74-year-old female with screening detected lesions in the right breast 7:00 position presents for Allen Penn research study There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast:Heterogeneously enhancing irregular mass in the right breast 7:00 position measures 20 x 13 x 10 mm (AP x ML X CC). Located anterior to this are 3 small satellite lesions, anterior most satellite lesion measures 7 x 6 x 6 mm (AP x ML X CC). Total extent measures 33 x 17 x 11 mm. Located 14 mm medial and slightly posterior to the largest mass at approximately 6:00 position there is a 5 mm focus of enhancement which also appears suspicious making the total extent approximately 4 x 3.5 cm.Linear non mass enhancement measuring 11 x 6 x 6 mm (AP x ML X CC) is noted in the right breast 12:00 position.Left breast:Multiple small enhancing foci identified in the left breast, largest of them at 10:00 position measures 6 x 5 x 3 mm(AP x ML X CC). A focus is also noted at 5:00 position measuring 4 x 4 mm.No abnormal lymph nodes are identified in either axillary region.
1. A suspicious mass in the right breast 7:00 position with 3 small anterior satellite lesions. A small medial satellite lesion is also noted which appear suspicious. MR directed ultrasound can be attempted.2. Suspicious linear nonmass enhancement in the right breast 12:00 position for which MR directed ultrasound is recommended.3. Multiple enhancing masses/foci in the left breast, largest lesion located at 10:00 position, and a superficial focus noted at 5:00 position. MR directed ultrasound is recommended, if lesions not identified, six-month follow-up MRI is recommended to confirm stability of these small foci.4. No abnormal axillary lymph nodes are noted.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.