Evaluating Multifocal and Contralateral Breast Cancer Using MAMMOMAT B.Brilliant MammographyBahya Hospital, Cairo, Egypt

In this case, the MAMMOMAT B.Brilliant Mammography system with CESM enabled comprehensive assessment of both breasts in a single examination. The system not only characterized the known IDC in the left breast but also revealed multiple additional enhancing foci suggestive of multifocal disease and detected a suspicious enhancing focus in the contralateral breast.

By improving visualization of tumor extent and uncovering additional lesions that may be occult on conventional imaging, MAMMOMAT B.Brilliant CESM can support more accurate staging and inform surgical and systemic treatment planning, ultimately contributing to optimized patient management.

CESM on the MAMMOMAT B.Brilliant demonstrated a moderately enhancing, heterogeneous mass in the lower outer quadrant of the left breast, in a rather central location, measuring approximately 1.9 × 2.1 cm. 

In the right breast, MAMMOMAT B.Brilliant CESM revealed an additional enhancing focus in the lower inner quadrant, posterior third. This lesion measured approximately 0.4 × 0.6 cm and was located about 10 cm from the nipple, raising suspicion for a contralateral lesion and prompting further diagnostic work-up.

In this case, the MAMMOMAT B.Brilliant Mammography system with CESM enabled comprehensive assessment of both breasts in a single examination. The system not only characterized the known IDC in the left breast but also revealed multiple additional enhancing foci suggestive of multifocal disease and detected a suspicious enhancing focus in the contralateral breast.

By improving visualization of tumor extent and uncovering additional lesions that may be occult on conventional imaging, MAMMOMAT B.Brilliant CESM can support more accurate staging and inform surgical and systemic treatment planning, ultimately contributing to optimized patient management.

Biopsy of the right breast lesion revealed mucinous carcinoma, establishing synchronous bilateral breast cancer: invasive ductal carcinoma in the left breast and mucinous carcinoma in the right breast.

This case illustrates how MAMMOMAT B.Brilliant Mammography with CESM can: 

• Characterize the index malignancy and accurately depict its size and location.

• Detect a subtle, contralateral enhancing mass that might otherwise be underestimated or overlooked.

• Promptly biopsy of a BI-RADS 4 lesion, leading to the diagnosis of synchronous contralateral breast cancer.

By enabling sensitive bilateral assessment in a single examination, MAMMOMAT B.Brilliant CESM supports more accurate staging and treatment planning in patients with newly diagnosed breast cancer.

MAMMOMAT B.Brilliant CESM revealed a single, moderately enhancing heterogeneous mass in the lower outer quadrant of  the left breast. The lesion measured approximately 4.0 × 3.5 cm and was located about 2 cm from the nipple. The enhancement pattern and morphologic features were consistent with a known malignancy. Based on imaging and prior pathology, this lesion was categorized as BI-RADS 6 (known biopsy-proven malignancy).

In the right breast, CESM demonstrated a single mass in the lower inner quadrant, anterior third. The lesion showed homogeneous enhancement and measured approximately 12.5 × 11 mm, located about 2.5 cm from the nipple. 

Despite its relatively small size and homogeneous enhancement, the lesion was considered suspicious on CESM and classified as BI-RADS 4 (suspicious abnormality), warranting tissue diagnosis.

Biopsy of the right breast lesion revealed mucinous carcinoma, establishing synchronous bilateral breast cancer: invasive ductal carcinoma in the left breast and mucinous carcinoma in the right breast.

This case illustrates how MAMMOMAT B.Brilliant Mammography with CESM can: 

• Characterize the index malignancy and accurately depict its size and location.

• Detect a subtle, contralateral enhancing mass that might otherwise be underestimated or overlooked.

• Promptly biopsy of a BI-RADS 4 lesion, leading to the diagnosis of synchronous contralateral breast cancer.

By enabling sensitive bilateral assessment in a single examination, MAMMOMAT B.Brilliant CESM supports more accurate staging and treatment planning in patients with newly diagnosed breast cancer.

MAMMOMAT B.Brilliant Mammography with 3D tomosynthesis identified: 

• A right UOQ irregular mass with subtle distortion, corresponding to the palpable lump and considered a suspicious lesion.

• A left UOQ focal asymmetry with distortion, non-palpable but clearly suspicious on tomosynthesis.

Both lesions would be appropriately categorized as BI-RADS 4 (suspicious abnormalities), warranting further evaluation with targeted ultrasound and image-guided biopsies for histopathological confirmation. 

Clinical Message 

In patients presenting with a unilateral palpable lump, bilateral imaging with 3D tomosynthesis on MAMMOMAT B.Brilliant can reveal additional, clinically occult contralateral lesions.

