Ultrasound Findings of Breast Cancer in Dialysis Patients Require Careful Evaluation: A Case Report

Literature on the effects of renal failure on breast imaging in breast cancer patients on dialysis is scarce. A 73-year-old woman on dialysis noticed a mass in her left breast. In the left breast, which consisted entirely of fat tissue, mammography revealed two spiculated masses. Ultrasound also showed two irregular masses with internal low echoes, slightly attenuated posterior echoes, obscured margins, high depth-to-width ratios, no halos, and widespread peritumoral high echoes. In addition to axillary lymphadenopathy, MRI of the masses showed low signals on T1-weighted images and weakly high signals on fat-suppressed T2-weighted images. Core needle biopsy of the mass pathologically revealed atypical cells growing in trabecular and tubular patterns, with interstitial connective tissue proliferation and fat invasion, leading to a diagnosis of invasive ductal carcinoma. Due to impaired renal function, the patient underwent primary surgery, including a partial mastectomy and axillary lymph node dissection. Postoperative pathological examination showed scirrhous-type invasive ductal carcinomas infiltrating the surrounding fat tissue, nine metastatic lymph nodes, and abundant fat tissue with very scant mammary gland around the tumors. The patient had higher-than-usual postoperative drainage volumes, which varied from day to day, presumably due to the effects of dialysis. Despite a large 100 mL drainage volume on the fifth postoperative day, the patient was discharged on day six per her preference. Diagnostic physicians should note that breast cancer patients on dialysis can present with atypical breast imaging compared with patients without renal failure and should be treated with optimal surgical procedures based on thorough image evaluation.