Fig. 17.1 a-d Ultrasound of the right breast, inner quadrants.

Clinical Findings

Lumpy parenchymal texture, no suspect findings.

Fig. 17.2a,b Digital mammography, CC view.

Fig. 17.3a,b Digital mammography, MLO view.

Fig. 17.4 Magnification view of the right breast (CC).

Fig. 17.5a-c Contrast-enhanced MR mammography.

Fig. 17.6a-c Contrast-enhanced MR mammography.

Fig. 17.7 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 17.8 Signal-to-time curve (right breast, central region).

Ultrasound

Corresponding to the microcalcifications seen in mammography and the localized enhancement in MRI, the inner quadrants of the right breast showed inhomogeneous echogenicity. Multiple hypoechoic lesions 6-8 mm in diameter with nonechogenic borders and no distal shadowing. No definitively suspect findings. US BI-RADS right 3.

Mammography

Mammograms demonstrated bilaterally symmetric inhomogeneous dense parenchyma, ACR type 3. Imaging showed two clusters of polymorphous microcalcifications between the inner quadrants of the right breast and in the central part of the right breast. There were no masses, densities, or architectural distortions. BI-RADS right 4/left 1. PGMI: CC view P; MLO view G (inframammary fold not clearly imaged).

MR Mammography

A dendritic, partially ill-defined and inhomogeneous enhancement was seen in the upper inner quadrant of the right breast, with a strong initial signal increase (>100%) and postinitial plateau. This enhancing focus showed low signal intensity in T2-weighted images. No findings in the left breast.

MRI Artifact Category: 2

MRI Density Type: 2

Preliminary Diagnosis

DCIS, minimally invasive carcinoma, invasive carcinoma.

Fig. 17.9a,b Preoperative localization and magnification view (CC).

Procedure

Histopathological evaluation after US-guided core biopsy of the right upper inner quadrant.

Histopathology

Ductal carcinoma in situ.

Further procedure

Preoperative hook-wire localization.

Fig. 17.10a, b Preoperative localization and magnification view (MLO). Both calcification groups are marked with a Homer wire.

Fig. 17.11 Specimen radiography.