52 year old with multicentric ILC at 2 sites, OSH MRI was inadequate. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Right breast:Spiculated heterogenously enhancing mass with clip artifact is noted within the superior and posterior breast (lower axillary region) corresponding to biopsy proven cancer. It measures 20 x 16 x 13 mm (AP X ML X CC) with post biopsy changes tracking towards the skin surface. Clip artifact noted within the second biopsy proven cancer in the right breast 11 to 12:00 position that measures 32 x 33 x 30 mm (AP X ML X CC). It is irregular in shape with heterogenous enhancement difficult to locate the margins accurately. Located immediately lateral and posterior to this lesion is another irregular mass which measures 28 x 22 x 18 mm (AP X ML X CC) located in right breast 11:00 position. Extensive non mass enhancement is noted anterior to the anteriormost biopsy proven mass reaching within 9 mm from the nipple. Total extent of the masses and non mass enhancement (excluding the spiculated mass in the lower axillary region) within the right breast measures 110 x 62 x 60 mm (AP X ML X CC).No abnormal axillary lymph nodes are identified in right axillary region.Left Breast:Irregular heterogenously enhancing masses are seen in the central posterior left breast measuring 25 x 12 x 13 mm (AP X ML X CC) and at 11:00 position mid depth measuring 9 x 8 x 10 mm (AP X ML X CC). Extensive non mass enhancement adjacent to these masses is seen predominantly from 10 to 2:00 position in mid to anterior depth reaching 12 mm from the nipple. Total extent of masses with non mass enhancement is 63 x 50 x 46 mm (AP X ML X CC).No abnormal axillary lymph nodes are identified in left axillary region.
1. Two biopsy proven ILC sites in right breast with additional masses and extensive non mass enhancement measuring more than mammogram.2. Two suspicious masses in the left breast central posterior and 11:00 mid depth with adjacent non mass enhancement. MR directed ultrasound and spot compression views of focal asymmetries in the upper inner and central breast are recommended. If no correlate is found, MRI guided biopsy is recommended. 3. No abnormal axillary lymph nodes are seen bilaterally. BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.