59-year-old female with biopsy proven invasive lobular carcinoma in the left breast presents for breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is an irregularly shaped enhancing mass with a marker clip at 2:00 position, consistent with biopsy-proven carcinoma. The lesion measures 12 x 12 x 12 mm (AP x LR x CC).There is an enhancing focus with irregular margins at retroareolar 4:00 position in the left breast, measuring 5 x 4 x 5 mm. This enhancing focus is located 46 mm anterior and inferior to the index cancer.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.
1. Biopsy proven carcinoma at 2:00 position in the left breast.2. Indeterminate enhancing focus at retroareolar 4:00 position in the left breast. MR directed ultrasound study is recommended. If the lesion is not detected on ultrasound study, MR guided biopsy should be considered.3. No MRI evidence for malignancy in the right breast.4. No abnormal lymph nodes in either axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.