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

Figure 4:

Images in a 47-year-old woman with recurrent invasive lobular carcinoma (ILC) at the scar detected clinically 6 months after imaging (interval cancer). (A) Close-up craniocaudal (CC) (left) and mediolateral oblique (MLO) (right) digital breast tomosynthesis 6-mm slab images of the right breast show the area of scarring from breast-conserving therapy 2 years earlier for multifocal estrogen receptor (ER)/progesterone receptor (PR)-positive, human epidermal growth factor receptor 2 (HER2) (ERBB2 gene)–positive ILC, interpreted as benign, Breast Imaging Reporting and Data System (BI-RADS) 2, by both observers. The participant completed both neoadjuvant and adjuvant chemotherapy and was taking tamoxifen. (B) Close-up CC (left) and MLO (right) recombined contrast-enhanced mammography (CEM) images show nonmass enhancement at the scar (arrows), interpreted as benign, BI-RADS 2, by both observers. (C) US scan in longitudinal plane (left) obtained 6 months later, when the participant reported feeling a lump at the scar, shows a superficial irregular, parallel, hypoechoic mass (arrow) at the scar; the mass shows internal vascularity on transverse power Doppler scan (right, arrow). US-guided core biopsy and mastectomy revealed a 2.4-cm grade 3 ILC, ER-positive, PR-negative, HER2-positive lesion (Ki-67 proliferation index of 90%), with one of two sentinel nodes showing isolated tumor cells (N0).

Images in a 47-year-old woman with recurrent invasive lobular carcinoma (ILC) at the scar detected clinically 6 months after imaging (interval cancer). (A) Close-up craniocaudal (CC) (left) and mediolateral oblique (MLO) (right) digital breast tomosynthesis 6-mm slab images of the right breast show the area of scarring from breast-conserving therapy 2 years earlier for multifocal estrogen receptor (ER)/progesterone receptor (PR)-positive, human epidermal growth factor receptor 2 (HER2) (ERBB2 gene)–positive ILC, interpreted as benign, Breast Imaging Reporting and Data System (BI-RADS) 2, by both observers. The participant completed both neoadjuvant and adjuvant chemotherapy and was taking tamoxifen. (B) Close-up CC (left) and MLO (right) recombined contrast-enhanced mammography (CEM) images show nonmass enhancement at the scar (arrows), interpreted as benign, BI-RADS 2, by both observers. (C) US scan in longitudinal plane (left) obtained 6 months later, when the participant reported feeling a lump at the scar, shows a superficial irregular, parallel, hypoechoic mass (arrow) at the scar; the mass shows internal vascularity on transverse power Doppler scan (right, arrow). US-guided core biopsy and mastectomy revealed a 2.4-cm grade 3 ILC, ER-positive, PR-negative, HER2-positive lesion (Ki-67 proliferation index of 90%), with one of two sentinel nodes showing isolated tumor cells (N0).