THE BISI BUZZ MAY 2020

THE BISI BUZZ

The Member Newsletter Of The Breast Imaging Society, India

Table of contents

02 BISI Office Bearers

03 Editor’s Note - Dr Mukta Mahajan

04 Fond Memories - BISICON 2019 And 


A Special Feature On Dr Laszlo Tabar

07 In Focus - COVID 19

10 Members In News

15 Education - Breast Imaging Fellowships in India

16 Journal Watch

18 Interesting Case

Reflections - 

20 Glass Ceiling in Medicine- Myth or Reality? 

Dr Bagyam Raghavan

22 Insights - Dr Teena Sleeba

24 Word Find

25 Obituary - Dr Smiti Sripathy and Dr Mukund Joshi

27 BISI’s Write Side - The Essay Competition

32 Upcoming Events

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 THE BISI BUZZ MAY 2020

OFFICE BEARERS

President: Website Team:

Dr N. Khandelwal Dr Rupa Renganathan
Vice President: Dr Aparna Atre
Dr Bijal Jankharia
Dr Palak Popat
Secretary:
Dr Jyoti Arora Newsletter Team:
Dr Bagyam Raghavan
Joint Secretary:
Dr Jwala Srikala Dr Mukta Mahajan
Treasurer: Dr Aman Daftary
Dr Madhavi Chandra
Dr Shilpa Lad
Governing Council Members:
West: Dr. Neha Shah, Dr. Dr Upasna Sinha
Pratiksha Yadav, Dr. Sabita
Desai Dr Shikha Panwar

East: Dr. Mary Hazarika Bhuyan, Dr Ekta Dhamija

Dr. Suma Chakrabarthi
South: Dr. Bhawna Dev, Dr
Janaki P Dharmarajan, Dr
Mukta Mahajan
Quality Assurance Guidelines:
Dr Suma Chakrabarthi
Advisory team for elections

North: Dr. Vaneeta Kapur, Dr

Ekta Dhamija breastimagingsociety@gmail.com

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 THE BISI BUZZ MAY 2020

EDITOR’S NOTE
I am delighted to introduce the new look of the second official newsletter of the
Breast Imaging Society of India (BISI) - “THE BISI BUZZ”. THE BISI BUZZ provides an
exciting opportunity to share multifaceted content on a truly clinical subspecialty of
radiology and its rapidly growing community in India. The objective of THE BISI
BUZZ is to publish up-to-date, high-quality and original articles, academic as well as
introspective, alongside relevant and insightful reviews of happenings around the
globe. The newsletter aspires to be energetic and engaging and colourful and
collaborative. I thank Dr Bagyam Raghavan, the sole constructor of BISI’s first
newsletter, for kickstarting society’s core project and for building a solid base. The
Dr Mukta Mahajan
encouraging response to the first issue lead to formation of a dedicated newsletter
committee during the general council meeting in November 2019. Since the
newsletter is in its infancy, the members will witness it evolve through subsequent issues in terms of the subject
matter as well as design. We look forward to all constructive criticism and feedback that will contribute to growth
of THE BISI BUZZ.

This issue concentrates on the following types of subject matter. First, it celebrates the success of BISICON 2019
held in Hyderabad and brings back some fond memories. With excerpts on the very popular guest speaker it
showcases one of his greatest and unparalleled contributions to screening mammography. Yes, mammography
does save lives! Second, it captures some of the important evolving guidelines, changed practices and safety
measures in the wake of the current global pandemic affecting breast imaging worldwide. Third, “Members in
News” provides a crisp and concise account of invited speakers at prominent national and international
platforms, prestigious awards, breast cancer awareness drives and special features in media. The “Journal
Watch” will feature links to recently published high impact original research as well as to all articles by our
motivating BISI members. The members are also invited to submit cases with interesting findings or lesser
known pathologies to serve the reader the “ooh-ah” moment. Fourth, “Reflections” captures Women’s day
special written by Dr Bagyam and Insights by Dr Teena. We pay tribute to our dear mentors & colleagues whose
passion for breast imaging was a source of inspiration for many of us. “BISI’s Write Side” dives deep into breast
imager’s journey and how they fell in love with the subject. A sincere, almost meditative project that reclaimed
a small piece of our mindspace during the times of lockdown blues and stresses. Jump to page No .27 to find
out who the winners are! We reveal names of all the nine authors and take the pleasure of publishing a selection
of the three most appreciated essays by our voters. We also enlist details of all the formal fellowship
opportunities available in various prestigious centers in India to young radiologists looking forward to
developing their knowledge & skill. The society looks forward to future contributions by the GenNext. We
advertise two major upcoming events that are planned for this year by the society. To sort through the web of
webinars, we provide a calendar link to our interested audience. This link will be updated time-to-time with
details of events that are planned either by the society or individually by its members.

Lastly, on behalf of the newsletter committee, I would like to add that members who wish to submit articles for
the next issues, either individually or collaboratively, will make a generous contribution to development and
success of the BISI BUZZ. Best wishes and thank you!

Dr Mukta Mahajan is fellowship trained in Breast Imaging from Medical University of Vienna, Austria and University of
Breast Imaging Society, India 3 .
Ottawa, Canada & is a Consultant Radiologist at Cytecare Cancer Hospital, Bangalore
THE BISI BUZZ MAY 2020

FOND MEMORIES

BISICON 2019, the 7th annual conference of the Breast Imaging Society
of India (BISI) was held at the Marriott hotel and convention centre in
Hyderabad from 15th-17th November. More than 300 radiologists from
India and neighbouring SAARC countries have attended this 3 day
conference. The highlight of the conference was the ‘Multimodality
breast imaging teaching course’ by Dr Laszlo Tabar, the world renowned
Breast Radiologist, whose work has lead to establishment of breast
cancer screening programmes across the globe. Also we had Dr
Federica Pedeconi from University of Rome, Italy who was the
representative of European society of Breast Imaging (EUSOBI) at the
conference. Dr Maninderpal Gill from Malaysia, Dr Sujata Ghate from
University of North Carolina,USA and Dr Ramyesh Danovani from
Singapore were the other international speakers at the conference .

Some important topics such as the growing trends of beast cancer in

young women and the role of the latest technological advancements like
Breast Tomosynthesis and Contrast Mammography in early diagnosis of
breast cancer were discussed. Hands on workshop on Mammography
and Tomosynthesis, Breast MRI and USG guided Breast Interventions was
also conducted as a part of the conference.

Governor of Telangana, Her excellency Dr Tamilisai Soundarajan was the

chief guest at the inaugural. Dr Laszlo Tabar was presented the BISI
Lifetime achievement award by the Governor. A pink ribbon campaign
walk with a purpose to spread breast cancer awareness was undertaken
on the day 2 of the conference by all the participating delegates which
was covered very widely in the press and media.

