1Department of Radiology, Nara Medical University, 2Department of General Diagnostic Imaging Center, Nara Medical University, 3Department of Diagnostic Pathology, Nara Medical University, 4Department of Surgery, Nara Medical University
Breast cancers with intraductal components are usually evaluated by contrast-enhanced MRI, but contrast agents for MRI are contraindicated for persons with asthma and severe renal dysfunction. Sonazoid®, an ultrasound contrast agent, has few side effects, and it can be used in patients with asthma and severe renal dysfunction. We report two cases of breast cancer in which contrast-enhanced ultrasonography (CEUS) was useful in diagnosing intraductal spread. These patients were unable to undergo contrast-enhanced CT/MRI due to asthma and severe renal dysfunction, but they could receive CEUS with no side effects. Case 1 was a 73-year-old woman. On mammography (MG), the tumor and segmental pleomorphic calcifications contiguous to the tumor were recognized, suggesting the presence of intraductal components. However, only the tumor could be detected on B-mode ultrasound. Case 2 was a 67-year-old woman. Segmental pleomorphic calcifications around the tumor were detected on MG, and low echoic regions leading to the tumor were recognized on B-mode ultrasound, indicating the presence of intraductal components. In both cases, CEUS showed streamed zonal enhancement leading to the tumor. On TIC, the intraductal components showed curves equal with their tumors. Based on the results of CEUS, breast-conserving surgery was selected in case 1 and breast removal was selected in case 2. Pathologically, the zonal enhancement regions leading to the tumor reflected intraductal components. CEUS could contribute to surgical planning.