Thoa's mammogram at Tam Anh General Hospital in Ho Chi Minh City revealed regional microcalcifications in her left breast, classified as BIRADS 4B. This classification indicates a moderate suspicion of malignancy within the breast cancer risk assessment system based on imaging. Doctors advised a biopsy for precise diagnosis, but Thoa preferred further monitoring and did not want intervention.

Six months later, Thoa returned to the hospital for examination due to persistent left breast pain accompanied by thick brown nipple discharge. Doctors found a hard, ill-defined mass in her left breast. A subsequent breast X-ray showed a significant increase in microcalcifications compared to the previous images, with the calcified area extending approximately 7 cm and reaching close to the nipple, now classified as BIRADS 5.

To determine the nature of the lesion, doctors performed a large-core needle biopsy of the breast under computed tomography guidance. This technique precisely localized microcalcifications, which are difficult to observe with ultrasound. They collected 13 tissue samples representing the suspicious area to assess the lesion's characteristics. The results confirmed stage three ductal carcinoma in situ (DCIS).

Thoa undergoing a computed tomography scan of her chest. Photo: Tam Anh General Hospital

Doctor Le Nguyet Minh, Head of the High-Tech Unit for Breast Disease Diagnosis and Intervention, stated that the rapid increase in microcalcifications over six months indicated the lesion had likely spread and progressed to an invasive stage.

She underwent a whole-body MRI for a comprehensive evaluation. The results confirmed the left breast lesion had spread to approximately 9.5 cm, involving the nipple and part of the areola. Several abnormal lymph nodes were also detected.

Following a consultation, doctors recommended a total left mastectomy using the Patey procedure, combined with left axillary lymph node dissection. The surgical team completely removed the lesion with clear margins.

Post-operative histopathology results confirmed stage three ductal carcinoma in situ, consistent with the earlier biopsy findings. There was no evidence of vascular or neural invasion. All removed axillary lymph nodes were free of malignant cells, confirming the cancer had not metastasized.

Thoa was discharged one week after treatment and did not require additional therapy. She currently plans to undergo cosmetic breast implant surgery for breast reconstruction.

Breast pain can stem from various causes, including cancer. If pain persists or is accompanied by symptoms such as unilateral nipple discharge (brown or bloody), a palpable lump, or changes in breast shape, patients should seek timely examination and evaluation at a specialized facility.

Doctor Minh noted that early-stage breast cancer often presents no clear symptoms. It may manifest as small microcalcifications visible on digital mammograms. Specialized high-resolution X-ray techniques for breast tissue help detect minute lesions not apparent during clinical examination or ultrasound. This method offers highly effective breast cancer screening and supports diagnosis, monitoring, and treatment evaluation.

Tran Duong

*The patient's name has been changed.