- Dr Jwala Srikala

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THE BISI BUZZ MAY 2020

Dr Meenakshi Thakur, Dr Tamilisai Soundarajan, Dr Laszlo Tabar, Dr Brig Chander Mohan & Dr P Raghu Ram

Organizing team: Dr Annapurna, Dr Sirisha, Dr Rashmi Sudhir, Dr Jwala Srikala, Dr Ruju Doshi, Dr Jahnavi.

Pink Ribbon Walk along the Hussain Sagar Lake, Hyderabad.

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THE BISI BUZZ
Dr Laszlo Tabar received
lifetime achievement award by
BISI for his unparalleled
contribution to the field of
breast imaging. His insights
into anatomy and pathology of
the breast and the self-
explanatory pictorial
correlations to relate
microscopic structures with the
objects of nature were truly
fascinating. The concept &
practice of thick-section or 3D-
histology was new to most of
us. He shared wealth of his
knowledge and experience
with spellbound radiologists. A
meticulous researcher and a
passionate teacher has forever
left imprints of these images in
our minds.
Breast Imaging Society, India
MAY 2020
The Radiological Society of North
America (RSNA) presented its first
A l e x a n d e r M a rg u l i s A w a rd f o r
Scientific Excellence to László Tabár,
M.D., professor of radiology at the
University of Uppsala School of
Medicine and medical director of the
Department of Mammography at
Falun Central Hospital in Sweden, and
Dr Laszlo Tabar colleagues, for the article, "Swedish
Tw o - C o u n t y Tr i a l : I m p a c t o f
Mammographic Screening on Breast
Cancer Mortality During 3 Decades," published in
September 2011.
The Swedish Two-County Trial of mammographic
screening was the first breast cancer screening trial to
show a reduction in breast cancer mortality from
screening with mammography alone. The trial
randomized 133,065 women into two groups, one that
received an invitation to screening and another that
received usual care. At the conclusion of the study, there
were 30 percent fewer breast cancer deaths among all
women (attenders and non-attenders) in the group invited
to undergo screening.
The screening phase of the trial lasted approximately
seven years. Women between the ages of 40 and 49 were
screened, on average, every 24 months, and women age
50 to 74 were screened, on average, every 33 months.
Nearly three decades after the beginning of the trial, the
researchers analyzed the original data and the follow-up
data to estimate the long-term effect of mammography
screening on breast cancer mortality. At 29 years, this
represents the longest recorded follow-up period for a
mammography screening trial.
6
 THE BISI BUZZ MAY 2020

IN FOCUS - COVID 19

COVID-19 pandemic has changed our professional lives forever. Safety of our patients and staff is
paramount and the responsibility of continuation of essential services during this period is a juggling
act. Many international societies have made COVID-19 resources available on their webpages which
are updated almost on a weekly basis. Apart from Breast Imaging, most of us might be required to
contribute to general and emergency radiology services as well. Keeping We have listed some of the
important resources here that will enable you to modify and manage local workflows based on these
recommendations and practice guidelines .

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 THE BISI BUZZ MAY 2020

Suggestions from Society of Breast Imaging as we return to offering more routine

breast care while maintaining a safe environment for everyone.

1. Screen every patient at scheduling and

again immediately prior to entering the Click
facility for direct COVID exposure or here for
symptoms.

2. Proceed only with patients who have

cleared your COVID screening process.

3. Reduce or spread out appointments from

pre-COVID levels to avoid patients accumulating in waiting rooms. Return to pre-COVID levels
later as the risk of recurrent outbreaks further diminishes.

4. Evaluate and consider modifying waiting and changing rooms to ensure patients can maintain 

social distancing.

5. Evaluate and streamline registration, check-in and check-out processes to limit the amount of 

time patients are in the facility.

6. Evaluate numbers of staff involved in the care of each patient, and limit that number to the 

smallest possible for every visit.

7. Ensure staff and patients continue to wear masks for all visits.

8. Consider gowns and masks for all procedures along with gloves.

9. Please see CDC guidance for details of appropriate types of PPE. The CDC link is https://
www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html

10.Consider implementing streamlined or abbreviated imaging protocols to decrease time and

number of visits that patients make to your facility. Examples include abbreviated MRI protocols,
same day screening interpretation, same day biopsy performance, and coordination with clinical
services to image patients being seen on site by clinical colleagues. Every facility will have unique
circumstances that may dictate what is possible and what is best for their program.

Click here
for
Click 

Dr Bagyam’s
here
Presentation
on

Breast Imaging Society, India 8

THE BISI BUZZ MAY 2020

Click here for

COVID-19 resources
on RSNA webpage
for this page and
check back often to
access the latest

Breast Imaging Society, India 9

THE BISI BUZZ MAY 2020

MEMBERS IN NEWS
Book release: Dr Rashmi
Sudhir

Contrast enhanced digital

mammography (CEDM): An emerging
technology in diagnosis and
m a n a g e m e n t o f b r e a s t c a n c e r.
Launched in IRIA 2020 at Ahmedabad,
India.

Dr Rashmi Sudhir is a Senior Consultant

R a d i o l o g i s t a n d B re a s t I m a g i n g
Specialist & Co-ordinator FNB Breast
imaging at Basavatarkam Indo-American
Cancer Hospital & Research Centre,
Hyderabad.


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THE BISI BUZZ MAY 2020

#rsna19 Kudos to @DrPaulaGordon@DrDkopans

and global rads representing France, W.Austral, Croatia,
China, germany/USA, India

Invited Speaker: Dr Shilpa Lad

“India: Navigating Cultural & Socio-

Economic Challenges in Pursuit of Global
Breast Health” Radiology Society of North
America, RSNA December 2019.

National Oncology Meeting, Turkey.

Meme Kanserinde Yeni Yaklasimlar,
Istanbul, Turkey, January, 2020.

Breast Imaging Society, India 11

THE BISI BUZZ MAY 2020

Dr Bijal Jankharia has shared a video

of her presentation at RSNA 2019 on
IRIA Breast Outreach Programme.

Click here to watch the video.

Dr Bijal also received the IRIA President’s

Appreciation award from the Gujarat
Chief Minister Shri Vijay Rupani for
conceptualization and contribution to the
Breast Outreach Programs in India.

IRIA 2020, Gandhinagar, Gujarat

Are you organizing a conference or CME on Breast Imaging? To find out how BISI can
endorse your event, click here.

Breast Imaging Society, India 12

THE BISI BUZZ
India is experiencing an unprecedented rise in
the number of breast cancer cases across all
sections of society, accounting for 27% of all
cancers in women, less than 10% of
which are inherited. India also has far
lower survival rates of 66.1% for
breast cancer compared to 90.2% in
U S A . Th e re a re s e v e r a l s t a r k
differences for this disease in India
and the West.
Indian women often develop the
more aggressive subtype of the
cancer at a much younger age. At
the time of detection, the cancer is
often in advanced stage resulting in more
aggressive treatments and poorer outcomes.
Lack of nationwide screening program makes
detection of early curable breast cancer even
before development of any symptoms an
unrealistic goal. Even among the educated or
the urban population, only a few are aware of
the early signs and symptoms of breast cancer.

