Ms. Mills is a 55-year-old woman with indeterminant left breast calcifications for which stereotactic biopsy is recommended. She presents for bilateral breast MRI as part of the Alan Penn research study. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Right breast: There is a circumscribed oval mass in the lower outer quadrant of the right breast measuring approximately 0.9 x 1.0 x 1.0 cm. Faintly visualized is a small amount of fat density centrally within the mass on the T2-weighted sequences, suggestive of an intramammary lymph node. An MR directed ultrasound is recommended for further evaluation. Additional scattered enhancing foci are scattered throughout the right breast, none of which are more suspicious than the rest. Left breast: In the 12:00 position, posterior depth, there is a 0.8 x 0.9 x 1.2 cm enhancing mass, correlating to the posterior cluster of calcifications seen on diagnostic mammogram. There is no abnormal enhancement seen elsewhere in the left breast, specifically in the distribution of the calcifications identified on diagnostic mammogram. No abnormal lymph nodes are identified in either axillary region.
(1) Right Breast: Subcentimeter enhancing mass identified in the right lower outer breast. An MR directed ultrasound was performed immediately following the MRI, confirming the presence of a benign intramammary lymph node. No MRI or sonographic evidence of malignancy in the right breast.(2) Left breast: 1.2 cm enhancing mass in the left posterior central breast, corresponding to the posterior cluster of calcifications seen on the diagnostic mammogram. Please note that the patient had a two site stereotactic biopsy for the segmentally distributed calcifications identified on diagnostic mammogram (including the posterior cluster of calcifications corresponding to the MR-detected enhancing mass). The stereotactic biopsy has been reported under a separate accession.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.