44-year-old female with invasive ductal carcinoma in the lower inner left breast 2:00 location and metastatic disease in the left axillary lymph node presents for preop staging. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is no abnormal enhancement in the right breast.LEFT BREAST:There is high T2 and susceptibility artifact from the biopsy clip is identified in an enhancing mass in the left breast, 2:00 position, far posterior depth, which corresponds to the biopsy proven invasive ductal carcinoma in the left breast. This mass measures 2.5 x 2.6 x 3.1 cm (AP x LR x SI). This mass directly abuts the superficial skin with skin enhancement, which may represent skin involvement of the cancer and/or postbiopsy change in the skin. There is no involvement of the pectoralis muscle.No abnormal enhancement is seen elsewhere in the left breast. Axillae:The biopsied left axillary lymph node with Hydromark clip measures 1.5 cm. In addition, multiple abnormal appearing lymph nodes are identified in the left axilla and left subpectoral region. For example, one of the subpectoral lymph nodes measures 2.1 cm.No abnormal lymph nodes are identified in the right axillary region.
1. Unifocal 3.1 cm biopsied malignancy in the far posterior left breast 2:00 position. Enhancement of the overlying skin is highly suggestive of skin involvement of cancer and/or postbiopsy change of the skin.2. Multiple abnormal-appearing lymph nodes in the left axilla including the subpectoral region compatible with metastatic disease.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.