Figure 24.2. A 63-year-old woman with silicone implants had MRI for assessment of palpable nodularity. MRI demonstrates an irregular mass adjacent to the implant. This was localized under MRI guidance using a skin marker. Pathology yielded atypical ductal hyperplasia.
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High-Risk Lesions
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1. Atypical Duct Hyperplasia
Figure 24.1. A 60-year-old (high-risk) woman undergoes screen- ing contrast enhanced magnetic resonance imaging (MRI) that demonstrates clumped enhancement in the superior breast. No ultrasound correlate was identified. Subsequent magnetic reso- nance (MR) needle localization and surgical excision showed atypical ductal hyperplasia.
Figure 24.3. A 49-year-old woman with prior benign biopsies yielding atypical ductal hyper- plasia and lobular carcinoma in situ undergoes screening. An irregular mass seen posteriorly in the breast was not identified on mammo- gram or ultrasound. MRI needle localization with surgical excision yielded markedly atpical ductal hyperplasia.
Figure 24.4. A 60-year-old woman status post right mastectomy underwent MRI evaluation of left breast. Clumped enhancement was noted centrally in the breast (arrows). MRI needle localization yielded atypical duct hyperplasia.
Figure 24.6. A 50-year-old woman presents with palpable mass right breast, biopsy proven infiltrating lobular carcinoma. Patient is sched- uled for right mastectomy. MRI screening of the left breast demonstrates two areas of patchy enhancement for which needle local- ization was performed and pathology found lobular carcinoma in situ (LCIS).
2. Atypical Lobular Hyperplasia
Figure 24.5. A 46-year-old woman with infil- trating lobular carcinoma of the left breast scheduled for left mastectomy. MRI per- formed to screen right breast. Focal clumped enhancement was identified in the superior breast proven to represent atypical lobular hyperplasia focally at the level of lobular car- cinoma in situ (classical type).
3. Lobular Carcinoma In Situ
Figure 24.7. A 59-year-old woman with prior history of breast biopsy yielding LCIS. Screen- ing MRI demonstrates suspicious clumped linear enhancement (arrow) for which biopsy was suggested. The area was localized under MR guidance yielding LCIS.
Figure 24.8. A 60-year-old woman with family history of breast carcinoma. Prior reduction mammoplasty and benign biopsy in the upper outer quadrant yielding benign results. In the lower right breast there is clumped enhancement (arrow) with plateau kinetics. Magnetic resonance localization yielded LCIS.
Figure 24.10. A 62-year-old woman status post left lumpectomy for ductal carcinoma in situ (DCIS). Screening MRI performed.
Clumped nodular enhancement in the poste- rior breast was identified and subsequently localized yielding LCIS.
Figure 24.9. A 56-year-old status post bilateral breast biopsies yielding bilateral infiltrating ductal carcinoma (not shown).
MRI performed for staging. Patchy areas of enhancement are noted superiorly (arrows) that yielded LCIS at surgery. The patient opted for bilateral mastectomy.
Figure 24.11. A 44-year-old woman with a strong family history of breast carcinoma. The patient developed clumped enhancement in the superior breast (arrow) when compared to prior screening MRI examinations. Pathology was LCIS and proliferative fibrocystic changes.
Figure 24.12. A 69-year-old woman with normal mammogram had MRI which showed two suspicious areas of clumped enhancement in the right breast. One of these (not shown) proved to represent DCIS at surgery. The other (shown in the interior breast (arrow)) proved to represent LCIS.
4. Radial Scar
Figure 24.13. A 50-year-old woman with contralateral breast cancer undergoes con- tralateral screening MRI. At the time of contralateral mastectomy biopsy of the spicu- lated area (arrow) in the left breast was per- formed yielding radial scar.
