Fig. 1.1 Sonography of the left breast. Panoramic view.

Clinical Findings

Dense, mobile mass of diameter 2 cm in the upper outer quadrant of the left breast. Ptosis of the left breast.

Fig. 1.2a,b Digital mammography, MLO view.

Fig. 1.3 Magnification view of the upper outer quadrant of the left breast, CC view.

Fig. 1.4a—c Contrast-enhanced MRI of the breasts.

Fig. 1.5 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 1.6a, b Signal-to-time curve.

Ultrasound

Corresponding to the palpable mass, ultrasound demonstrates a suspect lobulated lesion with predominantly ill-defined borders and a hyperechoic marginal area. This lesion disturbs ligaments and leads to retraction of the surrounding parenchyma. Close to this lesion, ultrasound shows a pathologically enlarged lymph node. Assessment: US BI-RADS left 5.

Mammography

Mammography shows symmetric lipomatous breast tissue of ACR type 1. There are no pathological findings in the right breast. In the upper outer quadrant of the left breast, there is a lobulated mass (2 cm diameter) with ill-defined borders. A bridge of dense tissue is seen between the lesion and a prepectoral lymph node about 2 cm away. There is a further partially visible, enlarged lymph node in the left upper axilla. No microcalcifications are detectable (BI-RADS right 1/left 5). PGMI: G (the inframammary fold was not clearly discernible).

MR Mammography

Fig. 1.7 Contrast-enhanced MR mammography. Magnification view of the left breast, upper outer quadrant.

Caution: Other linear structures with increased vascularization correlate with contrast-enhanced veins (broken arrow).

MRI Artifact Category: 2

MRI Density Type: 1

Preliminary Diagnosis

Invasive breast cancer of the left breast with lymph node metastases, stage T2. No differential diagnosis.

Next step according guidelines

US-guided core biopsy of the palpable mass in the left breast

Performed step (departing from guidelines)

Due to the age of the patient and the clear findings in all imaging modalities, and in response to the patient’s own request, a US-guided core biopsy for preoperative histopathological diagonsis was not performed. The tumor was examined histopathologically following mastectomy.