HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berg, W. A. Articles by Ioffe, O. B. Search for Related Content PubMed PubMed Citation Articles by Berg, W. A. Articles by Ioffe, O. B.

Diagnostic Accuracy of Mammography, Clinical Examination, US, and MR Imaging in Preoperative Assessment of Breast Cancer¹

¹ From American College of Radiology Imaging Network, 301 Merrie Hunt Dr, Lutherville, MD 21093 (W.A.B.); Corporacion Nacional del Cancer, Santiago, Chile (L.G.); Departments of Radiology (M.S.N.), Surgery (W.B.C.), and Pathology (O.B.I.), University of Maryland, Baltimore; and American College of Radiology Technology Assessment Studies Assistance Program, Reston, Va (M.B., R.S.L.). From the 2001 RSNA scientific assembly. Received September 15, 2003; revision requested November 28; revision received March 5, 2004; accepted April 12. Supported by a grant from the Society of Breast Imaging. Address correspondence to W.A.B. (e-mail: wendieberg@hotmail.com).

View larger version (137K): [in a new window]   Figure 1a. Images in 46-year-old woman with nonpalpable 5-mm tubular carcinoma in left breast seen only at MR imaging. (a) Bilateral mediolateral oblique (MLO) and (b) spot-magnification mediolateral mammograms show subtle architectural distortion (arrow) suspicious for carcinoma in right breast, which proved to be atypical ductal hyperplasia at excision. (c) Transverse MIP reconstruction of subtracted three-dimensional spoiled gradient-echo coronal volume MR acquisition obtained 90 seconds after intravenous administration of 0.1 mmol/kg gadopentetate dimeglumine (10/3.6; flip angle, 30°; section thickness, 2.2 mm; field of view, 36 cm; 1.0 T) shows solitary intensely enhancing mass (arrowhead) in upper inner left breast and no abnormal enhancement in right breast. (d) Sagittal second-look US image (L12-7.5-MHz transducer) obtained in 10 o’clock position in left breast demonstrates irregular hypoechoic shadowing mass (arrowhead). US-guided needle localization revealed 5-mm (tubular) IDC. Patient underwent lumpectomy with radiation therapy.

View larger version (115K): [in a new window]   Figure 1b. Images in 46-year-old woman with nonpalpable 5-mm tubular carcinoma in left breast seen only at MR imaging. (a) Bilateral mediolateral oblique (MLO) and (b) spot-magnification mediolateral mammograms show subtle architectural distortion (arrow) suspicious for carcinoma in right breast, which proved to be atypical ductal hyperplasia at excision. (c) Transverse MIP reconstruction of subtracted three-dimensional spoiled gradient-echo coronal volume MR acquisition obtained 90 seconds after intravenous administration of 0.1 mmol/kg gadopentetate dimeglumine (10/3.6; flip angle, 30°; section thickness, 2.2 mm; field of view, 36 cm; 1.0 T) shows solitary intensely enhancing mass (arrowhead) in upper inner left breast and no abnormal enhancement in right breast. (d) Sagittal second-look US image (L12-7.5-MHz transducer) obtained in 10 o’clock position in left breast demonstrates irregular hypoechoic shadowing mass (arrowhead). US-guided needle localization revealed 5-mm (tubular) IDC. Patient underwent lumpectomy with radiation therapy.

View larger version (63K): [in a new window]   Figure 1c. Images in 46-year-old woman with nonpalpable 5-mm tubular carcinoma in left breast seen only at MR imaging. (a) Bilateral mediolateral oblique (MLO) and (b) spot-magnification mediolateral mammograms show subtle architectural distortion (arrow) suspicious for carcinoma in right breast, which proved to be atypical ductal hyperplasia at excision. (c) Transverse MIP reconstruction of subtracted three-dimensional spoiled gradient-echo coronal volume MR acquisition obtained 90 seconds after intravenous administration of 0.1 mmol/kg gadopentetate dimeglumine (10/3.6; flip angle, 30°; section thickness, 2.2 mm; field of view, 36 cm; 1.0 T) shows solitary intensely enhancing mass (arrowhead) in upper inner left breast and no abnormal enhancement in right breast. (d) Sagittal second-look US image (L12-7.5-MHz transducer) obtained in 10 o’clock position in left breast demonstrates irregular hypoechoic shadowing mass (arrowhead). US-guided needle localization revealed 5-mm (tubular) IDC. Patient underwent lumpectomy with radiation therapy.

