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Figure 1d. Cytologically confirmed invasive carcinoma in a 37-year-old patient with a palpable lump in the left breast. (a-c) Preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given before surgery. (a) Mediolateral mammographic images of both breasts. Since the breast parenchyma was dense, the tumor could not be delineated. R = right breast, L = left breast. (b) Axial gadolinium-enhanced T1-weighted MR image of the breast (early subtraction 3D fast spoiled GRE 7.7/1.8 with a 30° flip angle) obtained at initial presentation showed extensive tumor growth (arrow). (c) Coronal USPIO-enhanced MR images obtained at initial presentation (left: T1-weighted SE 450/8; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) demonstrated multiple axillary nodes (arrows) mostly lacking USPIO enhancement that were subsequently confirmed to be metastatic by means of US-guided fine-needle aspiration biopsy. (d) Axial follow-up MR image obtained after neoadjuvant chemotherapy showed no contrast-enhanced lesion in the breast. (e) Coronal USPIO-enhanced MR images obtained after chemotherapy (left: T1-weighted SE; right: T1-weighted GRE) showed regression of axillary nodes; peripheral rim enhancement (arrows) surrounding the fatty hilum of the node is seen.