Clinical Findings

No findings.

Fig. 42.1 Ultrasound.

Fig. 42.2a,b Digital mammography, CC view.

Fig.42.3a,b Digital mammography, MLO view.

Fig. 42.4 Spot compression, left breast.

Fig. 42.5a-c Contrast-enhanced MRI of the breasts.

Fig. 42.6a-c Contrast-enhanced MRI of the breasts.

Fig. 42.7 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 42.8a-d Signal-to-time curves.

Ultrasound

In the upper outer quadrant of the left breast there was an irregular, hypoechoic lesion with distal acoustic shadowing (diameter8 mm). US BI-RADS left 4.

MR Mammography

MRI demonstrated a spiculated, ill-defined mass (diameter: 1 cm) in the upper outer quadrant with strong initial signal increase and postinitial plateau as well as a reduced signal in T2-weighted imaging. 1.2 cm caudal of this mass there were two homogeneously enhancing lesions, each of 5 mm diameter, with initial signal increase of 80% and postinitial plateau as well as reduced signal in T2-weighted imaging (MRI BI-RADS 3).

Mammography

Imaging showed an asymmetric (right>left), partially inhomogeneous dense parenchyma, ACR type 3. There was an isodense, slightly spiculated mass (diameter 1 cm) in the upper outer quadrant of the left breast. Spot compression obtained a more precise depiction of the spiculated quality of this lesion. BI-RADS right 1/left 4. PGMI: CC view P; MLO view G (inframammary fold).

Note

Fig. 42.9 MR mammography three years earlier demonstrated a hypervascularized lesion in the left breast [imaging not performed by authors]. 256 matrix.

Fig. 42.10 Current MR mammography for comparison. 512 matrix.

Preliminary Diagnosis

Left upper outer quadrant: Carcinoma.

Left between outer quadrants: Fibroadenoma.

Differential Diagnosis

Adenosis, papilloma.

Fig. 42.11 a,b US-guided core biopsy of the left breast. Pre-fire and post-fire documentation.

Procedure

Fig. 42.12a-c MR-guided preoperative hook-wire localization. Pre-contrast image, subtraction image and documentation of the wire inposition.