View larger version (181K): [in a new window]   Figure 1d. Images in 46-year-old woman with nonpalpable 5-mm tubular carcinoma in left breast seen only at MR imaging. (a) Bilateral mediolateral oblique (MLO) and (b) spot-magnification mediolateral mammograms show subtle architectural distortion (arrow) suspicious for carcinoma in right breast, which proved to be atypical ductal hyperplasia at excision. (c) Transverse MIP reconstruction of subtracted three-dimensional spoiled gradient-echo coronal volume MR acquisition obtained 90 seconds after intravenous administration of 0.1 mmol/kg gadopentetate dimeglumine (10/3.6; flip angle, 30°; section thickness, 2.2 mm; field of view, 36 cm; 1.0 T) shows solitary intensely enhancing mass (arrowhead) in upper inner left breast and no abnormal enhancement in right breast. (d) Sagittal second-look US image (L12-7.5-MHz transducer) obtained in 10 o’clock position in left breast demonstrates irregular hypoechoic shadowing mass (arrowhead). US-guided needle localization revealed 5-mm (tubular) IDC. Patient underwent lumpectomy with radiation therapy.

View larger version (99K): [in a new window]   Figure 2a. Images in 43-year-old woman with nonpalpable 4-mm colloid carcinoma seen only at mammography and many bilateral fibroadenomas seen at US and MR imaging. (a) Bilateral craniocaudal mammograms and (b) spot-magnification craniocaudal mammogram show cluster of amorphous calcifications (arrowhead) in right breast yielding (colloid) IDC at stereotactic vacuum-assisted biopsy. (c) Radial sonograms (L13-7-MHz transducer) obtained in 11 o’clock position in right breast and (d) in 12 o’clock position in left breast show representative ovoid circumscribed hypoechoic masses (arrows) seen diffusely in both breasts. (e) Transverse three-dimensional MIP of subtracted coronal volume MR images obtained 90 seconds after administration of 0.1 mmol/kg gadopentetate dimeglumine (5.3/2.2; section thickness, 1.8 mm; field of view, 42 cm; 1.0 T) shows diffuse bilateral intense foci of enhancement with no one dominant suspicious mass. US-guided core biopsy was performed after MR imaging of two masses in right breast and one in left breast in regions shown and yielded fibroadenomas. The known carcinoma could not be depicted clearly at US or MR imaging, though a 4-mm residual (colloid) IDC was found at excision. Patient underwent lumpectomy and radiation therapy, and other multiple bilateral masses have resolved after 36 months.

View larger version (144K): [in a new window]   Figure 2b. Images in 43-year-old woman with nonpalpable 4-mm colloid carcinoma seen only at mammography and many bilateral fibroadenomas seen at US and MR imaging. (a) Bilateral craniocaudal mammograms and (b) spot-magnification craniocaudal mammogram show cluster of amorphous calcifications (arrowhead) in right breast yielding (colloid) IDC at stereotactic vacuum-assisted biopsy. (c) Radial sonograms (L13-7-MHz transducer) obtained in 11 o’clock position in right breast and (d) in 12 o’clock position in left breast show representative ovoid circumscribed hypoechoic masses (arrows) seen diffusely in both breasts. (e) Transverse three-dimensional MIP of subtracted coronal volume MR images obtained 90 seconds after administration of 0.1 mmol/kg gadopentetate dimeglumine (5.3/2.2; section thickness, 1.8 mm; field of view, 42 cm; 1.0 T) shows diffuse bilateral intense foci of enhancement with no one dominant suspicious mass. US-guided core biopsy was performed after MR imaging of two masses in right breast and one in left breast in regions shown and yielded fibroadenomas. The known carcinoma could not be depicted clearly at US or MR imaging, though a 4-mm residual (colloid) IDC was found at excision. Patient underwent lumpectomy and radiation therapy, and other multiple bilateral masses have resolved after 36 months.