Subtle architectural distortion and focal asymmetries may be better defined on tomosynthesis than on 2D mammography, supporting accurate BI-RADS assessment and guiding biopsy of synchronous lesions in both breasts.

Imaging of the right breast demonstrated a small, irregular, equally dense mass lesion in the upper outer quadrant (UOQ), associated with subtle architectural distortion. The lesion measured approximately 15 × 11 × 14 mm and was located about 8 cm from the nipple.

While the finding was already suspected on 2D mammography, MAMMOMAT B.Brilliant 3D tomosynthesis clearly confirmed the presence and morphology of the mass and better delineated the surrounding distortion, increasing confidence that this represented a suspicious lesion corresponding to the palpable abnormality.

In the left breast, FFDM revealed a focal asymmetry with architectural distortion in the upper outer quadrant (UOQ), located approximately 76 mm from the nipple. This finding did not correspond to any known clinical symptoms.

On 3D tomosynthesis, the focal asymmetry and distortion were confirmed and became more conspicuous, indicating a second suspicious lesion in the contralateral breast. Tomosynthesis helped separate the lesion from overlapping parenchymal structures, which is particularly important in subtle bilateral findings.

MAMMOMAT B.Brilliant Mammography with 3D tomosynthesis identified: 

• A right UOQ irregular mass with subtle distortion, corresponding to the palpable lump and considered a suspicious lesion.

• A left UOQ focal asymmetry with distortion, non-palpable but clearly suspicious on tomosynthesis.

Both lesions would be appropriately categorized as BI-RADS 4 (suspicious abnormalities), warranting further evaluation with targeted ultrasound and image-guided biopsies for histopathological confirmation. 

Clinical Message 

In patients presenting with a unilateral palpable lump, bilateral imaging with 3D tomosynthesis on MAMMOMAT B.Brilliant can reveal additional, clinically occult contralateral lesions.

Subtle architectural distortion and focal asymmetries may be better defined on tomosynthesis than on 2D mammography, supporting accurate BI-RADS assessment and guiding biopsy of synchronous lesions in both breasts.

Imaging demonstrated a non-palpable, malignant looking mass in the left breast at 12 o’clock, distinct from the palpable cyst. 

Based on the architectural distortion seen on MAMMOMAT B.Brilliant FFDM, the irregular vascular mass on ultrasound, and confirmatory 3D tomosynthesis findings, the lesion was classified as BI-RADS 4 (suspicious abnormality). Biopsy and bilateral contrast-enhanced mammography were recommended for further characterization and staging.

Recommendation 

Referral to the breast clinic was advised for image-guided biopsy of the left 12 o’clock lesion and subsequent management planning.

Bilateral FFDM on MAMMOMAT B.Brilliant showed heterogeneously dense breast parenchyma (ACR category C), a known challenge for lesion detection and characterization due to tissue overlap.

Bilateral scattered microcalcifications were present. In the left upper quadrant, an area of architectural distortion with an overlying tiny calcific focus was identified, separate from the area of the clinically palpable lump. Skin thickness and contour were normal, and the nipple–areolar complexes appeared unremarkable. Bilateral nonspecific axillary lymph nodes were seen.

Targeted ultrasound of the area corresponding to the palpable lump in the left breast demonstrated a benign-appearing cyst, explaining the palpable finding.

Additional targeted ultrasound of the left upper quadrant at 12 o’clock revealed a separate, irregular solid mass measuring approximately 2.5 × 1.1 cm, with an overlying calcific focus and mild internal vascularity on color Doppler. This lesion was located about 7.5 cm from the nipple and 0.5 cm from the skin. Both breasts showed heterogeneous mottled parenchyma with bilateral scattered cysts, consistent with fibrocystic changes.

3D Tomosynthesis (MAMMOMAT B.Brilliant) 

3D tomosynthesis on the MAMMOMAT B.Brilliant Mammography system was performed to further evaluate the subtle architectural distortion seen on 2D imaging. Tomosynthesis significantly improved lesion conspicuity within the dense parenchyma, confirming an underlying mass in the left upper quadrant that corresponded to the irregular solid lesion on ultrasound.

Importantly, tomosynthesis helped clearly distinguish this suspicious, non-palpable mass from the superficial palpable cyst, overcoming the limitations of tissue overlap in dense breasts.

Imaging demonstrated a non-palpable, malignant looking mass in the left breast at 12 o’clock, distinct from the palpable cyst. 

Based on the architectural distortion seen on MAMMOMAT B.Brilliant FFDM, the irregular vascular mass on ultrasound, and confirmatory 3D tomosynthesis findings, the lesion was classified as BI-RADS 4 (suspicious abnormality). Biopsy and bilateral contrast-enhanced mammography were recommended for further characterization and staging.

Recommendation 

Referral to the breast clinic was advised for image-guided biopsy of the left 12 o’clock lesion and subsequent management planning.