Known right breast cancer on I-Spy 2 protocol. MRI #2. Index mass in the right retroareolar region is larger than on the prior and predominately peripherally enhancing, with nodular peripheral enhancing areas measuring up to 1.3 cm. It is now not possible to differentiate exactly the boundary between the mass and the medial fluid collection, as the clip that was previously in the fluid collection is contiguous with the mass. At least a portion of the fluid collection appears pushed towards the skin by the mass. Overall measurement of the mass/collection is 6.5 x 4.9 x 5.2 cm, previously, the mass and collection separately measured 3.9 x 3.7 x 3.8 cm and 2.6 cm respectively. In a few locations, the rim enhancement may be less, though this is an equivocal finding given the increase in size/ increase in central necrosis. Associated skin thickening again noted. Satellite masses posterior to the index lesion are similar to prior measurements, up to 1.5 and 0.9 cm respectively. An enhancing 8 mm focus medial to the mass is seen now as well.The left breast scattered benign foci and masses are not significantly changed.Proven metastatic right axillary node with clip measures 2.4 x 1.6 cm, previously 2.9 x 1.9 cm. An additional node adjacent to the biopsied node is now seen and has areas suggesting central necrosis. This node measures 1.6 x 1.3 cm. Normal left axillary nodes.Probable hepatic cyst in the dome again noted. Non-specific heterogeneous signal in the sternum is noted but there is no specific enhancing lesion within it.
Known right breast cancer is increased in size overall. There may be a few areas where the peripheral enhancement is less compared to prior enhancing areas. Biopsied right axillary lymph node has slightly decreased in size. An additional right axillary node is now noted to be necrotic, likely due to metastatic involvement/treatment effect. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.