Fig. 28.1 a,b Ultrasound.

Clinical Findings

Resistance (diameter 2 cm) between upper quadrants of the left breast.

Fig. 28.2 Color-coded Doppler sonography.

Fig. 28.3a,b Digital mammography, MLO view.

Fig. 28.4a,b Digital mammography, CC view.

Fig. 28.5a–c Contrast-enhanced MRI of the breasts.

Fig. 28.6 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 28.7a,b Signal-to-time curves.

Ultrasound

Corresponding to the resistance between the upper quadrants of the left breast, along a vertical axis from the nipple, the ultrasound depicted an oval hypoechoic lesion (diameter: 2,5 cm) with moderate distal acoustic increase and a lateral echo decrease. US BI-RADS3.

Mammography

Mammograms showed inhomogeneous dense parenchyma ACR type 3. Between the upper quadrants of the left breast an isodense, partially ill-defined lesion (diameter 2,5 cm) with a semicircular “Halo sign” was depicted. There were no other suspect densities or architectural distortions and no microcalcifications visible. BI-RADS right 1/left 3. PGMI: P for CC; M for MLO (inframammary fold).

MR Mammography

In the central region of the left breast MRI demonstrated a well-defined mass (diameter 3 cm) enclosed by a narrow section of lipomatous tissue. After administration of contrast, homogeneous enhancement with strong initial signal increase (120%) followed by washout were visible. Signal in T2-weighted imaging was increased.

MRI Artifact Category: 1

MRI Density Type: 2

Preliminary Diagnosis

1Fibroadenoma.

Differential Diagnosis

Papilloma, adenoma, phyllodes tumor, medullary carcinoma.

Procedure

Investigation of the lesion in the left breast by US-guided core biopsy.

Histology of the specimen

Tubular adenoma.

Fig. 28.8a,b US-guided core biopsy. Pre-fire and post-fire documentation.