Case History

A 47-year-old woman presents with a palpable left breast mass.

Physical Examination

• Palpable lump in the left 4 o’clock position

Mammogram

Fig. 36.1 In the left outer inner quadrant, there are two irregular masses (arrows). (A) Left ML spot compression. (B) Left CC spot compression.

Fig. 36.2 The left breast palpable masses and the mammographic masses correspond to two solid irregular masses at the 4 o’clock and 5 o’clock positions. (A) Left transverse breast sonogram of the mass at the 4 o’clock position. (B) Left transverse breast sonogram of the mass at the 5 o’clock position.

Fig. 36.3 Contrast-enhanced bilateral breast MRI maximum projection intensity (MIP) image. There are two highly enhancing suspicious irregular masses that correspond to the sonographic masses (small arrowheads). Suspicious enhancing axillary adenopathy is also evident (large arrowhead).

Fig. 36.4 The positron emission tomography–computed tomography (PET-CT) scan performed after the MRI demonstrates extensive ¹⁸F-fluorodeoxyglucose (FDG) uptake in the left breast (B), axillary (A), supraclavicular (S), and mediastinal (M) region. (A) Maximum intensity projection (MIP) PET image prior to chemotherapy. (B) Axial PET-CT prior to chemotherapy.

Fig. 36.5 After 4 months of chemotherapy, PET-CT demonstrates resolution of the uptake in the left breast and previously abnormal lymph nodes. (A) MIP PET image after 4 months of chemotherapy. (B) Axial PET-CT image after 4 months of chemotherapy.

• Left mastectomy and axillary dissection (performed 2 weeks after the second positron emission tomography [PET] scan) demonstrates a residual invasive ductal cancer 0.8 cm in size. Six of eight axillary nodes exhibit metastatic disease. The largest metastatic axillary nodal involvement is < 2 mm.

Management

• Left mammographic and sonographic mass: BI-RADS assessment category 5, highly suggestive of malignancy