Ms. Edens is a 58 year old female presenting for MRI evaluation of screen detected calcifications in the left breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.LEFT BREAST: Spanning the entire left superior breast is a segmental distribution of clumped nonmass enhancement spanning approximately 9.0 x 2.3 x 3.4 cm (AP x ML x SI). This clumped nonmass enhancement extends to within 1 cm from the left nipple base and approximates the distribution of the mammographically detected calcifications. There are a few additional foci of enhancement seen in the left inferior and left lower outer breast, none of which are more suspicious than the rest.RIGHT BREAST: Slight motion artifact limits sensitivity of the right breast. However, there is no abnormal enhancement seen in the right breast.AXILLA: There are two abnormal morphology lymph nodes identified in the left axilla, the largest one of which measures approximately 2.1 cm. There are no abnormal lymph nodes identified in the right axillary region.
(1) 9.0 cm of clumped nonmass enhancement in a segmental distribution in the left superior breast, approximating the distribution of the mammographically detected calcifications. A two site ultrasound-guided biopsy with clip placement is recommended for further evaluation.(2) Abnormal morphology lymph node in the left axilla. An MR directed ultrasound with ultrasound-guided biopsy is recommended for further evaluation.(3) No MRI evidence of malignancy in the right breast.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. 