69-year-old with right breast 8 cm spanning DCIS (biopsy posteriorly), no biopsy performed of the anterior calcifications (which she declines). MRI performed to assess extent of disease prior to surgical spanning. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Right breast:Few subcentimeter cysts identified in the right breast. Few dilated fluid filled ducts are seen in the right retroareolar region.Clip artifact identified in the right upper-outer quadrant posterior depth at approximately 9:00 position. Extensive area of segmental clumped nonmass enhancement is seen from 9 to 2:00 position, extending anteriorly towards the nipple. Non mass enhancement is also seen extending in a discontinuous fashion medially and anteriorly. Total non mass enhancement measures 12 x 7.7 x 4.4 cm (AP X ML X CC). Distance of the nonmass enhancement from the nipple measures 8 mm. The nonmass enhancement especially in the medial anterior breast approximately 1 to 2:00 position appears more nodular and clumped, with rapid uptake and washout kinetics, cannot rule out microinvasion.Left breast:No abnormal enhancement is seen in left breast. Few benign morphology enhancing foci are noted in the left breast including a benign intramammary lymph node with a correlate on T2-weighted sequence and on the mammogram. A complicated septated cyst with peripheral rim enhancement is identified in the left breast 3:00 position measuring 19 x 19 x 16 mm (AP X ML X CC).No abnormal lymph nodes are identified in either axillary region.
1. Extensive nonmass enhancement in the right breast extending from 9 to 2:00 position, more than seen on the mammogram spanning 12 cm in maximum dimension. Areas of clumped nodular enhancement and suspicious kinetics in the medial anterior breast, cannot rule out microinvasion. If additional tissue sampling is needed at that site, MR directed ultrasound can be performed to find a correlate.Closest distance of the nonmass enhancement from the nipple measures approximately 8 mm.2. Complicated cyst and a benign intramammary lymph node in the left breast.3. No abnormality noted in the axillary regions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.