Biopsy proven left breast cancer and metastatic left axillary lymph node. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally. The marked background enhancement is a limitation to this study. The proven malignancy in the left upper breast near 12:00 is seen as an irregularly enhancing mass with internal artifact from the Hydromark biopsy clip and measures 2.1 x 2.3 x 2.1 cm. Mild enhancement extending towards the skin from this mass is likely related to the recent biopsy. There is an additional mass in the left lower outer breast that measures 1.6 x 1.2 x 1.2 cm. Also, inferior to the index mass near the central 9:00-9:30 position is a smaller enhancing mass measuring up to 7 mm that has a lack of central enhancement. This may represent a benign etiology such as peripherally enhancing cysts. Within the right breast, an area of rounded enhancement in the lower inner quadrant may represent globular parenchyma. This measures 1.7 x 1.5 x 1.2 cm. The two biopsied lymph nodes in the left axilla are seen and measure 1.1 and 1.6 cm respectively. It is noted also that lymph nodes in the right axilla are at least as large as those on the left and have mildly thickening cortices of at least 5 mm. Representative nodes measure up to 1.6 and 2.0 cm. A high T2 signal left hepatic lobe lesion is probably benign such as a cyst or hemangioma.
Marked background enhancement in this patient with newly diagnosed left breast cancer, with the index mass measuring up to 2.3 cm. The background enhancement limits this exam. However, the following additional findings should be further evaluated with MRI directed ultrasound:1. A 1.6 cm mass in the left lower outer quadrant. If no ultrasound correlate is found, then MRI guided biopsy would be necessary. 2. A 7 mm enhancing lesion in the central left 9:00-9:30 position. If no ultrasound correlate is found, then 6 month MRI should be considered.3. A right lower inner quadrant 1.7 cm area of enhancement that more likely represents globular parenchyma and could also be followed on MRI if ultrasound is negative.4. Right axillary lymph nodes, which are as prominent or more so than the proven left axillary metastatic lymph node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.