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

Figure 3:

Images in a 77-year-old woman with invasive ductal carcinoma (IDC) seen only at contrast-enhanced mammography (CEM) and ductal carcinoma in situ (DCIS) seen only on low-energy (LE) images and digital breast tomosynthesis images at year 2. (A) Bilateral craniocaudal (CC) (left) and mediolateral oblique (MLO) (right) LE images show heterogeneously dense parenchyma and postsurgical changes with dystrophic calcifications in the upper right breast and clips in the right axilla from breast-conserving therapy for a grade 1 IDC, estrogen receptor (ER)– and progesterone receptor (PR)–positive, human epidermal growth factor receptor 2 (HER2) (ERBB2 gene)–negative, 19 years earlier, for which she had taken Anastrozole for 4 years. Only observer 1 recalled the participant for linear calcifications in the left breast (arrows), which are better seen on (B) close-up CC (left) and MLO (right) LE images (arrows) and (C) a spot magnification CC view of the central left breast. In addition to typically benign calcifications more laterally and fine linear calcifications (arrow in C), seen only on C more anteriorly, there is a group of amorphous calcifications (circle in C). Both areas of calcification were recommended for biopsy, despite lack of enhancement on (D) recombined CC (left) and MLO (right) CEM images. A moderately conspicuous enhancing mass in the retroareolar left breast was newly seen, which was only evident at CC CEM (arrow in D) and was assessed as Breast Imaging Reporting and Data System (BI-RADS) 4A, low suspicion, by observer 1 and as BI-RADS 4B, moderate suspicion, by observer 2. (E) CEM-directed US images (left = transverse plane, right = longitudinal plane) of the retroareolar left breast show an irregular, hypoechoic mass (arrows) with an echogenic rim, highly suggestive of malignancy (BI-RADS 5). US-guided core biopsy and mastectomy revealed a 2.1-cm grade 3 ER and PR-positive, ERBB2-negative IDC. Stereotactic biopsy of the linear calcifications revealed high-grade ER and PR-positive DCIS, and biopsy of the amorphous calcifications yielded atypical ductal hyperplasia. At mastectomy, 5.5 cm of high-nuclear-grade DCIS was found, discontinuous with the retroareolar IDC. One of two sentinel nodes showed isolated tumor cells (N0).

Images in a 77-year-old woman with invasive ductal carcinoma (IDC) seen only at contrast-enhanced mammography (CEM) and ductal carcinoma in situ (DCIS) seen only on low-energy (LE) images and digital breast tomosynthesis images at year 2. (A) Bilateral craniocaudal (CC) (left) and mediolateral oblique (MLO) (right) LE images show heterogeneously dense parenchyma and postsurgical changes with dystrophic calcifications in the upper right breast and clips in the right axilla from breast-conserving therapy for a grade 1 IDC, estrogen receptor (ER)– and progesterone receptor (PR)–positive, human epidermal growth factor receptor 2 (HER2) (ERBB2 gene)–negative, 19 years earlier, for which she had taken Anastrozole for 4 years. Only observer 1 recalled the participant for linear calcifications in the left breast (arrows), which are better seen on (B) close-up CC (left) and MLO (right) LE images (arrows) and (C) a spot magnification CC view of the central left breast. In addition to typically benign calcifications more laterally and fine linear calcifications (arrow in C), seen only on C more anteriorly, there is a group of amorphous calcifications (circle in C). Both areas of calcification were recommended for biopsy, despite lack of enhancement on (D) recombined CC (left) and MLO (right) CEM images. A moderately conspicuous enhancing mass in the retroareolar left breast was newly seen, which was only evident at CC CEM (arrow in D) and was assessed as Breast Imaging Reporting and Data System (BI-RADS) 4A, low suspicion, by observer 1 and as BI-RADS 4B, moderate suspicion, by observer 2. (E) CEM-directed US images (left = transverse plane, right = longitudinal plane) of the retroareolar left breast show an irregular, hypoechoic mass (arrows) with an echogenic rim, highly suggestive of malignancy (BI-RADS 5). US-guided core biopsy and mastectomy revealed a 2.1-cm grade 3 ER and PR-positive, ERBB2-negative IDC. Stereotactic biopsy of the linear calcifications revealed high-grade ER and PR-positive DCIS, and biopsy of the amorphous calcifications yielded atypical ductal hyperplasia. At mastectomy, 5.5 cm of high-nuclear-grade DCIS was found, discontinuous with the retroareolar IDC. One of two sentinel nodes showed isolated tumor cells (N0).