Breast Imaging Society, India
MAY 2020
Attention to routine breast examination by
own self as well as by trained medical
personnel, is still dismal. Lack of expertise,
misconceptions about mammography and
biopsy further decrease the chances of timely
detection. This, along with a general
indifference towards women’s health, financial
constraints and social stigma increases
hurdles to effective treatment.
On a brighter side, when detected ‘early’
breast cancer is curable, needs less
aggressive treatments, has lesser
psychological impact and certainly has far
lesser financial and social burden on the
family. Small scattered efforts to empower
women to be “breast-aware” through
simplified information are picking up pace.
The need for routine examinations, improved
access to trained personnel at a community
level and quick referrals to specialized
centers is being realized.
What to expect during a visit to a breast
clinic?
A woman with a breast complaint
will have a physical examination
followed by appropriate tests
suited for her age and seriousness
of her symptoms. Mammogram
(preferably 3D digital
mammogram) and ultrasound are
the initial steps of assessment of
any suspicious breast symptom.
Breast radiologists expedite
breast biopsies in these patients to
confirm presence and type of cancer. Image-
guided breast biopsy is a highly accurate,
minor, almost painless OPD procedure and
requires little preparation from the patient.
No special care is required after the biopsy
and the woman can resume her daily
schedule the same day. The biopsy results are
ready within few days for further discussion
13
 THE BISI BUZZ
Do all breast lumps need to be surgically
removed?  also worthy of mention, since VABB can avoid
Most breast lumps are fortunately non-
cancerous. This can be confirmed easily on a
mammogram and/or the ultrasound. A small
subset of these lumps needs further assessment
with simple core biopsies to confirm their
benign nature. Benign i.e. non-cancerous lumps
don’t need surgical removal. It is important to
mention that role of rampantly performed
needle test known as FNAC in breast diseases is
long gone and now only reserved in remote
primary health centers with limited-resources.
Core biopsy has become the minimum standard
of assessment. There has been a steady
improvement in the yield, accuracy and
negative predictive value of minimally invasive
breast biopsy procedures through newer
sophisticated techniques such as vacuum
assisted breast biopsy or VABB.
More on VABB
Entry of VABB in clinical practice has been a
game-changer. It is an accurate one-step OPD
procedure that has simplified diagnosis of
paucicellular breast cancers and even
precursors of breast cancer that earlier needed
admission, general anaesthesia and surgery. It is
performed in a radiology suite with help of
ultrasound, mammogram or MRI. Suspicious
area of any size and depth can be accurately
targeted using a mechanized VABB needle-
suction apparatus. Needle position is guided
and confirmed by a radiology scan followed by
withdrawal of series of large samples across 360
degrees rotation through a single needle entry.
VABB reduces underestimation of cancerous
disease, re-biopsy rates, number of surgeries
and overall cost burden for women with
cancerous lumps. VABB has the potential to
diagnose and even treat benign diseases that
cause bloody or watery nipple discharge
without missing a hidden cancer.
Breast Imaging Society, India
MAY 2020
Its role in certain small non-cancerous lumps is
surgery, scarring and disfigurement of breasts.
Compared to surgical excision, VABB shows
significantly lower rates of operative and
recovery times, blood loss, as well as wound
infections. There is adequate evidence of safety
and efficacy of VABB in diagnostic biopsies as
well as excisions of small benign lumps such as
fibroadenomas. VABB has been approved by
the FDA (USA) as well as NICE (National
Institute for Health and Care Excellence, UK).
VABB has consistently shown high satisfaction
and lowest pain perception on several patient
surveys.
How do breast radiologists contribute
towards improving breast cancer
outcomes?
Breast radiologists are a part of the core team
of multidisciplinary cancer care of pathologists,
surgeons, medical and radiation oncologists as
well as pain and palliation specialists. Breast
radiologists receive specialized training in
screening, diagnosis, staging and response
assessment tests as well as minimally-invasive
procedures. Misdiagnosis o f cancer and false
assurance of wellness is a missed opportunity
for all of us to save lives. Avoiding such delays
needs continuous education, review and
improvement of our services. Breast imaging
society of India is setting the ground by
standardizing practice guidelines and quality
assurance measures for centre that offer these
services.
14
THE BISI BUZZ
EDUCATION
Gratitude
Special mention of Dr brig Chander
Mohan for his vision & contribution to
formal education in breast imaging in
India. Over 4 years of sustained efforts
by him & his colleagues has culminated
in fellowship programmes accredited by
NBE.
Share powerful patients’ stories with us. In your words or theirs.
Let's learn together how we can help weave happy endings.
bisinewsletter@gmail.com
Breast Imaging Society, India
MAY 2020
FNB Fellowships
Recognized by National Board of
Examinations. Last date of application for
2020 and start date : plz check the site
natboard.edu.in
• Medanta The Medicity Gurugram, HN

No of seats: 1 

Course director: Dr.Jyoti Arora
dr.jyotiarora76@gmail.com
• Kovai Medical Center and Hospital,
Coimbatore, TN

No of seats: 2 Course director: Dr.R.Rupa
Renganathan drrrupa@gmail.com
• Indo American Cancer Hospital and
Research Institute, Hyderabad

No of seats: 2

Course director: Dr.Rashmi Sudhir 

rashmi4210gmail.com,
drveeraiah@induscancer.com

PATIENT STORIES
15
THE BISI BUZZ MAY 2020

Deemed University Fellowships

• Tata Memorial Centre
 • Amrita Institute of Medical sciences and

No. of seats : 1, Duration : 1 year 
 Research Centre, Kochi, Kerala

For details: www.tmc.gov.in 
 No. of Seats: 1, Starts in June

Contact person : 02224177000 (TMH) Course Director: Dr Janaki P Dharmarajan

Contact: janaki19727@aims.amrita.edu.in
• PGIMER, Chandigarh

No. of seats: 1, Starts in July
 • Dr D Y Patil Vidyapeeth ,Pune, MH

Course Director: Dr Veenu Singhla 
 No. of Seats: 2, Duration:1 year, Starts in Sept

Contact: modin72@gmail.com Course Director: Dr Pratiksha Yadav
Professor 

• Sri Ramachandra Institute of Higher Contact: pgsection.medical@dpu.edu.in,
Edcation & Research, Chennai, TN
 pratiksha.yadav@dpu.edu.in

No. of seats: 1, Starts in June
 Ph no. 020-27805900, 020-7709085551
Course Director: Dr Bhawna Dev

Contact: bhawnadev@gmail.com

JOURNAL WATCH
Special Focus

The Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial is a randomised, controlled
trial to study the effect of supplemental MRI on the incidence of interval cancers in women with
extremely dense breast tissue. Performed in the Netherlands, the study team assigned 40,373
women between the ages of 50 and 75 years with extremely dense breast tissue and normal results
on screening mammography to a group that was invited to undergo supplemental MRI or to a
group that received mammography screening only. The authors concluded that they found that
supplemental screening with MRI in women with extremely dense breast tissue resulted in the
diagnosis of significantly fewer interval cancers than the use of mammography alone.

