Ms. Lisec is a 31 year old female with a personal history of left breast invasive ductal carcinoma with calcifications measuring up to 4.9 cm on mammogram and metastatic disease in the left axillary lymph node. She presents today for imaging response of the tumor to the chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:No abnormal enhancement is seen in the right breast.LEFT BREAST:There is no residual abnormal enhancement seen in the left breast, consistent with complete imaging response after neoadjuvant therapy. Previously identified linear nonmass enhancement in the inferior aspect of the left breast is not seen on today's exam either.AXILLAE:Biopsy proven left axillary lymph node has now decreased in size measuring 0.8 cm versus 1.1 cm on the prior. Susceptibility artifact from the biopsy clip is identified in this left axillary lymph node. There is no suspicious lymph node in the right axilla.
(1) Complete MR-imaging response of the known left breast malignancy and decrease in size of known metastatic left axillary lymph node. Based on recent diagnostic workup, there are multiple residual pleomorphic calcifications in the superior and upper outer left breast, that measure up to 5 cm and 3 cm respectively. If breast conservation therapy is desired, then double wire localization would have to be performed. (2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.