The initial ultrasound of Ms. Hong's breast revealed a hypoechoic nodule measuring approximately 4x3 mm in her left breast. This finding was classified as BIRADS 4A, indicating a low suspicion of malignancy. However, a subsequent X-ray mammography provided a clearer picture, identifying a cluster of 5 microcalcifications, arranged in a line, in the upper outer quadrant of her left breast. The individual lesions were spaced about 1 mm apart.

Dr. Le Nguyet Minh, Head of the High-Tech Diagnostic and Interventional Breast Unit, emphasized the critical role of X-ray mammography in such cases. She explained that in very early stages, ductal carcinoma in situ (DCIS) often does not form a palpable mass, making it challenging for ultrasound to detect or fully assess. X-ray mammography, therefore, becomes instrumental in identifying abnormal microcalcifications, which can be the earliest sign of DCIS.

A cluster of microcalcifications nearly 5 mm on a breast X-ray. Photo: Tam Anh General Hospital

A cluster of microcalcifications nearly 5 mm on a breast X-ray. Photo: Tam Anh General Hospital

To determine the precise nature of the lesions, doctors performed a vacuum-assisted biopsy (VABB) guided by X-ray. This procedure presented a high degree of difficulty, according to Dr. Minh, because the lesions were extremely small, visible only as microcalcifications on the X-ray images. Accurate sample collection was crucial, as an incorrect biopsy site could lead to an inaccurate diagnosis.

To ensure precision, the medical team utilized a digital tomosynthesis mammography system. This advanced technology allowed them to calculate the exact three-dimensional coordinates of the suspicious area. With this precise data, a specialized vacuum-assisted biopsy needle was guided directly to the target lesions, maximizing the chances of obtaining an accurate tissue sample.

The subsequent histopathological examination confirmed the lesions as grade three ductal carcinoma in situ (DCIS). This particular type of DCIS carries a higher risk of progressing to invasive breast cancer compared to lower and intermediate grades if left untreated, underscoring the importance of early intervention.

Following the diagnosis, Ms. Hong was advised to undergo surgery, which included breast implant placement for breast reconstruction. A personalized treatment plan was then developed based on the post-operative histopathology results, ensuring a comprehensive approach to her care.

Dr. Minh consults with Ms. Hong about her breast biopsy results. Photo: Tam Anh General Hospital

Dr. Minh consults with Ms. Hong about her breast biopsy results. Photo: Tam Anh General Hospital

Dr. Minh further explained that DCIS is a form of breast cancer that remains confined within the milk ducts and has not yet spread to the surrounding breast tissue. When detected at this early stage, the likelihood of a complete cure is very high. Identifying the disease through a small cluster of microcalcifications on an X-ray enables early intervention, preventing the cancer from becoming invasive or causing clinical symptoms.

For women aged 40 and above, regular health check-ups and a combination of X-ray mammography and breast ultrasound are recommended, as advised by their doctors. This approach significantly enhances the ability to detect small lesions early, improving outcomes.

Individuals considered high-risk, such as those with a first-degree relative who has had breast cancer, carriers of BRCA1 or BRCA2 gene mutations, a personal history of cancer, or previous radiation therapy to the chest area, may require earlier and more individualized screening protocols tailored to their specific circumstances.

Currently, a range of breast cancer screening methods are available, including clinical breast exams, breast ultrasounds, and mammograms. Doctors select the most appropriate method for each patient, considering factors such as breast tissue characteristics, age, and risk level, to achieve optimal detection effectiveness.