Breast-specific gamma imaging (BSGI) true negative result in 66-year-old female with personal history of right breast malignancy and a clinical indication for diagnostic imaging of an area of palpable concern within the lower left breast. A: Craniocaudal (CC) and mediolateral oblique (MLO) views of the right and left breast demonstrated a focal asymmetry in the upper central right breast at mid- to posterior depth as well as the surgical scar at posterior depth in the lower left breast (arrows). B: This focal asymmetry persisted on right magnified CC (RMCC) and right magnified MLO (RMMLO) views of the upper central right breast at middle depth (arrows). C: Correlative US imaging of the left breast demonstrated a mass-like appearance of the surgical scar but without prior US for direct comparison. D: Correlative US imaging of the right breast failed to demonstrate a sonographic abnormality. Breast-specific gamma imaging was ordered due to persistent clinical concern and inconclusive mammography and US. E: No areas of abnormal radiotracer uptake were seen in either breast on subsequent BSGI. A total of 2 biopsies were averted (right stereotactic and left wide US-guided sampling of the scar), and no cancer was detected on follow-up. This case highlights the strong negative predictive value of BSGI due to its higher specificity even in complex cases. Abbreviations: LCC, left craniocaudal; LMLO, left mediolateral oblique; RCC, right craniocaudal; RMLO, right mediolateral oblique.