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Case 08

(continued)

Answer:

Fat necrosis can have variable enhancement on CEM.

This is an example of fat necrosis surrounding the lumpectomy site. It presented as a developing asymmetry with non-mass enhancement. Given the change in appearance and correlate on ultrasound, there was concern for scar carcinoma and ultrasound-guided core biopsy was performed. Breast MRI is not needed and annual exam or follow-up imaging is not appropriate.

Similar to other imaging modalities, fat necrosis can have variable appearance on CEM and may be difficult to differentiate from malignancy. It is not uncommon for biopsy to be needed.

Amir T, Hogan MP, Jacobs S, et al. Comparison of False-Positive Versus True-Positive Findings on Contrast-Enhanced Digital Mammography. AJR Am J Roentgenol. 2021 Nov 24.

Perry H, Phillips J, Dialani V, et al. Contrast-Enhanced Mammography: A Systematic Guide to Interpretation and Reporting. AJR Am J Roentgenol. 2019 Jan;212(1):222-231.

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