title: False-negative contrast-enhanced spectral mammography: use of more than one imaging modality and application of the triple test avoids misdiagnosis.
abstract: A 50-year-old woman presented with chest tenderness. On examination, both breasts were lumpy. Bilateral mammography showed heterogeneously dense parenchyma, with possible stromal distortion laterally on the right at the 0900 position. On ultrasound (US), a corresponding 13×9×10 mm irregular hypoechoic mass with internal vascularity was noted and both breasts had a complex heterogeneous fibroglandular background pattern. US-guided core biopsy with marker clip insertion was performed with the diagnosis of a grade 2 invasive ductal carcinoma (IDC). In view of the parenchymal pattern on mammography and US, contrast-enhanced spectral mammography (CESM) was performed for local staging. Mild background enhancement was noted, but there was no enhancement at the lesion site. The patient elected to have bilateral mastectomies and sentinel node biopsies. Final histopathology showed a node negative 11 mm grade 2 oestrogen and progesterone receptor positive, IDC.
authors.affiliation: Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Donna
authors.identifier: http://orcid.org/0000-0002-1481-1141
authors.initials: D
authors.lastname: Taylor
authors.affiliation: Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: O'Hanlon
authors.affiliation: Department of PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Latham
mesh_terms: D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000601:surgery; D003287:Contrast Media; D003951:Diagnostic Errors; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D064847:Multimodal Imaging; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*
chemical_list: D003287:Contrast Media