Ms. Broomfield is a 66 year old female with known right breast cancer and metastatic right axillary lymph node. She has been on neoadjuvant chemotherapy and presents for MR re-imaging. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:In the right superior breast, there has been an interval decrease in size of biopsy-proven malignancy, now appearing as three subcentimeter enhancing masses/foci. The total span of enhancement measures approximately 2.1 x 1.1 x 1.5 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen at the posterior aspect of this enhancement. There is no additional abnormal enhancement seen in the right breast.LEFT BREAST:There is no abnormal enhancement seen in the left breast.AXILLAE:Biopsy-proven metastatic right axillary lymph node with associated biopsy marker clip now measures 0.6 cm, previously measuring 1.1 cm. Multiple additional prominent right axillary lymph nodes are present. No abnormal axillary lymph nodes are identified in the left axillary region.
(1) Interval decrease in size of biopsy proven right breast malignancy and metastatic right axillary lymph node. If breast conservation therapy is desired, the biopsy clip should be targeted for preoperative surgical guidance (with knowledge that residual MR enhancement is seen extending anterior to the clip). (2) No MRI evidence for malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.