Fig. 65.1 Ultrasound.

Clinical Findings

No findings.

Fig. 65.2 a,b Digital mammography, MLO view [imaging not performed by authors].

Fig. 65.3 a,b Digital mammography, CC view [imaging not performed by authors].

Fig. 65.4 a-c Contrast-enhanced MRI of the breasts.

Fig. 65.5 a-c Contrast-enhanced MRI of the breasts.

Fig. 65.6 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 65.7 a,b Signal-to-time curves.

Ultrasound

Ultrasound showed a cluster of round, hypoechogenic lesions with linear distal echo shadowing situated in the left breast behind the nipple. US BI-RADS 4.

Mammography

Mammograms showed bilaterally symmetric, inhomogeneously dense parenchyma, ACR type 3. Particularly in the center of the left breast there were no suspicious lesions or densities. Images showed no suspicious microcalcifications and no architectural distortion. BI-RADS right 1/left 1. PGMI: MLO view I (right pectoralis muscle not depicted; inframammary fold not depicted, prominent abdominal skin fold); CC view M (medial parenchyma not fully visible).

MR Mammography

A mass composed of three well-defined, oval, homogeneously enhancing components, each around 1 cm in diameter, was visible in the center of the left breast. It had initial signal increase of 150% and a postinitial washout. In T2-weighted imaging the section of the triple lesion nearest the nipple showed increased signal, while the two sections farther from the nipple had reduced signal. Maximum intensity projection showed a chain of lymph nodes within the breast.

MRI Artifact Category: 1

MRI Density Type: 3

Differential Diagnosis

Left: Papilloma, fibroadenoma, adenoma, carcinoma.

Procedure

MR-guided vacuum biopsy was performed because ultrasound could not categorize the suspicious triple lesion seen in MR mammography.

Histopathology

Focal sclerosing adenosis.

Fig. 65.8 a-e MR-guided vacuum biopsy of the left breast.