From a benign nodule to Stage IIB cancer: The importance of ultrasound findings in breast pathology. Case report

Abstract

A case is presented of a 53-year-old woman with a history of a breast nodule and left-sided mastodynia of two years’ duration. Previous ultrasound studies had demonstrated a lesion suspicious for malignancy; however, two fine-needle aspiration biopsies (FNAB) yielded negative results for malignancy, leading to discharge without follow-up. One year later, the patient returned due to persistent pain. A new breast ultrasound revealed, in the upper inner quadrant of the left breast, a hypoechoic lesion with spiculated margins, antiparallel orientation, architectural distortion, and marked posterior acoustic shadowing—findings highly suggestive of malignancy, classified as BI-RADS 5 (≥95%). Mammography and core needle biopsy (CNB) were subsequently performed for histological confirmation, with results positive for invasive ductal carcinoma. This case underscores the relevance of meticulous ultrasound interpretation, the appropriate selection of the biopsy technique (avoiding fine-needle aspiration in solid lesions), the need for periodic surveillance of breast nodules even when initially deemed benign, and the value of a multidisciplinary approach in the management of complex breast pathology.