Fig. 3

Two cases: the first case was a 35-year-old female presented with left breast palpable lump. Biopsy revealed bilateral invasive ductal carcinoma. a Digital mammogram of both breasts MLO views that showed dense breasts with left breast deep central spiculated mass (BI-RADS 5) (arrow) and right breast retroareolar probably benign (BI-RADS 3) linear asymmetry (circle). b CEM of both breasts MLO views showed left breast mass that was seen on the mammogram and additional newly detected multiple adherent masses (BI-RADS 5- multifocal carcinoma) (circle). The right breast also presented retroareolar ill-defined focal nodule of contrast uptake corresponding to the linear opacity that was seen on the mammogram (BI-RADS 4 proved to be a contra-lateral carcinoma) (circle). The carcinomas were more obvious at the CEM. The second case was a 48-year-old high-risk female that needed a screening mammogram. Biopsy revealed left breast invasive ductal carcinoma. c Left-sided digital mammogram CC and MLO views that showed dense breast with upper outer and lower inner two ill-defined suspicious focal masses (circles). d CEM of the left breast confirmed the malignant suspicion of the left lower mass as it presented rim contrast uptake, moreover another similar focus was also noted nearby (i.e. multifocal not a unifocal carcinoma) (circle). The upper outer mass previously noted on the mammogram showed no contrast uptake (proved to be benign cyst by complementary ultrasound). CEM not only detected the breast masses, but also estimated the accurate extension of the cancer in spite of the high density of the breast parenchyma