View larger version (129K): [in a new window]   Figure 2c. Images in 43-year-old woman with nonpalpable 4-mm colloid carcinoma seen only at mammography and many bilateral fibroadenomas seen at US and MR imaging. (a) Bilateral craniocaudal mammograms and (b) spot-magnification craniocaudal mammogram show cluster of amorphous calcifications (arrowhead) in right breast yielding (colloid) IDC at stereotactic vacuum-assisted biopsy. (c) Radial sonograms (L13-7-MHz transducer) obtained in 11 o’clock position in right breast and (d) in 12 o’clock position in left breast show representative ovoid circumscribed hypoechoic masses (arrows) seen diffusely in both breasts. (e) Transverse three-dimensional MIP of subtracted coronal volume MR images obtained 90 seconds after administration of 0.1 mmol/kg gadopentetate dimeglumine (5.3/2.2; section thickness, 1.8 mm; field of view, 42 cm; 1.0 T) shows diffuse bilateral intense foci of enhancement with no one dominant suspicious mass. US-guided core biopsy was performed after MR imaging of two masses in right breast and one in left breast in regions shown and yielded fibroadenomas. The known carcinoma could not be depicted clearly at US or MR imaging, though a 4-mm residual (colloid) IDC was found at excision. Patient underwent lumpectomy and radiation therapy, and other multiple bilateral masses have resolved after 36 months.

View larger version (131K): [in a new window]   Figure 2d. Images in 43-year-old woman with nonpalpable 4-mm colloid carcinoma seen only at mammography and many bilateral fibroadenomas seen at US and MR imaging. (a) Bilateral craniocaudal mammograms and (b) spot-magnification craniocaudal mammogram show cluster of amorphous calcifications (arrowhead) in right breast yielding (colloid) IDC at stereotactic vacuum-assisted biopsy. (c) Radial sonograms (L13-7-MHz transducer) obtained in 11 o’clock position in right breast and (d) in 12 o’clock position in left breast show representative ovoid circumscribed hypoechoic masses (arrows) seen diffusely in both breasts. (e) Transverse three-dimensional MIP of subtracted coronal volume MR images obtained 90 seconds after administration of 0.1 mmol/kg gadopentetate dimeglumine (5.3/2.2; section thickness, 1.8 mm; field of view, 42 cm; 1.0 T) shows diffuse bilateral intense foci of enhancement with no one dominant suspicious mass. US-guided core biopsy was performed after MR imaging of two masses in right breast and one in left breast in regions shown and yielded fibroadenomas. The known carcinoma could not be depicted clearly at US or MR imaging, though a 4-mm residual (colloid) IDC was found at excision. Patient underwent lumpectomy and radiation therapy, and other multiple bilateral masses have resolved after 36 months.

View larger version (96K): [in a new window]   Figure 2e. Images in 43-year-old woman with nonpalpable 4-mm colloid carcinoma seen only at mammography and many bilateral fibroadenomas seen at US and MR imaging. (a) Bilateral craniocaudal mammograms and (b) spot-magnification craniocaudal mammogram show cluster of amorphous calcifications (arrowhead) in right breast yielding (colloid) IDC at stereotactic vacuum-assisted biopsy. (c) Radial sonograms (L13-7-MHz transducer) obtained in 11 o’clock position in right breast and (d) in 12 o’clock position in left breast show representative ovoid circumscribed hypoechoic masses (arrows) seen diffusely in both breasts. (e) Transverse three-dimensional MIP of subtracted coronal volume MR images obtained 90 seconds after administration of 0.1 mmol/kg gadopentetate dimeglumine (5.3/2.2; section thickness, 1.8 mm; field of view, 42 cm; 1.0 T) shows diffuse bilateral intense foci of enhancement with no one dominant suspicious mass. US-guided core biopsy was performed after MR imaging of two masses in right breast and one in left breast in regions shown and yielded fibroadenomas. The known carcinoma could not be depicted clearly at US or MR imaging, though a 4-mm residual (colloid) IDC was found at excision. Patient underwent lumpectomy and radiation therapy, and other multiple bilateral masses have resolved after 36 months.

