Ms. Pistorio is a 31-year-old female with known history of triple negative left breast cancer and metastatic left axillary lymphadenopathy. She presents for MRI evaluation to assess for response during neoadjuvant chemotherapy. There is extreme amount of fibroglandular tissue in both breasts. Marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.LEFT BREAST:In the left upper outer breast, there is revisualization of the index malignancy, now measuring 2.6 x 2.0 x 4.3 cm, previously measuring 3.2 x 2.5 x 5.1 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this lesion, compatible with index malignancy.Extending antero-inferiorly from this index malignancy are multiple additional enhancing masses, the inferior-most one of which is biopsy-proven to be malignant. Total span of enhancement of the additional satellite lesions now measures approximately 2.1 x 2.3 x 2.6 cm, previously measuring 3.3 x 2.9 x 2.7 cm. The total span of enhancement (index lesion + additional satellite lesions) in the AP oblique dimension measures approximately 8.3 cm, previously measuring 8.8 cm. The two biopsy marker clips (index + satellite) are separated by approximately 8.1 cm in the AP dimension. In the left axilla, the biopsy proven lymph node with biopsy marker clip now measures 1.6 cm, previously measuring 2.2 cm. RIGHT BREAST:Stable enhancing benign-appearing masses in the right breast. There is no new abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.
(1) Interval decrease in size of known multicentric left breast cancer. Detailed measurements as above.(2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. 