47-year-old patient with breast cancer, right breast

Dr. S. Metz, Institute for Diagnostic and Interventional Radiology at the Technical University of Munich, Klinikum Rechts der Isar. Munich, Germany. 

Case description

A tomosynthesis (Image 1) of a 47 year-old patient without clinical symptoms shows a lesion with surrounding architectural distortion. The sonography shows a correlating hypoechoic lesion. After an ultrasound-guided punch biopsy was performed (Image 2), a clip marker was positioned with Tumark Vision. Histological finding: Infiltrate of a moderately differentiated, invasive cancer of ductal type / NST as well as small-lesion lobular neoplasia (LIN II). Tumor biology: Estrogen receptor: Positive (100%), Progestin receptor: positive (100%) HER2-neu: moderate expression (score 2+). FISH negative.

Course of treatment

Pre-operative MRI shows the susceptibility artefact due to clip (image 3).

A segment excision (SE) was performed following pre-operative ultrasound-guided wire marking (image 4).

Sample radiography (image 5).

Conclusion

Good sonographic visibility of the expanded clip in a hypoechoic tumor. Also depiction of mammographic and MR tomographic clip properties. Successful resection following pre-operative ultrasound-guided fine needle marking (FNM) of tumor / clips. 

Pictures

Tomosynthesis-level image shows lesion with surrounding architectural distortion.

Image 1: DBT
Tomosynthesis-level image shows lesion with surrounding architectural distortion.

Breast cancer shown as hypoechoic lesion and the (not yet expanded) clip within, directly after application.

Image 2: Sonography
Breast cancer shown as hypoechoic lesion and the (not yet expanded) clip within, directly after application.

Susceptibility artefact due to clip in the T1-w dynamic subtraction. Examination performed approximately two weeks after clip application and a few days pre-surgery.

Image 3: MRI
Susceptibility artefact due to clip in the T1-w dynamic subtraction. Examination performed approximately two weeks after clip application and a few days pre-surgery.

Good sonographic visibility of expanded clip in hypoechoic tumor prior to FNM.

Image 4: Sonography
Good sonographic visibility of expanded clip in hypoechoic tumor prior to FNM.

Mammographic depiction of the clip.

Image 5: Sample radiography
Mammographic depiction of the clip.