View larger version (130K): [in a new window]   Figure 3a. Images in 44-year-old woman with palpable mass in right breast due to grade II IDC with associated EIC of micropapillary type, which is best depicted with MR imaging. (a) MLO mammograms show dense parenchyma with focal asymmetry corresponding to palpable mass marked with radiopaque marker. (b) Radial sonogram (L13-7-MHz transducer) of palpable mass in 9 o’clock position in right breast shows hypoechoic irregular mass with posterior enhancement, interpreted as solitary cancer with surrounding heterogeneous echotexture. (c) Transverse MIP of subtracted MR image obtained 3 minutes after contrast agent injection (same parameters as Fig 2) shows linear clumped enhancement (arrowheads) extending anterior and posterior to the known invasive cancer, due to extensive DCIS (EIC). A few small scattered foci of enhancement in contralateral breast were followed for 18 months and have resolved. (d) Second-look sonogram in radial orientation demonstrates hypoechoic mass with duct extension (arrowheads) and small adjacent hypoechoic masses (arrows) due to EIC. Patient opted for mastectomy.

View larger version (128K): [in a new window]   Figure 3b. Images in 44-year-old woman with palpable mass in right breast due to grade II IDC with associated EIC of micropapillary type, which is best depicted with MR imaging. (a) MLO mammograms show dense parenchyma with focal asymmetry corresponding to palpable mass marked with radiopaque marker. (b) Radial sonogram (L13-7-MHz transducer) of palpable mass in 9 o’clock position in right breast shows hypoechoic irregular mass with posterior enhancement, interpreted as solitary cancer with surrounding heterogeneous echotexture. (c) Transverse MIP of subtracted MR image obtained 3 minutes after contrast agent injection (same parameters as Fig 2) shows linear clumped enhancement (arrowheads) extending anterior and posterior to the known invasive cancer, due to extensive DCIS (EIC). A few small scattered foci of enhancement in contralateral breast were followed for 18 months and have resolved. (d) Second-look sonogram in radial orientation demonstrates hypoechoic mass with duct extension (arrowheads) and small adjacent hypoechoic masses (arrows) due to EIC. Patient opted for mastectomy.

View larger version (73K): [in a new window]   Figure 3c. Images in 44-year-old woman with palpable mass in right breast due to grade II IDC with associated EIC of micropapillary type, which is best depicted with MR imaging. (a) MLO mammograms show dense parenchyma with focal asymmetry corresponding to palpable mass marked with radiopaque marker. (b) Radial sonogram (L13-7-MHz transducer) of palpable mass in 9 o’clock position in right breast shows hypoechoic irregular mass with posterior enhancement, interpreted as solitary cancer with surrounding heterogeneous echotexture. (c) Transverse MIP of subtracted MR image obtained 3 minutes after contrast agent injection (same parameters as Fig 2) shows linear clumped enhancement (arrowheads) extending anterior and posterior to the known invasive cancer, due to extensive DCIS (EIC). A few small scattered foci of enhancement in contralateral breast were followed for 18 months and have resolved. (d) Second-look sonogram in radial orientation demonstrates hypoechoic mass with duct extension (arrowheads) and small adjacent hypoechoic masses (arrows) due to EIC. Patient opted for mastectomy.

