Clinical Findings

Macromastia. No abnormalities.

Fig. 55.1a,b Ultrasound imaging between the upper quadrants of the right breast.

Fig. 55.2a,b Conventional mammography, MLO view [imaging not performed by authors].

Fig. 55.3a,b Conventional mammography, CC view [imaging not performed by authors].

Fig. 55.4a–c Contrast-enhanced MR mammography. Earliest subtraction.

Fig. 55.5a-c Contrast-enhanced MR mammography. Earliest subtraction.

Fig. 55.6 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 55.7a,b Signal-to-time curves.

Ultrasound

Ultrasound showed inhomogeneous echogenicity of the breast parenchyma. No suspicious lesions were seen in the initial ultrasound images. However, once the results of MR mammography were known, the sonographic examination was repeated and a hypoechoic mass measuring 8 mm with distal echo shadowing was depicted between the upper quadrants of the right breast. No architectural distortion. US BI-RADS right 3/left 1.

Mammography

Mammograms showed asymmetric, partially inhomogeneous dense parenchyma, ACR type 3. There were no suspicious findings and no microcalcifications. BI-RADS right 1/left 1. PGMI: CC view P; MLO view G (angle of pectoral muscle, inframammary fold).

MR Mammography

A solitary, partially ill-defined, spiculated mass of 1.5 cm diameter with homogeneous enhancement was found between the upper quadrants of the right breast. Initial signal increase was 120% followed by a postinitial plateau. There was a partially reduced signal of this lesion in T2-weighted imaging. No other suspect findings.

MRI Artifact Category: 1

MRI Density Type: 2

Differential Diagnosis

Focal adenosis, radial scar, carcinoma (tubular?).

Procedure

MR-guided vacuum biopsy. A US-guided biopsy could also be considered as an alternative. In the latter case, the correspondence between US and MRI findings must be very firmly established.

Histology

Invasive lobular carcinoma.

Fig. 55.8a–d MR-guided vacuum biopsy.

a Subtraction image reproducing the suspicious finding.

b Documentation of coaxial needle.

c Area of resection after biopsy.

d Final documentation following further contrast administration, showing enhancement due to bleeding.