DOI: 10.1056/NEJMoa1903986

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THE BISI BUZZ MAY 2020

Publications by members

• “Imaging of Breast Hamartoma on Mammography, Ultrasound and MRI”  Pratiksha Yadav

DOI: 10.7860/JCDR/2019/42063.13163

• “Multi-Parametric MR Imaging in Characterisation of Benign and Malignant

PhyllodesTumours”  Pratiksha Yadav, Surbhi Chauhan,Vilas M kulkarni International Journal of
Anatomy, Radiology and Surgery. 2019, Apr, Vol-8(2): RO01-RO03 

• Original article: Pratiksha Yadav, Saroja Variar “Utility of whole breast ultrasound and digital
tomosynthesis as an adjunct with mammography in dense breast to detect breast
lesions”  International Journal of Radiology and Diagnostic Imaging 2019; 2(2): 112-118

• “Diffusion-Weighted MRI of the Breast in Women with a History of Mantle Radiation:

Does Radiation Alter Apparent Diffusion Coefficient?” Punam Bajaj, MD, Chiara Iacconi, MD,
David D Dershaw, MD, Elizabeth A Morris, MD Journal of Breast Imaging, Volume 1, Issue 3,
September 2019, Pages 212–216, https://doi.org/10.1093/jbi/wbz035

• “Densely calcified metaplastic carcinoma of breast: An undescribed mammographic

feature” Breast J. 2019;00:1-2. wileyonlinelibrary.com/journal/tbj Upasna Sinha MD1 |
Chandan Kumar Jha, Shreekant Bharti, Aparna S, Ruchi Sinha, Prem Kumar Received: 22
October 2019 DOI: 10.1111/tbj.13702

• “Diffusion weighted imaging in breast cancer – Can it be a noninvasive predictor of

nuclear grade?” IJRI Mar 2020 R Rupa, R Thushara, S Swathigha, R Athira, N Meena, Mathew P
Cherian DOI: 10.4103/ijri.IJRI_97_19

Click here for full texts of some of the articles above.

ASK THE EXPERT

Perplexed about approach to a clinical problem?
Unresolved rad-path discordance? Unclear about
the next step? Recurring image quality problems?
Need help with the department workflow?
Write to our experts with your queries and we’ll try
to get you a solution !
bisinewsletter@gmail.com

Breast Imaging Society, India 17

THE BISI BUZZ MAY 2020

INTERESTING CASE
1 2 Case History: A 55 year old female
presented with palpable mass in upper
aspect of the right breast for one year, with
rapid increase in size since last one month.
Dr Shalini Jain.
Figure 1: B/L Mammogram CC and MLO view
shows a large hyperdense mass with well defined
anterior margin in upper quadrant of right breast.
The posterior margin is indistinct with non
visualised pectoralis muscle – possibility of
infiltration of pectoralis muscle.


Figure 2: Ultrasound shows a large, irregular ,
heterogeneous, solid-cystic mass with indistinct
margin and posterior acoustic enhancement.
3 4
Right axilla showed a round lymphnode with loss
of hilum.

Figure 3: CECT Chest shows a large ill-

marginated heterogeneously enhancing mass
with areas of necrosis in upper quadrant of right
breast. Mass is infiltrating underlying pectoralis
muscle & is abutting the overlying skin. The lesion
measures 10x9.8x9.1cms

4 Figure 4: PET CT shows a large, lobulated, soft

tissue mass with increased FDG uptake (SUV max
10.08) in upper quadrant of right breast
infiltrating underlying pectoralis muscle, with loss
of fat planes with overlying skin, and a small right
axillary lymph node with minimal FDG uptake
(SUV max 1.27)

Core biopsy: Metaplastic carcinoma breast with diffuse sarcomatous differentiation.

Immunohistochemistry: CK - Focally positive, vimentin – diffusely positive, GATA 3 - Positive.

SMA, Desmin, Bci – 2, Synaptophysin, ER, Her 2 - neu – Negative.

Breast Imaging Society, India 18

THE BISI BUZZ
Discussion:
Metaplastic carcinoma (MPC) of the breast is an
uncommon but often aggressive form of breast
cancer comprising less than 5% of breast cancer
patients. It often presents as a large palpable mass in
women >50years. Most cases of MPC are sporadic. It
consists of a heterogeneous group of malignant
neoplasms containing both glandular and non-
glandular components with mixed epithelial &
mesenchymal differentiation. MPCs are often not
associated with estrogen & progesterone receptors,
or Her 2 expression. The axillary lymphnode
involvement at the time of presentation is variable
with rates ranging from 8% to 40%. There is a high
hematogenous metastatic potential to lung and bone
rather than lymphatic spread.
The common mammographic appearance has been
described as a high-density mass with either
circumscribed, obscured, irregular, spiculated or
circumscribed with partially spiculated margins. The
lesions are often non-calcified. If calcifications are
present, the pattern is amorphous, coarse, punctate
or pleomorphic. Our case had a common imaging
feature of a large non calcified high density mass with
circumscribed anterior and indistinct posterior
margin.
On ultrasonogram MPCs usually shows a
heterogeneous or hypoechoic solid mass or mixed
cystic & solid mass as seen in our case. The mass can
be oval, round, lobular or irregular shaped with
circumscribed, microlobulated, irregular or indistinct
margins. MPCs often demonstrate posterior acoustic
enhancement which was also seen in our case, as
compared with posterior shadowing most often seen
with invasive ductal carcinoma.
The MRI features described for MPC varies from
round or lobular to irregular mass with smooth to
spiculated margins and often shows intermediate to
BUDDY CASE
Breast Imaging Society, India
MAY 2020
increased T2 signal intensity. Although T2
hyperintensity is often associated with benign
lesions, it can be secondary to necrosis, or mucoid
production in cancer. The T2 hyperintensity with
MPC is reported secondary to necrosis, with
differential considerations including invasive ductal
carcinoma with abundant necrosis & mucinous
carcinoma. The documented enhancement
characteristics of these lesions include ring like,
heterogeneous or containing non-enhancing
internal components. The kinetic pattern may be
variable but more often early enhancement with
delayed washout or plateau pattern is seen.
Thus MPC shows variable imaging features ranging
from benign to malignant findings, and can lead to
misinterpretation. It needs to differentiated from
benign lesions as well as from its close malignant
differential of invasive ductal or invasive lobular
carcinoma & primary breast sarcoma as these differs
in treatment and prognosis. But it is challenging to
differentiate them radiologically due to overlapping
imaging features and the histopathological
examination with immunohistochemistry gives the
definitive diagnosis of MPC
References:
1.Rebecca Leddy, Abid irshad, Tihana Rumboldt,1 Abbie Cluver, Army
Campbell, and Susan Ackerman Review of Metaplastic Carcinoma of the
Breast: Imaging Findings and Pathologic Features J Clin Imaging Sci.
2012;2:21. Published online 2012 Apr 28.

