Ms. Crook is a 62-year-old female with recent diagnosis of right breast cancer. She presents today for MR imaging evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the right upper outer breast, there is an irregular enhancing mass with associated biopsy marker clip measuring approximately 2.1 x 2.0 x 2.2 cm (AP x ML x SI), compatible with biopsy-proven malignancy. However, extending anteriorly and inferiorly from this malignancy is extensive clumped nonmass enhancement. Total span of abnormal enhancement (index malignancy + NME) measures approximately 9.0 x 3.2 x 5.6 cm. The nonmass enhancement extends into the right nipple. In the left breast, a few foci of enhancement are identified, none of which appear more suspicious than the rest. No abnormal axillary lymph nodes are identified in either axillary region.
(1) Extensive abnormal enhancement seen in the right upper outer breast, measuring up to 9.0 cm in total span. The posterior extent is biopsy proven to be malignant. If confirmation of anterior disease is desired, then an US-guided biopsy can be performed; given that additional hypoechoic lesions (likely corresponding to the MR detected NME) were seen on recent ultrasound from 4/5/2016. (2) No MR evidence of enhancement in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.