57-year-old woman with recurrent right breast triple negative invasive ductal carcinoma gr 3, recently switched her care from OSH to University of Chicago. Patient submitted outside study for review. Submitted for review are breast MRI (11/2/2015) performed at Advocate Lutheran General Hospital. No comparisons are available. BREAST MRI: There are scattered fibroglandular tissue in both breasts. Mild amount of background parenchymal enhancement is seen bilaterally.RIGHT BREAST: Posttreatment/postsurgical changes are seen in the right breast which include architectural distortion, periareolar skin thickening, and small volume of the right breast. Additional scattered foci of susceptibility artifact are seen and may be related to surgical clips from prior lumpectomy as well as post biopsy changes.Within the central breast at the lumpectomy site near the 12:00 location, there is a spiculated heterogeneously enhancing mass, with susceptibility artifact noted at the anterior aspect of mass, consistent with the biopsy-proven recurrent cancer. The mass measures approximately 3.4 x 2.7 cm in AP and transverse dimension, respectively. There is is loss of the fat planes between the mass and the pectoralis muscle posteriorly, with associated tenting/pulling of the pectoralis muscle, and pectoralis muscle involvement cannot be excluded. Also in the right breast in the subareolar region, there is a an irregular enhancing mass measuring 1.2 x 0.9 cm in AP and transverse dimension, respectively, suspicious for malignancy.There is an enhancing focus in the right subpectoral region, measuring approximately 5 mm, indeterminate, and could be a lymph node. Given the location, this area may be difficult to evaluate on ultrasound and may not be amenable to ultrasound-guided biopsy.LEFT BREAST: There is no discrete enhancing mass or suspicious morphology in left breast. No suspicious findings in the left axilla.OTHER: There is a T2 bright lesion in the right hepatic lobe which is incompletely characterized and statistically could represent a cyst or hemangioma. Further evaluation with a triphasic CT scan of the abdomen with contrast or MRI of the liver with contrast could be obtained for further evaluation as clinically indicated. It could also be evaluated on PET.
(1) Spiculated heterogeneously enhancing mass in the right central breast with possible pectoralis involvement measuring up to 3.4 cm consistent with the biopsy-proven recurrent cancer.(2) Additional irregular enhancing mass measuring up to 1.2 cm in the right retroareolar region, suspicious for malignancy.(3) Small right subpectoral lymph node. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.