Ms. Strug is a 46 year old female with biopsy proven DCIS of the left breast. She presents for MR imaging for further evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Spanning the entire left upper outer breast are multiple enhancing masses/clumped non-mass enhancement with suspicious appearance and kinetics. The total span of enhancement measures approximately 5.1 x 2.0 x 4.9 cm (AP x ML x SI). The total AP extent on the sagittal view is approximately 6.3 cm. At the mid-depth of this enhancement is the area of biopsy proven DCIS with susceptibility artifact from biopsy marker clip. At the posterior most extent of this abnormal enhancement is a spiculated enhancing mass measuring 2.1 x 1.9 x 1.6 cm. At the anterior most extent of this abnormal enhancement is an area of clumped nonmass enhancement measuring 1.5 x 0.8 x 1.1 cm, approaching to within 1 cm of the left nipple base.In the right medial breast, there are two enhancing foci/masses identified measuring approximately 0.5 and 0.8 cm respectively. These two enhancing areas do have a more benign appearance with non-suspicious kinetics. No abnormal axillary lymph nodes are identified in either axillary region.
(1) Abnormal enhancement spanning the entire left upper outer breast, suspicious for additional disease than what was initially mammographically detected. Additional workup, including MR-directed ultrasound, can be performed targeting the anterior and posterior most extent of suspected disease. If found, additional biopsies with clip placement can be performed as clinically warranted.(2) Two enhancing foci/masses with benign morphology in the right breast for which MR-directed ultrasound can be performed. If no corresponding sonographic correlate is identified, then a short term 6 month MRI follow-up can be performed to confirm stability of these findings.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. 