View larger version (122K): [in a new window]   Figure 3d. Images in 44-year-old woman with palpable mass in right breast due to grade II IDC with associated EIC of micropapillary type, which is best depicted with MR imaging. (a) MLO mammograms show dense parenchyma with focal asymmetry corresponding to palpable mass marked with radiopaque marker. (b) Radial sonogram (L13-7-MHz transducer) of palpable mass in 9 o’clock position in right breast shows hypoechoic irregular mass with posterior enhancement, interpreted as solitary cancer with surrounding heterogeneous echotexture. (c) Transverse MIP of subtracted MR image obtained 3 minutes after contrast agent injection (same parameters as Fig 2) shows linear clumped enhancement (arrowheads) extending anterior and posterior to the known invasive cancer, due to extensive DCIS (EIC). A few small scattered foci of enhancement in contralateral breast were followed for 18 months and have resolved. (d) Second-look sonogram in radial orientation demonstrates hypoechoic mass with duct extension (arrowheads) and small adjacent hypoechoic masses (arrows) due to EIC. Patient opted for mastectomy.

View larger version (106K): [in a new window]   Figure 4a. Images in 57-year-old woman with bilateral diffuse foci of ILC. Patient presented with palpable node in neck, with fine-needle aspiration biopsy findings consistent with metastatic ILC. (a) Bilateral craniocaudal mammograms showed heterogeneously dense parenchyma with several vague asymmetries (arrows) in left breast developing since acquisition of a prior mammogram, seen only in craniocaudal view. (b) MLO mammograms show extensive bilateral axillary adenopathy (arrows). (c) Radial sonogram (L13-7-MHz transducer) obtained in 9 o’clock position in left breast shows multiple irregular hypoechoic masses (arrows), as were seen diffusely throughout both breasts. (d) Transverse MIP of subtracted MR image obtained 3 minutes after contrast agent injection (same parameters as in Fig 2) shows multiple diffuse intensely enhancing irregular masses in both breasts, as well as intensely enhancing adenopathy. One representative mass in each breast underwent core-needle biopsy with US guidance, confirming ILC. Patient underwent bilateral mastectomy and axillary node dissection, which confirmed diffuse ILC and metastatic adenopathy.

View larger version (117K): [in a new window]   Figure 4b. Images in 57-year-old woman with bilateral diffuse foci of ILC. Patient presented with palpable node in neck, with fine-needle aspiration biopsy findings consistent with metastatic ILC. (a) Bilateral craniocaudal mammograms showed heterogeneously dense parenchyma with several vague asymmetries (arrows) in left breast developing since acquisition of a prior mammogram, seen only in craniocaudal view. (b) MLO mammograms show extensive bilateral axillary adenopathy (arrows). (c) Radial sonogram (L13-7-MHz transducer) obtained in 9 o’clock position in left breast shows multiple irregular hypoechoic masses (arrows), as were seen diffusely throughout both breasts. (d) Transverse MIP of subtracted MR image obtained 3 minutes after contrast agent injection (same parameters as in Fig 2) shows multiple diffuse intensely enhancing irregular masses in both breasts, as well as intensely enhancing adenopathy. One representative mass in each breast underwent core-needle biopsy with US guidance, confirming ILC. Patient underwent bilateral mastectomy and axillary node dissection, which confirmed diffuse ILC and metastatic adenopathy.

View larger version (117K): [in a new window]   Figure 4c. Images in 57-year-old woman with bilateral diffuse foci of ILC. Patient presented with palpable node in neck, with fine-needle aspiration biopsy findings consistent with metastatic ILC. (a) Bilateral craniocaudal mammograms showed heterogeneously dense parenchyma with several vague asymmetries (arrows) in left breast developing since acquisition of a prior mammogram, seen only in craniocaudal view. (b) MLO mammograms show extensive bilateral axillary adenopathy (arrows). (c) Radial sonogram (L13-7-MHz transducer) obtained in 9 o’clock position in left breast shows multiple irregular hypoechoic masses (arrows), as were seen diffusely throughout both breasts. (d) Transverse MIP of subtracted MR image obtained 3 minutes after contrast agent injection (same parameters as in Fig 2) shows multiple diffuse intensely enhancing irregular masses in both breasts, as well as intensely enhancing adenopathy. One representative mass in each breast underwent core-needle biopsy with US guidance, confirming ILC. Patient underwent bilateral mastectomy and axillary node dissection, which confirmed diffuse ILC and metastatic adenopathy.

