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Fig. 1 | Egyptian Journal of Radiology and Nuclear Medicine

Fig. 1

From: Diffusion-weighted imaging or MR spectroscopy: Which to use for the assessment of the response to chemotherapy in breast cancer patients?

Fig. 1Fig. 1

A 34-year-old female presented with right breast lump. Pre-therapy: a Focal spiculated mass at the central portion of the right breast. Associate ipsilateral dermal thickening and interstitial edema with few pathologically enlarged right axillary lymph nodes (not seen in the figure). The mass showed delayed peak of contrast uptake at 260 s with corresponding maximum relative enhancement at 208% and delayed washout curve pattern Ib. b ADC map showed intermediate signal of the tumor and a low ADC value of 0.861 × 10−3 mm2/s. c MRS was positive for choline (choline peak = 0.9 mmol/l). Histopathology: Invasive lobular carcinoma pleomorphic type grade II associated with lobular carcinoma in situ. Immunohistopathology: Negative for ER and PR, positive for HER 2 NEU (class 3+), Ki 67 15%. Treatment decision: Neo-adjuvant chemotherapy and breast conservative surgery. Post-therapy: d Dramatic reduction in the size of the right breast mass. The skin thickening of 4 mm is still noted. Faint contrast uptake was noted at the confine of the right breast mass, arrow (note, a clip is seen inserted within the vicinity of the mass), with marked reduction in the percentage of signal intensity to be 23%. e DWI examination showed increased ADC value of 1.255 × 10−3 mm2/s. f MRS showed favorable post-chemotherapeutic response in the form of reduced choline peak to reach 0.2 mmol/l. Pathology report of the surgical specimen: Tiny remnants of intra duct carcinoma surrounded by hyalinosis. Examination of sentinel lymph nodes showed positive metastatic deposits (1/1). All of the dissected axillary lymph nodes were negative for metastatic deposits (0/11). The surgical margins were free. Comments: Near complete pathological and radiological response

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