Ms. Trimby is a 64-year-old female with biopsy-proven right breast cancer with disease positive right axillary lymph node. She presents for a baseline MRI prior to starting neoadjuvant therapy. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:In the right upper outer breast, there is an irregular enhancing mass measuring 1.8 x 1.4 x 2.3 cm. Susceptibility artifact from biopsy marker clip is seen within this mass, compatible with the biopsy proven malignancy. Located approximately 2.0 cm anterior to this biopsy-proven malignancy is an additional irregular enhancing mass measuring 0.9 x 0.9 x 1.0 cm. This is suspicious for an satellite lesion. Total span of enhancement (index lesion + suspected satellite lesion) measures approximately 4.2 cm in AP dimension.In addition, in the right inferior breast, there is a faint area of enhancement measuring 0.7 x 0.6 x 0.4 cm.A markedly enlarged right axillary lymph node is identified measuring approximately 3.2 cm in maximal dimension. This is presumed to be the previously biopsied disease positive lymph node at the outside hospital. No clip artifact is identified.LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.
(1) Biopsy-proven malignancy in the right upper outer breast measuring approximately 2.3 cm in maximal dimension. (2) Located approximately 2 cm to the biopsy-proven malignancy is an additional irregular enhancing mass, suspicious for a satellite lesion. An MR directed ultrasound is recommended for further evaluation. Of note, the patient did have an MR directed ultrasound later that day with a sonographic correlate identified. An ultrasound-guided biopsy with clip placement was performed. Pathology is pending.(3) 0.7 cm faint area of enhancement in the right inferior breast. An MR directed ultrasound is recommended for further evaluation.Of note, the patient did have an MR directed ultrasound with no sonographic correlate identified. A six-month follow-up MRI is recommended to confirm stability of this finding.(4) 3.2 cm abnormal right axillary lymph node, biopsy-proven to be disease positive. An ultrasound-guided clip placement was performed later that day.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.