Ms. Byars is a 59-year-old female with recently diagnosed node positive right breast cancer, with recent CT chest abdomen pelvis with concerning lymph nodes, presenting for MRI to assess extent of disease as well as assess contralateral breast. There is scattered fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, at the 12:30 position, is an irregular, spiculated mass with heterogeneous enhancement (with clip artifact within it), measuring 2 x 2 x 1.4 cm (AP by transverse by CC), corresponding to patient's known high-grade invasive ductal carcinoma. Multiple additional masses extend laterally, superiorly, and posteriorly to this index lesion, with additional surrounding areas of nonmass enhancement.In the lateral right breast, at the 10:00 position (with adjacent clip artifact) is an area of nonmass enhancement with multiple adjacent enhancing foci, measuring 6.3 x 1.9 x 2.6 cm (AP by transverse by CC), corresponding to area of known ductal carcinoma in situ. There is a small associated hematoma/seroma at the site of stereotactic biopsy, which measures 2.0 x 1.1 cm.In total, the area of mass and nonmass enhancement extends from roughly the 10:00 to 2:00 position in the right breast, measuring 13.8 x 10.0 x 7.3 cm (AP by transverse by CC), and extending to the nipple.There are a total of 4 enlarged right axillary lymph nodes, the largest of which contains a biopsy clip, and measures 18 x 15 mm; these nodes demonstrate hypermetabolic activity on recent PET/CT.An enlarged right intramammary lymph node is also identified, which measures 1.9 x 1.1 cm, which also demonstrated hypermetabolic activity on recent PET/CT.There is no suspicious enhancing foci in the left breast. There are mildly prominent left axillary lymph nodes, which retain their normal architecture and fatty hila.
1.Extensive mass and nonmass enhancement in the right breast, corresponding to known right breast malignancy, with enlarged right axillary and right intramammary lymph nodes, as described above.2.No abnormal enhancement in the left breast or left axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.