View larger version (98K): [in a new window]   Figure 4d. Images in 57-year-old woman with bilateral diffuse foci of ILC. Patient presented with palpable node in neck, with fine-needle aspiration biopsy findings consistent with metastatic ILC. (a) Bilateral craniocaudal mammograms showed heterogeneously dense parenchyma with several vague asymmetries (arrows) in left breast developing since acquisition of a prior mammogram, seen only in craniocaudal view. (b) MLO mammograms show extensive bilateral axillary adenopathy (arrows). (c) Radial sonogram (L13-7-MHz transducer) obtained in 9 o’clock position in left breast shows multiple irregular hypoechoic masses (arrows), as were seen diffusely throughout both breasts. (d) Transverse MIP of subtracted MR image obtained 3 minutes after contrast agent injection (same parameters as in Fig 2) shows multiple diffuse intensely enhancing irregular masses in both breasts, as well as intensely enhancing adenopathy. One representative mass in each breast underwent core-needle biopsy with US guidance, confirming ILC. Patient underwent bilateral mastectomy and axillary node dissection, which confirmed diffuse ILC and metastatic adenopathy.

View larger version (111K): [in a new window]   Figure 5a. Images in 41-year-old woman with multifocal ILC and multiple foci of lobular carcinoma in situ. (a) Bilateral MLO mammograms show dense parenchyma with no discrete abnormality. Palpable mass in lower left breast is marked with radiopaque marker. (b) Radial sonogram (L13-7-MHz transducer) obtained in 6 o’clock position in left breast demonstrates at least five discrete hypoechoic irregular masses suspicious for cancer. US-guided core biopsy was performed for palpable largest mass (right arrowhead) and a second mass 3 cm superior to it (left arrowhead), both proving to be ILC. Similar findings were noted on (c) sagittal MIP of subtracted MR image obtained 90 seconds after contrast agent injection (same parameters as Fig 2), with biopsied masses indicated by arrowheads. Patient opted for mastectomy. Only the two cored masses proved to be ILC. Remainder were lobular carcinoma in situ.

View larger version (101K): [in a new window]   Figure 5b. Images in 41-year-old woman with multifocal ILC and multiple foci of lobular carcinoma in situ. (a) Bilateral MLO mammograms show dense parenchyma with no discrete abnormality. Palpable mass in lower left breast is marked with radiopaque marker. (b) Radial sonogram (L13-7-MHz transducer) obtained in 6 o’clock position in left breast demonstrates at least five discrete hypoechoic irregular masses suspicious for cancer. US-guided core biopsy was performed for palpable largest mass (right arrowhead) and a second mass 3 cm superior to it (left arrowhead), both proving to be ILC. Similar findings were noted on (c) sagittal MIP of subtracted MR image obtained 90 seconds after contrast agent injection (same parameters as Fig 2), with biopsied masses indicated by arrowheads. Patient opted for mastectomy. Only the two cored masses proved to be ILC. Remainder were lobular carcinoma in situ.

View larger version (87K): [in a new window]   Figure 5c. Images in 41-year-old woman with multifocal ILC and multiple foci of lobular carcinoma in situ. (a) Bilateral MLO mammograms show dense parenchyma with no discrete abnormality. Palpable mass in lower left breast is marked with radiopaque marker. (b) Radial sonogram (L13-7-MHz transducer) obtained in 6 o’clock position in left breast demonstrates at least five discrete hypoechoic irregular masses suspicious for cancer. US-guided core biopsy was performed for palpable largest mass (right arrowhead) and a second mass 3 cm superior to it (left arrowhead), both proving to be ILC. Similar findings were noted on (c) sagittal MIP of subtracted MR image obtained 90 seconds after contrast agent injection (same parameters as Fig 2), with biopsied masses indicated by arrowheads. Patient opted for mastectomy. Only the two cored masses proved to be ILC. Remainder were lobular carcinoma in situ.

