Simple cyst on contrast mammogram

Case contributed by Sarah Tennant
Diagnosis certain

Presentation

Patient presented with a suspicious mass in the left breast

Patient Data

Gender: Female
mammography

Low energy images show a moderately dense background pattern, with a mass in the left upper outer quadrant.

Recombined images show an absence of enhancement, consistent with a simple cyst.  

The right breast is normal.

ultrasound

This was confirmed as a cyst at ultrasound – image shows an anechoic, well-defined lesion with posterior acoustic enhancement.

Case Discussion

Commercially available contrast mammography equipment utilizes the dual-energy technique, also known as contrast-enhanced spectral mammography (CESM),

Two images are produced from each compression: low-energy – equivalent to a standard digital mammogram; and recombined - the background breast tissue is suppressed to highlight areas of contrast uptake.

This case demonstrates the typical appearances of a cyst - an absence of enhancement in a well-defined, rounded lesion.  CESM has a high negative predictive value for invasive malignancy.

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