Ms Greco is a 37 year old female with history of right triple negative breast cancer and metastatic right axillary lymphadenopathy, status post neoadjuvant chemotherapy. Patient is on I-SPY 2 research protocol, with most recent breast MRI (10/10/2016) demonstrating reduction in size of the index mass, satellite lesions and metastatic right axillary lymph node. Patient also has history of benign right 9:00 biopsy (fibrocystic change, ductal ectasia) and benign left retroareolar biopsy. Family history is positive for premenopausal breast cancer in a maternal aunt. This is I-Spy MRI #4. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There is a 3 mm enhancing focus located several centimeters medial to the site of the previously enhancing right breast index malignancy. This focus has central high T2 signal and thin peripheral enhancement. The high T2 signal at this site is even more apparent on the most recent prior study. The appearance is compatible with either a small inflamed cyst or an oil cyst/fat necrosis (consensus opinion of 3 breast radiologists). The two Hydromark clips in the right breast and one on the left are well seen. The index malignancy clip is not well seen on MRI today. The anterior left breast proven benign mass does not significantly enhance today. The biopsied right axillary lymph node contains Hydromark clip artifact and measures up to 8 mm, previously 1.3 cm on the October MRI. The additional axillary clip is seen outside of this node, in fat anterolateral to the node. No abnormal axillary lymph nodes are identified in the left axillary region.
1. No significant residual enhancement at the sites of proven right breast malignancy. 2. Interval decrease in size of biopsied right axillary lymph node.3. Enhancing focus in the right medial breast is benign in appearance, compatible with an inflamed cyst or oil cyst/fat necrosis. Once treatment is completed, an annual MRI follow up should be considered based on her breast density and young age at cancer diagnosis.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.