Known left upper inner breast IDC/DCIS. Question of additional lesions at 10:00 and 11:00. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are multiple enhancing masses/foci in the left breast. This includes the index mass in the upper inner quadrant, which is seen as a 1.0 x 1.5 x 1.5 cm spiculated mass with artifact from the Hydromark biopsy clip. Additionally, a 0.8 cm mass in the far posterior depth of the left upper outer breast is the likely correlate to the additional finding seen on mammograms. Morphologically, this may represent a lymph node, though a clear fatty hilum is not seen. Finally, a 0.5 cm avidly enhancing focus is present in the central left breast, at the anterior aspect of fainter foci/non-mass enhancement. No abnormal enhancement is seen medial to the index lesion, and the mammographic appearance medially may have been the result of tissue overlap. In the right central breast, there is linear non-mass enhancement extending 2.2 cm AP. No abnormal axillary lymph nodes are identified in either axillary region.
1. Multiple findings in the left breast: -Biopsy proven index cancer in the upper inner quadrant measuring up to 1.5 cm.-5 mm avidly enhancing focus for which MRI directed ultrasound is recommended. If no correlate is seen, MRI guided biopsy will be necessary.-Additional mass which may be a lymph node in the posterior depth of the upper outer breast. This mass is likely the correlate for the additional mammographic finding. MRI directed ultrasound is recommended to evaluate for this mass, and to determine morphology if this is in fact a lymph node. 2. Linear non-mass enhancement in the right breast for which MRI guided biopsy is recommended. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.