Fig. 14
From: Hyperechoic breast images: all that glitters is not gold!
Invasive ductal carcinoma. Annual surveillance in a patient at very high risk already treated for left breast cancer. a MRI, gadolinium-enhanced T1 subtraction sequence, demonstrating an irregular, poorly circumscribed mass at the junction of the upper quadrants of the left breast. The gadolinium-enhanced examination shows initial 90% enhancement with washout at the late phase. b Mammography guided by MRI in the same patient, oblique view: demonstration of a non-calcified mass (arrows), with architectural distortion at the junction of the upper quadrants of the left breast. c MRI-guided ultrasound of the left breast in the same patient. At the junction of the upper quadrants, at the 12.30 position, 4 cm from the nipple, presence of a hyperechoic nodule with microlobular margins, with posterior attenuation classified as high ACR4. Microbiopsy demonstrated poorly differentiated invasive ductal carcinoma (grade II, low MI, HR+, HER2-)