A patient submitted outside study for review. There are two biopsy proven IDC (12:30 position and 1:00 position) in the left breast. Submitted for review are breast MRI (8/16/16) performed at outside institution. For comparison, digital mammographic images (6/14/16), ultrasound images of left breast (7/8/16), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (8/2/16) are available. Breast MRI was performed with a protocol outlined in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.LEFT BREAST:There are two marker clips in the left breast from recent biopsy at 12:30 position and 1:00 position (12:30 clip is superior to 1:00 clip). Inferior to the 1:00 clip, there is a 17 mm hematoma. On the post-contrast images, there is an enhancing mass measuring 8 x 9 x 8 mm (AP x LR x CC) at immediately anterior to the 12:30 clip, and another enhancing mass around the 1:00 clip, measuring 9 x 10 x 6 mm, located just superior to the hematoma. Both correspond to the proven carcinoma. Overall measurement of these two masses is 15 x 15 x 24 mm.In addition, there is a linear non-mass enhancement extending anteriorly from the masses, measuring 30 x 12 x 12 mm. Overall AP measurement of the masses and the non-mass enhancement is 43 mm.RIGHT BREAST:No abnormal enhancement is seen in right breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.
1. Two proven carcinoma with clip associated with hematoma at 12:30 - 1:00 position in the left breast. Suspicious non-mass enhancement extending anteriorly from the proven cancer. MR guided biopsy of the non-mass enhancement should be considered if breast conservation surgery is planned.2. No abnormal enhancement in right breast. 3. No abnormal lymph nodes are identified in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.