Ms. Balstrode is a 47 year old female with a recent diagnosis of right breast invasive lobular carcinoma and right breast ADH. She presents for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.In the right upper outer breast, posterior depth, there is a spiculated enhancing mass identified measuring approximately 2.1 x 2.1 x 2.4 cm (AP times mL times SI). Susceptibility artifact from biopsy marker clip is seen within this lesion, compatible with biopsy-proven malignancy. Located approximately 0.6 cm infero-posteriorly is an additional oval enhancing mass which measures approximately 1.0 cm. This is suspicious for a satellite lesion. Total span of enhancement (index lesion + satellite lesion) measures approximately 2.7 cm in the AP dimension and 3.1 cm in the SI dimension. This satellite lesion can be seen in retrospect on the original diagnostic workup (particularly on the C-view on the right MLO).In the right upper inner breast, there is an additional oval enhancing mass identified measuring 2.3 x 1.3 x 1.4 cm. Susceptibility artifact from biopsy marking clip is seen within this lesion, compatible with biopsy-proven atypia. In the left breast, there is no abnormal enhancement. No abnormal axillary lymph nodes are identified in either axillary region.In the right midlung, there is a T2 hyperintense, enhancing lesion identified, that measures approximately 1.4 cm in maximal dimension.
(1) Biopsy proven malignancy along with suspected satellite lesion seen in the right upper outer breast. Total span of enhancement measures up to 3.1 cm. Clip is within the index malignancy. (2) 2.3 cm enhancing mass in the right upper inner breast corresponding to biopsy proven atypia. Clip is within the mass. If breast conservation therapy is desired, patient may need a bracketed wire localization for the index+satellite masses along with a single wire targeting the clip at site of atypia. (3) 1.4 cm enhancing lesion in the right mid-lung of indeterminate significance. If a patient has had prior cross-sectional imaging, that should be submitted in order to aid further characterization. Otherwise, patient should get a contrast-enhanced CT scan for further evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.