2. Okada N, Hasebe T, Iwasaki M, Tampura N, Akashi-Tanaka S, Hojo t, et al.
Metaplastic Carcinoma of the breast. HumPathol.2010;41:960-70. [Pub
Med] [Goggle Scholar].

3. Yang WT, Hennessy B, Broglio K, Mills C, Sneige N, Davis WG, et al.
Imaging differences in metaplastic and invasive ductal carcinomas of the
breast. AJR Am J Roentgenol. 2007;189:1288-92 [Pub Med]

4. Tse GM, Tan PH, Lui PC, Chaiwun B, Law BK. Metaplastic carcinoma of
the breast: A clinicopathological review. J Clin Pathol. 2006; 59:1079-83.

5. Velasco M, Santamaria G, Ganau S, Farrus B, Zanon G, Romagosa C,et al.
MRI of metaplastic carcinoma of the breast. AJR Am J Roentgenol.
2005;184:1274-8. [Pub Med] [Goggle Scholar]. 

6. Park JM, Han BK, Moon WK, Choe YH, Ahn SH, Gong G. Metaplastic
carcinoma of the breast: Mammographic and sonographic findings: J Clin
Ultrasound. 2000; 28:179-86 [Pub Med] [Goggle Scholar].

7. Brenner JR, Turner RR, Schiller V, Arndt R, Giuliano A. Metaplastic
carcinoma of the breast : Report of three cases. Am Cancer Soc.
Contributed by Reviewed by 

Dr Shalini Jain Dr Upasna Sinha 19
 THE BISI BUZZ MAY 2020

REFLECTIONS
Glass Ceiling in Medicine- Myth or Reality?

The sensuality and presentation of gender differences are natural, and

instinctive, like the dancing of the peacock or the flamingo and most people
present and act in ways that enhance their gender expression. The
presentation and expression of gender is an instinctive and personal  right
and no human being can misuse use gender within a power equation in
personal, professional and institutional capacities. Historical power
Dr. Bagyam equations within society mean that it is assumed that some men have right of
Raghavan way in most aspects of life. We see this in seemingly simple things our movies
with their raucous songs which I also am guilty of humming, and in more
complex things like workplace discrimination. This constant normalisation of gender discrimination
desensitises all of us and commodifies women in particular, making them subservient in many walks
of life.

When I speak about gender discrimination as a societal value or norm, I want to clarify that I am not
speaking about individuals. We all internalise these harmful values and we can see gender
discrimination being perpetrated by both men and women, just as we see both men and women
fighting for gender equity and equality. However, at the level of institutions and society, it is men who
overwhelmingly benefit from gender discrimination. Violating the right  to be myself can never be
condoned and is unpardonable. There are many men in my life who taught me this, starting from my
dad who made my world a safer one to be in.

Opportunities given to the gander have to be available to the goose too. We, the  elite make a hue
and cry, when the prize money of the female tennis star is lesser for playing a three setter  than her
male counterparts whilst  female farm workers suffer with lesser wages for doing the same work
because this is not "cool" and doesn’t touch us. In the urban set up too it has been documented that
women have to play up on their sexuality to get ahead, at some point in their career. The glass ceiling
exists even in a so-called gender neutral field like medicine.

I have always thought that medicine is a gender neutral field but there seems to be a veiled glass
ceiling even here. I discovered this to my dismay when I was privy to the angst of women doctors from
radiology, surgery & other specialities in the private confines of the duty rooms. Registrars &
Consultants lamenting the lack of opportunities- who feel saddled by huge load of the mundane
monotony- of being forced to limit themselves to women’s health whilst their male counterparts thrive
financially and otherwise in all specialities including all aspects of women’s Diseases. Women in
academia in the US and Europe too face this problem. In a 2005 study conducted in America, it was
Breast Imaging Society, India 20
 THE BISI BUZZ MAY 2020
found that women were 2.2 times more likely than were men to report basing some part of their
specialty choice decisions on gender discrimination and sexual harassment concerns, and they were
1.8 times more likely to report that gender discrimination and sexual harassment concerns affected
their rankings of residency programs1. Similarly, a 2004 study conducted by the American College of
Radiology states that “gender disparity in academic medicine is well documented… women face
greater obstacles to promotion… only 12% of women in academic medicine are professors compared
with 31% of men”2.

Gender oriented perceptions of practice shape who should do what. A successful ENT surgeon said
to me that his daughter should take up his wife's successful practice of Ob & Gyn not because lady
patients prefer to go to a woman doctor, but because of the prevalence of patriarchy in ENT (he asked
me “how many successful women do you know in ENT”), despite it having better hours and more
family time. A 2014 study conducted in Spain3 found that “among 800 Catalan general practitioners, a
formal hierarchal position was held by 18.7% of the women compared with 33.8% of men studied.” A
2004 study conducted by the American College of Radiology notes that women do not choose
diagnostic radiology due to negative gender- related discrimination, and a lack of mentors in the
field. A 2016 Canadian study mirrored these findings, stating that “female radiologists have attributed
deficient career support to their gender and they are underrepresented at higher levels of
administration and in tenured positions in Radiology”.

This is reflective of the larger prevalence of gender discrimination within medicine. I also want to draw
your attention to the fact that there are no readily available statistics for the Indian scenario, which
highlights the urgent need for us to examine gender discrimination in our context. Society is so
entrenched in patriarchy that whilst men support men, women don't offer so much support or go out
of the way because of their own patriarchal upbringing and the fear that if we help other women, then
we will be seen as “trouble makers”!

Another practical example of how gender discrimination operates in medicine is networking.

Networking is a part of any profession, but especially so in  private/corporate medical practice. As
women, we are often totally cut out of these “old boys club” and this was the lament of a lot of my
female colleagues from other specialities especially surgical. A lot of women doctors feel that they are
out of the loop. Similarly, a lot of the camaraderie happens in the pre-dinner bonding sessions in
organisational hierarchies and meetings. Women, often lose out on these opportunities too because
of their family commitments, or safety concerns. On the rare occasion that they have the chance to
participate, they are afraid of being labelled as “fast” or “frivolous”.

When it comes to fights and battles, as women we are expected to slink away because fighting and
standing up for oneself is considered a man’s prerogative. Women who choose to stand their ground
and challenge the demure, docile feminine image tend to be labelled an aggressive or rude woman.
An aggressive man is seen as a “go-getter” whilst the same trait in a woman is considered as “being
pushy or overbearing”.

