Case 60 Answer

Bi-RADS 4, Suspicious. This is an oval solid palpable mass. Margins are obscured on mammogram, but are well defined at ultrasound examination. The mass lacks a thin white echogenic pseudocapsule.

Because this is symptomatic, it cannot be "probably benign". Because there is no long-term stability (2-3 years), we cannot judge this mass to be benign.

A core needle biopsy yielded fibroadenoma.

While you are performing the ultrasound, the patient relays the fact that she has had a sex change operation. She would like to know your recommendations for screening.

What is the ACR recommendation for screening mammography in the transsexual population?

• Annual screening starting at age 40
• No screening is recommended