41-year-old with newly diagnosed left breast DCIS. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST:Signal void artifact from biopsy clip in the central left breast mid to posterior depth. Extending from this point anteriorly and superiorly towards the nipple there is clumped nonmass enhancement in a linear distribution. Anterior to the clip this measures 5.2 x 3.2 cm (AP by transverse). There is additional clumped nonmass enhancement immediately lateral to the biopsy clip and also extending posteriorly for a length of 1.5 cm. The total extent of nonmass enhancement measures 6.4 x 3.3 x 6.0 cm (AP x ML X SI). The most anterior extent is 5 mm from the nipple.Scattered benign-appearing parenchymal enhancing foci. No focal enhancing mass.RIGHT BREAST:There is clumped nonmass enhancement with a linear distribution in the 9:00 radian mid depth. This measures 2.7 x 1.4 x 1.2 cm (AP x ML X SI).Scattered benign-appearing parenchymal enhancing foci. No focal enhancing mass.LYMPH NODES:There is a moderately enlarged left retropectoral lymph node with thickened cortex measuring 9 mm in maximum dimension. Scattered benign-appearing bilateral axillary lymph nodes. No enlarged internal mammary lymph nodes.OTHER:Within the mid thoracic spine there is a T2 bright nonenhancing right paraspinal focus likely representing a meningocele.
1. Extensive non mass enhancement extending anterior and posterior to the clip in the central left breast suspicious for DCIS. Few scattered calcifications are noted anteriorly on the mammogram extending towards the nipple. If additional tissue sampling is necessary, ultrasound behind the nipple can be performed to look for an invasive component or stereotactic biopsy can be performed targeting the calcifications behind the nipple.2. Although low suspicion, area of non mass enhancement in the right breast 9:00 position needs further evaluation with MR directed ultrasound. If no correlate is seen on ultrasound, MR guided biopsy is recommended.3. Asymmetric left prominent retropectoral lymph node.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.