes out badly, then it is not directly on the operating table to do a large range, but to again about a major surgery, so then it seems that I am not the most assured. 3.If the computer locates the minimally invasive resection, do I need multiple x-rays to locate it? Some doctors say that at least 6-7 films are needed to determine the position, I wonder if this is also the case in your hospital? I’m not sure if this is the case at your hospital, but I’d like to ask Dr. Liu to give me some guidance in his busy schedule. Patient: Director Liu, if you are busy with the Internet, please give me an answer to my questions in a comprehensive manner. 1. Does the minimally invasive surgery you introduced refer to “McMurdo”? I have read the introduction that biopsy can be performed for suspected breast cancer patients, but the lump rotation surgery should be avoided. Is biopsy different from rotary surgery? 2, if the computerized excision of this lesion is indeed more accurate, but the problem is that in case everything comes out badly, then it is not a direct operation on the table to do a wide range, but to make another appointment for a major operation, in which case it seems that I am not the most comfortable. 3.If the computer locates the minimally invasive resection, do I need multiple x-rays to locate it? Some doctors say that at least 6-7 films are needed to determine the position, I wonder if this is also the case in your hospital? I’m not sure if this is the case at your hospital. I’d like to ask Dr. Liu to give me some pointers in his busy schedule for 3 questions. Breast Surgery Department of Hangzhou First People’s Hospital Liu Jian: Hello! It’s been a long time since I’ve answered online, I don’t know if your problem has been solved. If your breast calcification problem has not been biopsied, you need to follow up, that is to say, about six months to do a mammogram to see the comparison, if the lesion does not change can continue to follow up, if there are changes then consider biopsy. It is because of the uncertainty of the quality that a biopsy is needed, and nowadays all developed countries are biopsied before surgery. If it is a molybdenum target stereotaxic biopsy with McMurdo, usually 4-6 films are taken, intraoperative rapid frozen section is sent, if malignant is directly transferred to general anesthesia surgery. Patient: Thank you for your reply, I have not been on this network for a long time, and I appreciate your reply. My problem is that I haven’t had a biopsy yet. The mammogram I had 2 years ago has not changed much from the last one I had last year, and there are a few small calcified spots on the left and right sides, so I am more comfortable with this situation, but I am always torn without a biopsy. Thank you.