Skip to main content
. 2024 Apr 30;311(1):e231991. doi: 10.1148/radiol.231991

Figure 2:

Images in a 67-year-old woman with triple receptor–negative invasive ductal carcinoma (IDC) seen only at contrast-enhanced mammography (CEM) at year 2. (A) Left craniocaudal (CC) (left) and mediolateral oblique (MLO) (right) low-energy images show scattered fibroglandular density and postsurgical scarring, with clips in the lower inner quadrant at the site of lumpectomy for a 2.1-cm grade 3 IDC, estrogen receptor– and progesterone receptor–positive and human epidermal growth factor receptor 2 (HER2) (ERBB2 gene)–negative lesion 11 years prior. Scattered benign-appearing calcifications are noted. The participant also completed radiation therapy and adjuvant chemotherapy and was treated with tamoxifen for 7 years and then with an aromatase inhibitor for 3 years, with last use 1 year prior to study entry. (B) Recombined CC (left) and MLO (right) CEM images obtained in year 2 show moderately conspicuous enhancement of an oval mass in the upper outer left breast (arrows), which was new from the prior CEM examination (not shown). This lesion was assessed as Breast Imaging Reporting and Data System (BI-RADS) 4B, moderately suspicious, by observer 1 and as BI-RADS 3, probably benign, but recommended for additional evaluation, by observer 2. At the time, CEM-guided biopsy was not available, so the participant underwent MRI and MRI-guided biopsy. (C) Axial maximum intensity projection from T1-weighted fat-suppressed MRI (left) shows moderately intense enhancement of the same mass (arrow), with plateau and washout kinetics (arrow) on axial post-contrast fat-suppressed T1-weighted image with kinetic overlay (right). MRI-guided biopsy and excision revealed a 0.5-cm grade 3 IDC, triple receptor–negative lesion (Ki-67 proliferation index of 55%). Three sentinel nodes were negative for metastasis.

Images in a 67-year-old woman with triple receptor–negative invasive ductal carcinoma (IDC) seen only at contrast-enhanced mammography (CEM) at year 2. (A) Left craniocaudal (CC) (left) and mediolateral oblique (MLO) (right) low-energy images show scattered fibroglandular density and postsurgical scarring, with clips in the lower inner quadrant at the site of lumpectomy for a 2.1-cm grade 3 IDC, estrogen receptor– and progesterone receptor–positive and human epidermal growth factor receptor 2 (HER2) (ERBB2 gene)–negative lesion 11 years prior. Scattered benign-appearing calcifications are noted. The participant also completed radiation therapy and adjuvant chemotherapy and was treated with tamoxifen for 7 years and then with an aromatase inhibitor for 3 years, with last use 1 year prior to study entry. (B) Recombined CC (left) and MLO (right) CEM images obtained in year 2 show moderately conspicuous enhancement of an oval mass in the upper outer left breast (arrows), which was new from the prior CEM examination (not shown). This lesion was assessed as Breast Imaging Reporting and Data System (BI-RADS) 4B, moderately suspicious, by observer 1 and as BI-RADS 3, probably benign, but recommended for additional evaluation, by observer 2. At the time, CEM-guided biopsy was not available, so the participant underwent MRI and MRI-guided biopsy. (C) Axial maximum intensity projection from T1-weighted fat-suppressed MRI (left) shows moderately intense enhancement of the same mass (arrow), with plateau and washout kinetics (arrow) on axial post-contrast fat-suppressed T1-weighted image with kinetic overlay (right). MRI-guided biopsy and excision revealed a 0.5-cm grade 3 IDC, triple receptor–negative lesion (Ki-67 proliferation index of 55%). Three sentinel nodes were negative for metastasis.