43 year old with highly suspicious mass with extensive suspicious calcifications in the right breast presents for MR evaluation. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There are multiple cysts in both breasts.An irregularly shaped, rim enhancing mass is present at anterior 11 o'clock position in the right breast, measuring 29 x 22 x 35 mm (AP x LR x CC). This lesion is highly suggestive for malignancy.There are several round enhancing foci and masses surrounding the large rim enhancing mass, likely satellites. Overall measurement of the main mass with possible satellites is 40 x 33 x 43 mm.In addition, there is segmental non mass enhancement extending upper outer and lower outer quadrants in the right breast, measuring 68 x 49 x 130 mm.In the right axilla, there is an abnormal lymph node with thickened cortex, measuring 13 mm. In the left breast, there are multiple enhancing foci, which are likely parenchymal enhancement. There are a few small enhancing masses (less than 1 cm) in the left breast. Those masses are all similar in shape and show sow benign type kinetic pattern. The largest enhancing mass is located anterior 12 o'clock position, measuring 6 x 9 x 7 mm.No abnormal lymph nodes are identified in left axillary region.
1. Highly suspicious mass in the right 11 o'clock with possible satellites and suspicious non mass enhancement distributing segmentally in the right upper outer and lower outer quadrant.2. Suspicious right axillary lymph node3. Benign appearing masses in the left breast4. No abnormal lymph nodes in left axillary regionFollowing procedures were performed after this MRI.1. Ultrasound guided biopsy for the suspicious mass at 11 o'clock position in the right breast and abnormal right axillary lymph node2. Stereotactic core needle biopsy for the right breast calcifications which correspond to the non mass enhancing lesion3. MR directed ultrasound and ultrasound guided biopsy for the left 12 o'clock mass BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.