Comedo necrosis case study: A 70-year-old woman with a history of microcalcification, lumpectomy, and whole-breast x-ray therapy for microinvasive cancer.
A 70-year-old woman with a history of microcalcification of the right breast, lumpectomy, and whole-breast x-ray therapy on right side for microinvasive cancer presented for annual digital mammogram.
Right breast: Category 3, probably benign finding. Postsurgical changes in the right breast are stable from prior examination on Sept. 26, 2007. Inferiorly within the right breast are two linear calcifications that were present on the prior exam, only one of which was present on Dec. 19, 2006. Small calcifications are identified throughout the breast, stable from prior imaging. Thus, with the patient's history of breast carcinoma, very close follow-up examination of this area is recommended with a three-month follow-up. Alternatively, further evaluation given the patient's history of breast carcinoma and this area of microcalcifications within the breast, MRI examination may also be useful as clinically indicated. This MRI examination took place two weeks later.
A segmental area of enhancement (both type I and type II) in the six o'clock position extends from the nipple posteriorly and inferiorly (Figures 1 and 2). Figure 3 shows rapid wash-in and wash-out areas in the 5.5 × 3-cm enhanced segment.
MR-guided biopsy was performed and core samples were obtained at the most posterior and anterior aspects of the ductal enhancement (Figure 4). Pathology showed ductal carcinoma in-situ, high grade with comedo necrosis in both locations.
This case clearly demonstrates the benefit of determining extent of disease preoperatively with MRI. Despite subtle changes at mammography, the patient actually had extensive disease that was detected only with MR mammography. Appropriate therapy and surgical management were only possible with the added benefit of breast MRI and the MRI-guided breast biopsy.
Case submitted by Paige Huber, M.D., with AnMed Health in Anderson, SC; Bernadette M. Kaufman, BSRS, RT(R)(MR), breast care product manager for Invivo in Pewaukee, WI; and Patricia MacDonald, a medical writer based in Garland, TX.
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