View larger version (114K): [in a new window]   Figure 6. Images in 59-year-old woman with multicentric intermediate-grade solid and cribriform DCIS that was underestimated mammographically. A, Laterally exaggerated craniocaudal and, B, MLO mammograms demonstrate indistinctly-marginated mass (arrow) in axillary tail of left breast, seen best on B, and minimal scattered fibroglandular density. C, Transverse sonogram (L12-7.5-MHz transducer) obtained in 2 o’clock position in left breast confirms the finding (marked by calipers). US-guided 14-g core biopsy revealed intermediate-grade cribriform DCIS. Lumpectomy was planned. D, MIP of subtracted contrast-enhanced three-dimensional gradient-echo MR image in sagittal plane (same technique as above) showed the known focus of cancer (arrow) and three other similar foci of enhancement (arrowheads). Second-look transverse sonograms obtained in, E, 9 o’clock position and, F, 6 o’clock position after MR imaging showed multiple additional masses (marked by calipers) that corresponded to additional lesions found at MR imaging. Additional core biopsies were performed, confirming additional foci of DCIS. Patient underwent mastectomy.

View larger version (97K): [in a new window]   Figure 7a. Images in 33-year-old woman with synchronous bilateral high-grade IDC, palpable in right breast and depicted at US and MR imaging in left breast. (a) Bilateral MLO mammograms show dense parenchyma with vague asymmetry in lower right breast that corresponds with palpable mass (marked with radiopaque marker). (b) Transverse sonogram (L13-7-MHz transducer) obtained in 6 o’clock position in right breast shows mass with mixed echogenicity (arrow) with posterior enhancement corresponding to palpable mass. (c) Transverse sonogram obtained in 10 o’clock position in left breast shows nearly anechoic irregular mass (arrowhead) with posterior enhancement. (d) Transverse MIP of subtracted MR image obtained 90 seconds after contrast agent injection (same technique as Fig 2) shows solitary bilateral enhancing masses (arrow on right breast and arrowhead on left breast) proved to be bilateral grade III IDC at US-guided core biopsy, as well as normal variant nipple enhancement bilaterally. Patient opted for bilateral mastectomy.

View larger version (137K): [in a new window]   Figure 7b. Images in 33-year-old woman with synchronous bilateral high-grade IDC, palpable in right breast and depicted at US and MR imaging in left breast. (a) Bilateral MLO mammograms show dense parenchyma with vague asymmetry in lower right breast that corresponds with palpable mass (marked with radiopaque marker). (b) Transverse sonogram (L13-7-MHz transducer) obtained in 6 o’clock position in right breast shows mass with mixed echogenicity (arrow) with posterior enhancement corresponding to palpable mass. (c) Transverse sonogram obtained in 10 o’clock position in left breast shows nearly anechoic irregular mass (arrowhead) with posterior enhancement. (d) Transverse MIP of subtracted MR image obtained 90 seconds after contrast agent injection (same technique as Fig 2) shows solitary bilateral enhancing masses (arrow on right breast and arrowhead on left breast) proved to be bilateral grade III IDC at US-guided core biopsy, as well as normal variant nipple enhancement bilaterally. Patient opted for bilateral mastectomy.

View larger version (111K): [in a new window]   Figure 7c. Images in 33-year-old woman with synchronous bilateral high-grade IDC, palpable in right breast and depicted at US and MR imaging in left breast. (a) Bilateral MLO mammograms show dense parenchyma with vague asymmetry in lower right breast that corresponds with palpable mass (marked with radiopaque marker). (b) Transverse sonogram (L13-7-MHz transducer) obtained in 6 o’clock position in right breast shows mass with mixed echogenicity (arrow) with posterior enhancement corresponding to palpable mass. (c) Transverse sonogram obtained in 10 o’clock position in left breast shows nearly anechoic irregular mass (arrowhead) with posterior enhancement. (d) Transverse MIP of subtracted MR image obtained 90 seconds after contrast agent injection (same technique as Fig 2) shows solitary bilateral enhancing masses (arrow on right breast and arrowhead on left breast) proved to be bilateral grade III IDC at US-guided core biopsy, as well as normal variant nipple enhancement bilaterally. Patient opted for bilateral mastectomy.

