Fig. 26.1 a,b Ultrasound

Fig. 26.2a,b Digital mammography, MLO view.

Clinical Findings

No abnormalities.

Fig. 26.3a,b Digital mammography, CC view.

Fig. 26.4a–c Contrast-enhanced MRI of the breasts.

Fig. 26.5 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 26.6a,b Signal-to-time curves.

Ultrasound

Retrospectively, in view of the MRI findings, an ill-defined hypoechoic lesion of 5 mm diameter with irregular borders and indeterminate distal echo behavior was depicted by sonography. There was no architectural distortion. US BI-RADS right 3.

Mammography

Mammography showed bilaterally symmetric, extremely dense parenchyma, ACR type 4. Particularly in the inner quadrants of the right breast, there were no suspicious densities or lesions and no microcalcifications. No architectural distortion (BI-RADS right 1/left 1). PGMI: CC view P; MLO view G (inframammary fold, axillary skin fold).

MR Mammography

Between the inner quadrants of the right breast, there was an ill-defined, spiculated lesion of approx. 5 mm diameter. This lesion demonstrated ring enhancement, a strong initial signal increase of 140%, and a postinitial plateau. Signal in T2-weighted imaging was indeterminate. No further suspect lesions.

MRI Artifact Category: 2

MRI Density Type: 2

Preliminary Diagnosis

Carcinoma.

Differential Diagnosis

Focal adenosis.

Consideration

Does the sonographically depicted lesion correspond exactly with the enhancing area in MR mammography? Since the imaging evidence was not conclusive on this point, MR-guided investigation of the lesion was recommended.

Procedure

MS-guided vacuum biopsy of the lesion in the center of the right breast.

Histopathology of the biopsy specimen, right breast

Adenosis.