Ms. Pistorio is a 31-year-old female with a personal history of left triple negative breast cancer, with left axillary metastatic lymph nodes, status post neoadjuvant chemotherapy. She presents today for MRI evaluation to assess for treatment response. I-Spy trial MRI #4. There is extreme amount of fibroglandular tissuein both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.LEFT BREAST: The known index malignancy in the left axillary tail no longer enhances on this examination. However, there are several enhancing foci/masses seen extending inferiorly, the largest one of which measures approximately 0.9 x 0.7 x 1.0 cm, previously measuring 0.9 x 0.5 x 0.9 cm. Susceptibility artifact from a hydromark biopsy clip is again noted lateral to this lesion. The total span of abnormal enhancement (of the residual enhancing foci/masses) measures approximately 4.9 cm in the AP oblique dimension, previously measuring 5.1 cm. However, the total span of enhancement including the biopsy marker clip from index malignancy and residual enhancing foci/masses measures approximately 6.9 cm. This corresponds to the mammographically-identified distance between the index malignancy biopsy marker clip and satellite lesion biopsy marker clip of 7.2 cm.In the left axilla, the biopsy proven lymph node now measures 0.9 cm, compared to 0.9 cm. RIGHT BREAST: Several benign enhancing foci/masses are again seen in the right breast, and stable when compared to prior MRI examinations. There is no new abnormal enhancement within the right breast. No abnormal right axillary lymph nodes are identified.
(1) Interval decrease in enhancement of left axillary tail index malignancy. Total span of abnormal enhancement (of residual enhancing foci/masses), measures approximately 4.9 cm. Total span of abnormal enhancement (including biopsy marker clip from index malignancy + residual enhancing foci/masses), measures approximately 6.9 cm. Any breast conservation therapy would have to include both biopsy marker clips (index + satellite) which are currently separated by approximately 7 cm (on both MRI and mammogram). (2) Stable size and appearance of metastatic left axillary lymph node.(3) No MRI evidence of malignancy of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.