View larger version (77K): [in a new window]   Figure 7d. Images in 33-year-old woman with synchronous bilateral high-grade IDC, palpable in right breast and depicted at US and MR imaging in left breast. (a) Bilateral MLO mammograms show dense parenchyma with vague asymmetry in lower right breast that corresponds with palpable mass (marked with radiopaque marker). (b) Transverse sonogram (L13-7-MHz transducer) obtained in 6 o’clock position in right breast shows mass with mixed echogenicity (arrow) with posterior enhancement corresponding to palpable mass. (c) Transverse sonogram obtained in 10 o’clock position in left breast shows nearly anechoic irregular mass (arrowhead) with posterior enhancement. (d) Transverse MIP of subtracted MR image obtained 90 seconds after contrast agent injection (same technique as Fig 2) shows solitary bilateral enhancing masses (arrow on right breast and arrowhead on left breast) proved to be bilateral grade III IDC at US-guided core biopsy, as well as normal variant nipple enhancement bilaterally. Patient opted for bilateral mastectomy.

View larger version (101K): [in a new window]   Figure 8a. Images in 49-year-old woman with tubular carcinoma seen best at mammography and US with fibroadenoma seen at MR imaging. (a) Mediolateral mammogram shows spiculated mass (arrow) in lower posterior left breast with clip placed at US-guided biopsy, which yielded tubular IDC. (b) Transverse sonogram (L12-7.5-MHz transducer) obtained in 6:30 clock position in left breast shows irregular hypoechoic shadowing mass (arrow) that corresponds to the mammographic abnormality, which was sampled for biopsy with US guidance. (c) Sagittal MIP of subtracted MR image obtained 4 minutes after contrast agent injection (same parameters as Fig 2) shows enhancing mass superiorly (arrowhead), which was found at second-look US and was sampled for biopsy, which showed fibroadenoma. The known cancer inferiorly (arrow) showed only 60% enhancement, similar to normal parenchyma, and was considered missed at MR imaging. Patient underwent lumpectomy and radiation therapy.

View larger version (163K): [in a new window]   Figure 8b. Images in 49-year-old woman with tubular carcinoma seen best at mammography and US with fibroadenoma seen at MR imaging. (a) Mediolateral mammogram shows spiculated mass (arrow) in lower posterior left breast with clip placed at US-guided biopsy, which yielded tubular IDC. (b) Transverse sonogram (L12-7.5-MHz transducer) obtained in 6:30 clock position in left breast shows irregular hypoechoic shadowing mass (arrow) that corresponds to the mammographic abnormality, which was sampled for biopsy with US guidance. (c) Sagittal MIP of subtracted MR image obtained 4 minutes after contrast agent injection (same parameters as Fig 2) shows enhancing mass superiorly (arrowhead), which was found at second-look US and was sampled for biopsy, which showed fibroadenoma. The known cancer inferiorly (arrow) showed only 60% enhancement, similar to normal parenchyma, and was considered missed at MR imaging. Patient underwent lumpectomy and radiation therapy.

View larger version (133K): [in a new window]   Figure 8c. Images in 49-year-old woman with tubular carcinoma seen best at mammography and US with fibroadenoma seen at MR imaging. (a) Mediolateral mammogram shows spiculated mass (arrow) in lower posterior left breast with clip placed at US-guided biopsy, which yielded tubular IDC. (b) Transverse sonogram (L12-7.5-MHz transducer) obtained in 6:30 clock position in left breast shows irregular hypoechoic shadowing mass (arrow) that corresponds to the mammographic abnormality, which was sampled for biopsy with US guidance. (c) Sagittal MIP of subtracted MR image obtained 4 minutes after contrast agent injection (same parameters as Fig 2) shows enhancing mass superiorly (arrowhead), which was found at second-look US and was sampled for biopsy, which showed fibroadenoma. The known cancer inferiorly (arrow) showed only 60% enhancement, similar to normal parenchyma, and was considered missed at MR imaging. Patient underwent lumpectomy and radiation therapy.