Ms Greco is a 37-year-old female with known right triple negative breast cancer and metastatic right axillary lymphadenopathy. She presents for MRI evaluation to assess for response during neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.RIGHT BREAST:In the right upper outer breast, there is revisualization of the index malignancy, now measuring 3.0 x 2.2 x 1.9 cm, previously measuring 3.0 x 2.5 x 2.3 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this lesion, compatible with index malignancy.Extending postero-inferiorly from this index malignancy are multiple additional enhancing masses, the posterior-most one of which is biopsy-proven to be malignant. Total span of enhancement (index malignancy + additional satellite lesions) now measures approximately 5.8 x 2.7 x 5.2 cm, previously measuring 5.8 x 3.1 x 5.4 cm. The total span in the AP oblique dimension continues to be approximately 6.3 cm. The two biopsy marker clips (index + satellite) are separated by approximately 4.1 cm in the AP dimension. In the right axilla, there are three abnormal morphology lymph nodes with eccentric cortical thickening. The largest one is biopsy proven to be metastatic with biopsy marker clip, now measuring 1.7 cm, previously measuring 1.7 cm.LEFT BREAST:In the left retroareolar region, there is a stable oval circumscribed mass, which is biopsy proven to be benign. Few enhancing foci are seen in the left breast, none of which are more suspicious than the rest. There is no abnormal enhancement seen elsewhere in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.
(1) Stable to minimal interval decrease in size of known multicentric right breast cancer. Detailed measurements as above.(2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. 