Ms. Kerulis is a 37-year-old female with triple negative breast cancer in the left breast currently on neoadjuvant chemotherapy (after 3 weeks of paclitaxel). She presents today for MR evaluation for treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, there has been an interval decrease in size of known malignancy, now measuring approximately 5.3 x 3.5 x 3.1 cm (AP x ML x SI), compared to 7.4 x 3.9 x 6.0 cm. Susceptibility artifact from biopsy marker clip is seen within the central aspect of this malignancy. There is no additional abnormal enhancement identified in the left breast.At least 4 abnormal lymph nodes continue to be seen in the left axilla, the largest of which now measures approximately 2.4 cm, compared to 3.6 cm. Susceptibility artifact from biopsy marker clip is seen within one of these lymph nodes, compatible with biopsy-proven metastatic left axillary lymph node.RIGHT BREAST: No abnormal enhancement is seen in the right breast.No abnormal axillary lymph nodes are identified in the right axillary region. .
(1) Interval decrease in size of biopsy proven malignancy of the left breast and metastatic left axillary lymph nodes. (2) No MRI evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.