This is not to deny the progress that we have made in terms of gender equity and equality and, in
some respects the developing world is better than the so-called developed world because of the
share of women in high places be it politics, finance ,rocket launches ,medicine and radiology.
However, there needs to an equitable, proportional representation in the work space and
organisational hierarchy and not mere lip-service. In this, a Dutch engineering university is taking
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 THE BISI BUZZ MAY 2020

radical action to increase its share of female academics by opening job vacancies to women only.
Starting on 1 July, the Eindhoven University of Technology (TUE) in the Netherlands will not allow men
to apply for permanent academic jobs for the first 6 months of the recruitment process under a new
fellowship program. If no suitable applicant has been found within that time, men can then apply, but
the selection committee will still have to nominate at least one candidate of each gender. Fair play,
empathy and a non- discriminative attitude in work allocation, revenue sharing, academic
organisational responsibilities and mentorship can play a huge role in making a healthy balance in
communities.

Differences and uniqueness in genders is healthy, but using power to manipulate or oppress a certain
gender is unethical and harmful to us all. Women need to feel equal and cherished whether she is a
mother, sister, daughter, friend, colleague or a stranger. Swami Vivekananda in a letter to Swami
Ramakrishna had said: “there is no chance for the welfare of the world unless the condition of women
is improved. It is not possible for a bird to fly on one wing”.

1. https://journals.lww.com/academicmedicine/Fulltext/2005/04000/
Impact_of_a_Program_to_Diminish_Gender.20.aspx
2. 10.1016/j.jacr.2004.02.023
3. https://www.sciencedirect.com/science/article/pii/S0213911114001095 


I started this piece (the 1st para) when " Me too " movement started because in medical school a lot of times lady students
are often accused of using their inherent sensuality to get ahead in class. I have always felt that Medicine is a gender-
neutral field unlike entertainment, airline or hotel industry. I have never hesitated to do what a guy does in my
career or personal life and that is something we teach our children. Over the years, however I have heard and
felt the pain of my younger women colleagues (radiologists, surgeon etc) who feel restricted & confined into
their atavistic gender biased referral practice resulting in a deep sense of professional frustration & ennui.
When I went to ECR and attended the sessions on " women in focus “, I realised that it is an universal problem, a
cause which even an eminent radiologist like Dr. Hricakh espoused. I mustered courage to send and sent it to
Prof. Hricakh on a whom on Woman’s Day this March, not expecting a reply. Her feed-back & feed-back from
women and men enthused me to send it to BISI BUZZ.
Dr Bagyam is a senior consultant radiologist & co-ordinator in Apollo cancer institute, Chennai; 

founder member and past secretory of breast imaging society India;

& founder member & secretory of society of oncology imaging India .

hricakh@mskcc.org Mar 8, 2020, 12:03 AM

“I like your essay- heart felt and accompanied by statistics; I especially like the quote  - see below -
which you may want to tweet or use some other social media to disseminate the message – Swami
Vivekananda in a letter to Swami Ramakrishna had said: “there is no chance for the welfare of the
world unless the condition of women is improved. It is not possible for a bird to fly on one wing”.
Warmly HH.

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 THE BISI BUZZ MAY 2020
Insights

It’s only once in a blue moon that that I have lunch at our hospital canteen.
Checking on social media, while having a homemade snack in your own
cabin, works out quite convenient for me. Very shortly I intend to buy that
diamond necklace, which my radiology colleagues believe, is what I should
have saved for by now -after years of skipping paid lunches.

Speaking of our canteen, the largest clusters are inevitably female doctors.
Divided by specialties and small dislikes they are united by the need to make
Dr.Teena Sleeba most of the 45 minutes allotted luncheon. Naturally this space is buzzing with
exchange of information. And it’s amusing to see how my occasional entry has
resulted in a shift of topics-from the more interesting ones to breast cancer. 



“That lady was only 42 right? .so sad…so very scary” 

“It’s so common these days…so many cases in their forties … isn't it ?”

“Oh good!.. Seeing you reminds me I have been postponing a scan for so long now”

“Its high time I got a mammogram done…I have some family history too”

“By the way …what are the charges of mammogram?”

Well many a times I have been tempted to say “The same charges as when u last enquired ...a couple
of years ago”.

Isn’t it quintessentially feminine –to enquire the cost of something we don’t intend to buy!

A good 99% of those interactions with doctors have never materialised into a mammogram. I am also
aware of staff lower down in the rung who enquire about charges from the radiology reception and
leave without getting one done.

Women will continue doing complex mathematics of cost and time and at the same time cringe when
someone known to them is diagnosed with breast cancer. This is what got me thinking –why can’t we
offer free mammograms for our own staff. 

Woman constitute a good 60% of our 2500 plus hospital workforce. 

And only a third of these women are over forty. Meaning we needed to screen about 500 staff or so
on an annual basis. This is definitely not a huge number if spaced and accommodated into regular
work

Thankfully for this endeavour, I had the support of our social service department .They I must say, they
have been doing an amazing job already, analyzing and understanding stressors in working women
across of all ages.

The management too was quite receptive of the idea. The finance section did agonise over the
proposal for some time but finally gave clearance when we assured them that no films or written
reports would be released.

We have been successfully screening our women with mammogram for some time now. Undertaken
along with their annual check health check-ups the imaging is extended to all women, irrespective of
whether they are permanent or temporary employees. The images are reviewed later in the day and if
the need for a correlative ultrasound was felt, the concerned staff was asked to report back at a

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 THE BISI BUZZ MAY 2020

convenient time. For findings that required an intervention a written report was released against
payment. For younger woman with any breast related complaints, ultrasounds are undertaken at staff
concessional rates.

On a personal note I feel happy to add some action to the whole “screening and awareness” talk that
we do .It definitely takes some extra effort and time, but the gratitude expressed by our staff pays for it
all.

By supporting this endeavour, the institution has shown it cares for and supports its women force.
Charity should….definitely begin at home. And I’m secretly hoping to get a standing ovation I visit the
canteen next time…Just wishful thinking…

Dr. Teena Sleeba is a Consultant Radiologist at Rajagiri Hospital, Kochi, Kerala.

WORD FIND

Awareness
 Breast 

Cancer
 Health

Important
 Normal

Screening
 Test

Time
 Yearly

Abnormal
 Breast and Cervical
Exam
 Cancer Program

Mammogram
 Clinical Breast Exam

Ta k e Yo u r Early Detection

Time
 Forty Years And Older

Woman
 Regular Screening 







 


Link for key: Courtesy: Maryland department of health

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THE BISI BUZZ MAY 2020

OBITUARY
Dr Smiti Sripathy (1969-2018)

Dr. Smiti Sripathi, Professor and Head, Department of

Radio-diagnosis, Kasturba Medical College, Manipal
passed away on 8th December 2018 after a brief illness. In
a condolence message Dean of KMC said “The
Management, Staff and Students of Kasturba Medical
College and Hospital, Manipal place on record their deep
sense of sorrow at the passing away of Dr. Smiti S. We
express our condolence to the bereaved family. May God
grant courage and strength to the family members to cope
with irreparable loss. May her soul rest in peace.”

