Ms. Winston is a 77 year old female with disease positive left axillary lymph nodes and no definite breast primary. She presents for MR evaluation to identify a possible breast primary. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left breast, there is a subtle area of linear non-mass enhancement identified in the left lower outer breast, anterior depth, that may be a possible candidate for primary breast malignancy. This linear non-mass enhancement measures approximately 3.4 cm in the AP dimension and extends up to the anterior skin surface. There is minimal left breast skin thickening, particularly along the antero-medial aspect of the left breast. There is also a focal area of enhancement seen in the supero-anterior left breast skin, which correlates with history of recent skin punch biopsy.There are numerous (> 6) abnormal morphology lymph nodes located in the left axillary region, the largest of which measures approximately 3.8 x 1.6 cm. No susceptibility artifact is identified in any of these lymph nodes to indicate presence of biopsy marker clip. In addition, it is not apparent on this MRI as to which of these nodes were biopsied due to lack of obvious surrounding post-biopsy changes. There is no abnormal enhancement seen in the right breast. There are no abnormal axillary lymph nodes located in the right axillary region.
(1) Multiple abnormal left axillary lymph nodes, one of which has been biopsied and is malignant. No biopsy marker clip was placed at time of biopsy and it is unclear from MRI which specific node was biopsied. An US-guided clip placement can certainly be performed for one of these abnormal nodes if clinically desired.(2) Subtle area of linear non-mass enhancement in the left lower inner breast, spanning 3.4 cm in the AP dimension. This may be a possible candidate for the primary breast malignancy. An MR guided biopsy with clip placement can be performed if clinically warranted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.