A 57-year-old woman referred from a local hospital due to suspicious malignant microcalcifications (BI-RADS 4) on biennial mammographic screening.

(A) The low energy conventional mammogram on craniocaudal view showed a cluster of pleomorphic microcalcifications in the lower outer quadrant of left breast; however the sonographic evaluation revealed negative of associate mass. (B) CESM revealed a 0.7-cm irregular nodular enhancement over the associated microcalcifications. Stereotactic core needle biopsy diagnosed it to carcinoma in situ, however surgery subsequently proved it to be invasive ductal cancer.