Her area of interest was breast imaging. Her vision was to

develop a Breast Unit in the department. She was working
for creating Breast Cancer Awareness by writing newspaper articles, conducting inter active
sessions on breast cancer awareness and breast self-examinations. 

She was very kind hearted, a voracious reader, great cook and who loves to travel to explore
Mother Nature. Dr. Smiti Sripathi’s untimely demise as left lacunae in the field of Radiology,
especially in the field of Breast Imaging.

To carry forward Dr Smiti’s dream of promoting education

and research in breast imaging, her husband, Dr Sripathy
H expressed his wish to sponsor “SMITI SRIPATHY
MEMORIAL AWARD" during the condolence meeting held
at the 2019 BISICON conference.

Written by
Dr Bagyam Raghavan

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Dr Mukund. S. Joshi (1942-2020)

Dr. Mukund Joshi was born on 23rd March 1942. Inspired by his
father, a renowned ENT surgeon, he decided to pursue a career
in Medicine. He completed his undergraduate studies from Seth
G S Medical College and KEM Hospital, Bombay and his post
graduate diploma in medical radio-diagnosis from the College
of Physicians & Surgeons, Mumbai. Thereafter, he joined the Tata
Memorial Hospital, Mumbai. After practicing conventional
radiology for a few years, he, in his own words, “got bored” and
decided to explore the then emerging imaging modality-
ultrasound. He traveled to Denmark and trained for a year under
the ultrasound pioneer Dr. Hans Henrik Holm before moving to
U.K to learn from Prof. David Cosgrove at the Royal Marsden
Hospital. Dr. Joshi was a visionary who recognized the
tremendous untapped potential of ultrasound as a cost effective
diagnostic tool. After another learning stint, in breast ultrasound, at the Sydney Square Breast
Center in Australia, he returned to Mumbai to set up the ultrasound unit at LTMG Hospital and
later at Jaslok Hospital. Thus began a 40 year journey of this immensely gifted ultrasonologist
and teacher who came to be looked upon as the Father of Ultrasound in India. He mentored
generations of radiology residents, inspiring them to be empathetic and astute clinicians.

Committed to continuing radiological education, he contributed numerous articles to radiology

journals and textbooks and delivered over 500 lectures, both within India and abroad. He was
the editor of the Indian Journal of Radiology and Imaging and past president of the Indian
Radiological and Imaging Association, The Indian Federation of Ultrasound in Medicine and
Biology and the National Academy of Medical Sciences. In recognition of his contributions to
Indian Radiology, he was honored with the Lifetime Achievement Award by the Indian
Radiological and Imaging Association in 2019. He was also active in community outreach
programs and in his capacity as a member of the Expert Working Group of the Planning
Commission of India from 1997-2002, he helped frame the national policy for Supportive and
Diagnostic Services at Primary, Secondary and Tertiary Health-Care Levels. 

He was the recipient of many distinctions, awards and honors

in Radiology. He was the second Indian in 100 years to receive
a honorary membership of RSNA in 2012 and the first ever
Indian to be awarded a fellowship of the American College of
Radiology in 2013. The scroll presented by RSNA recognized
him as a ‘visionary clinician and mentor whose name has
become synonymous with ultrasound in Asia’. Undoubtedly, he
was instrumental in putting Indian radiology on the world
map.

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He served on RSNA's International Advisory

Committee from 2009 on and was a member of
the Advisory Committee on Education for the
International Society of Radiology. Besides
being an outstanding radiologist, he was a
fervent cricketer and played competitively as a
medical student. An ardent fan of Lata
Mangeshkar and passionate about music, he
trained in classical music and often enthralled his
wide circle of friends with old Hindi film songs.

Dr. Joshi passed away on 7th January 2020.

Memories of his vibrant personality and
affectionate nature are etched firmly in the
minds of all those who knew this legend. 

You are dearly missed Sir!

Written by Dr. Punam Bajaj

BISI’S WRITE-SIDE

Thanks to Dr Madhavi Chandra (and the lockdown) we are adding a new column to the newsletter -
Bisi’s write-side! The project took off in March after the lockdown was announced when many of us
were confined to our homes. News on corona occupied almost every waking hour, even flooded
the well-guarded fortress of breast imaging family WhatsApp group. There were rarely any new
cases to discuss. So a challenge was set. Dr Madhavi sparked off an essay competition on “How I
joined and fell in love with Breast Imaging”. Over next few weeks she received nine essay
entries that were anonymized and opened for the BISI members to vote their favourites.

We are thrilled to announce names of all the authors and publish the top three essays in the
current and subsequent newsletters. Links to all other brilliant essays have also been added. BISI
newsletter team thanks all the writers for taking us on a beautiful journey. Thank you all readers for
voting and bringing this project to fruition. With the overwhelming response from the members,
BISI’s write-side hopes to become a permanent feature that will showcase work of our creative BISI-
bees.

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Heartiest Congratulations to Dr Asawari, Dr Janaki & Dr Devashree

for winning your voters’ hearts!

Authors Of All Essays Announced !

• “IT Was Destined To Happen…” by Dr. Janaki P. Dharmarajan, Amrita Institute of

Medical sciences and Research Centre, Kochi, Kerala

• “EVERY CLOUD HAS A SILVER LINING…” by Dr. Asawari Deshmukh,

Consultant Radiologist, Dhruv Digital X-ray Sonography & Mammography Clinic, Nagpur

• “It Was Not Love At First Sight, It Was A Beautiful Arranged Marriage…” by
Dr Devashree Gadgil-Joshi, Radiologist, Deenanath Mangeshkar Hospital, Pune

• “My postgraduate training in radiology started…” by Dr Yojana Nalawade

• “World of Breast Imaging, is indeed intriguing, Lesions are legion, and

finding protean…” by Dr. Saryu Gupta, Associate Professor Radiodiagnosis, Govt.
Medical College & Rajindra Hospital Patiala (Punjab)

• “My journey towards breast imaging started little late but no doubt it is very
fascinating…” by Dr. Vrushali Deshpande, Shalaka Imaging Center, Aurangabad (MS)

• “Ever since my childhood, I have been in deep awe of my mother…” Dr.

Sonali Sharma, Fellow Breast Imaging and Intervention, Medanta, The Medicity, Gurugram.

• “Breast imaging is a specialty which is dedicated to evaluation of Breast

pathologies…” by Dr. Sikandar, Consultant PET-CT & Radiology, Yashoda Hospitals,
Hyderabad.

• “To me, it happened during the early stage of my senior residency, six years
back…” by Dr. Suchana Kushvaha, Breast Imagine Fellow, Kovai Medical Centre &
Hospital, Coimbatore

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“EVERY CLOUD HAS A SILVER LINING” by Dr. Asawari Deshmukh

Consultant Radiologist, Dhruv Digital X-ray Sonography & Mammography Clinic, Nagpur.

