Fig. 72.1 a,b Ultrasound.

Clinical Findings

Normal.

Fig. 72.2a,b Digital mammography, CC view.

Fig. 72.3a,b Digital mammography, MLO view.

Fig. 72.4a–c Contrast-enhanced MRI of the breasts.

Fig. 72.5 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 72.6a-c Enlarged view of lesion; signal-to-time curves.

Ultrasound

In the upper outer quadrant of the right breast, there was an ill-defined, lobulated, hypoechoic area within the glandular tissue with inhomogeneous internal texture. There was no echo alteration of the surrounding structures, but ligamental structures were clearly displaced by this region. US BI-RADS right 3.

Mammography

Mammograms showed inhomogeneously dense glandular tissue of ACR type 3 with a mild asymmetry of the upper outer quadrants. In the right breast there was a slight shrinking with some peripheral spiculation in the upper outer quadrant. There were no densities or definite lesions. No architectural distortions, and no microcalcifications. BI-RADS right 3/left 1. PGMI CC view P; MLO view G (inframammary fold).

MR Mammography

MRI demonstrated a single hypervascularized, ill-defined lesion with a ring enhancement between the outer quadrants of the right breast. There were no suspicious signal changes in the analysis of enhancement dynamics. The left breast showed a patchy enhancement, probably attributable to adenosis.

MRI Artifact Category: 1

MRI Density Type: 2

Differential Diagnosis

Right: Carcinoma, adenosis.

Procedure

Histopathological analysis of the lesion in the right breast by US-guided percutaneous core biopsy.

Histopathological analysis of the specimen (right breast)

Chronic fibrocystic mastopathy. No malignancy.

Further procedure

With regard to the discrepancy between the imaging findings in the right breast (in particular MRI) and the histological results, a further percutaneous core biopsy was necessary for increased accuracy. An MR-guided vacuum biopsy was recommended. Instead, in the present case, an excisional biopsy was performed on the lesion in the right breast at the patient’s request.