It was routine morning for them little did Vani knew that it is going to
change her outlook towards life forever. Her daughter and son were
preparing to go to school and she was busy preparing tiffin for them. Her
little daughter as usual not in mood to go to school and making excuses,
but as dauting mother she insisted her to go to school.

As they went off to school, She too went to her clinic and was busy the
whole day.

Suddenly around 4 pm Vani's phone rang and here came a very bad news that her daughter met
with an accident.

She rushed back and saw her princess in pool of blood ,as she had broken her leg bones when a
rashly driving scooterist directly hit her. They rushed her to doctor and next day she was operated
upon. Doctor convinced them that it is a fracture of her leg bones and since she was very young it
will heal within 6 weeks. Her little princess came out of the O.T. with her leg in plaster. Her doctor
said its not big deal you can go home the very next day hearing this she was very happy that she
will go home now! Little did she dreamt that things are not going to be the way she had thought.

We plan but god has the last word! This saying is so true!

During her follow up x ray of leg they could not see any signs of healing and that raised Vani's
doubts ... what is reason ? was it due to some hormonal issues as her daughter was fat for her age.
During one such visit to the hospital for follow up x ray Vani thought that she should scan her
thyroid and parathyroids as bones were not

healing. She did her sonography and oh God! what she saw was 2 cm .calcific lesion in thyroid
gland ... papilllary carcioma! another blow to her now!

Now they rushed her to Tata hospital Mumbai where things were confirmed by the doctors and
was advised for total thyroidectomy.

It was traumatic experience for the family. When she was in the hospital Vani could relate with so
many patients visiting to the hospital for their sufferings.

Vani had planned for her breast imaging course at Tata hospital which was due in very near
future .But she had to come to the same hospital but now for a very different and unpleasant
reason. Anyways ,now Vani had to stay at Mumbai for a month.

During her stay she had lot of spare time , Vani thought of sharpening her skill in breast imaging
as it was best to place to learn .She met Head of Radiology department and asked for a favour

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THE BISI BUZZ MAY 2020

whether she could get the course in breast imaging in same month. The department head was
very kind and permitted her. So now Vani's dream to learn more about breast imaging science was
going to be fulfilled.

“Kehte hai na kisi cheez ko tum agar shiddat se chaho to sari kaynaat tumhe us se milane ki sazish
me lag zati hai!” very filmy but true in her life.

And so in the mean time her daughter recovered completely and they returned back to home
town.

Now her daughter was in 10th standard getting ready for the board exams.

During the same time Vani's mammography machine was due for installation. It was due for a long
time and getting postponed for unavoidable circumstance !

Now Vani's dream for a long time was coming true. While it was installed they did some patients to
know about the technical details and imaging quality as is done for any machine.

Vani suddenly felt that she herself should get screening mammography done. Technical person
was surprised as no one check own machines by imaging themselves. Anyways it was done ,but
alas it was a nightmare for Vani, to see her own mammogram. She could see the most unexpected
findings .. a suspicious malignant lesion .

She could not believe and cried inconsolably in her clinic... why me again !

The technical person was very nice she gave her courage ,consoled her and told she will make all
arrangements for her at Tata/Hinduja hospital wherever she opts for the treatment as she had
earlier worked in those hospitals !

But for Vani it was difficult to return home with a straight face as if nothing has happened. Her
daughter had just returned home with her 1st maths board paper and she was happy that it was
good as per her expectations.

Now they had her whole exams ahead and Vani had so many doubts ... as how she is to react in
these situations.... very perplexing for Vani!

Now Vani could understand how it blows one off when she as doctor discloses same to the
patients or their relatives. and also understood the importance of screening mammograms which
are taken very lightly in India.

Then Vani's journey as cancer patient began . She had lobular carcinoma of breast and thankfully
with no nodes. She was was operated at Tata hospital , recovered fast and now it was the question
whether she would need chemotherapy for which she was not ready mentally.

Same time while discussing for any alternatives her chemotherapist and pathologist told her about

ONCO TYPE DX test which gives you some results whether chemo is really going be of help in her
case .

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THE BISI BUZZ MAY 2020

The test result were in Vani's favour and she was happy now that she can get away with
chemotherapy and only need hormonal treatment and follow up.

This experience was enough for Vani to change her outlook towards all breast cancer patients.

Now her mission was to get adequately trained in breast imaging and help patients to boldly face
the disease as when diagnosed early it gives you very optimistic results.

During same time BISI was formed and she became its founder member. And since then she got
an opportunity to learn from masters in this field. The W app group which is formed has many
stalwarts in this field and give immediate response to any query that is being posted on the group.
Not only do they solve your problems but it is backed by many articles from the renowned
Journals.

However silly the questions asked on this platform are, very seriously considered and answered to
the satisfaction of the learner and this makes the breast imaging very very interesting.

Vani started organizing camps of screening mammography for patients above 40 yrs , it was for
bare minimum charges but to her surprise foot falls were very

less .when enquired with the camp organizers as to why women are not taking advantage of it
they found them saying that they do not have complaints so what’s the need. So there is need for
educating people at large about the importance of screening and diagnostic mammography.

Recently she saw a case posted on the group about a young female who had been reffered with
complaints due to her secondaries and retrospectively found to be a case of primary Ca breast as
her clinician had missed her general examination. This reminded her a similar case with symtoms
of loss of weight, vomiting thinking her to be a case of jaundice but when did her usg there were
many secondaries in liver and when asked for other complaints she told about breast mass ..a
primary lesion.

This platform also gave her an opportunity to listen to revered teacher --Dr. Tabar in the
conference organized by BISI recently which was an eye opener for how one can co-relate
mammographic findings with histolpathologic diagnosis which has given her another leap in
breast imaging.

She started loving this platform of learning and executing the knowledge of breast imaging for
her patients at large!

“Everyone can not be learned like Sun in the sky ,


but with its light we learners can illuminated many lives”

LONG LIVE BISI !

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UPCOMING EVENTS

8th Annual Conference of Breast Imaging Society, India

Workshop: October 2, 2020
Conference: October 3-4, 2020
Venue: The Leela Ambience Gurugram Hotel & Residences

CLICK HERE TO REGISTER!

Conference Highlights

DR. ELIZABETH A. MORRIS

MD, FACR, FSBI, FISMRM
Chief, Brest Imaging Service, Larry Norton Endowed Chair Member,
Memorial Sloan Kettering Cancer Center Professor of Radiology,
Weill Cornell Medical College

DR. CHRISTOPHER COMSTOCK

MD
Breast Imaging Service,
Memorial Sloan Kettering Cancer Center

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THE BISI BUZZ MAY 2020

Watch for updates on the BISI website and WhatsApp

group for changing schedules in these events that were
already announced by the society.

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Breast Imaging Society, India 34