Ms. Walker is a 56-year-old female presenting for further evaluation of a suspicious right breast mass. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST: In the right inferior breast, 6:00 location, there is an irregular enhancing mass identified measuring approximately 2.0 x 1.3 x 1.9 cm (AP x ML x SI). Seen just superomedial to this is an additional irregular enhancing mass measuring approximately 1.0 x 0.8 x 0.7 cm. The total span of abnormal enhancement (index mass + suspected satellite lesion) measures approximately 2.7 cm in the AP oblique dimension. In addition, there is a circumscribed enhancing mass seen in the right upper outer breast, 10:00 location, measuring approximately 0.6 x 0.9 cm. This corresponds to the sonographically identified intramammary lymph node. There is an additional circumscribed enhancing mass seen in the right inferior breast, 6:00 location, measuring 0.6 x 0.7 cm. An ultrasound will be performed to further evaluate this lesion.LEFT BREAST: A few enhancing foci are seen in the left breast, none of which are more suspicious than the rest. There is no abnormal enhancement seen in the left breast. AXILLAE: There is an abnormal morphology lymph node identified in the right axilla, measuring approximately 1.1 x 0.8 x 1.1 cm. There are no abnormal lymph nodes identified in the left axillary or internal mammary region.
(1) 2.0 cm suspicious mass in the right inferior breast, for which an ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(2) Additional suspected satellite lesion seen just superomedial to the index malignancy. An MR directed ultrasound will be performed for confirmation of this finding.(3) Abnormal right axillary lymph node, for which ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(4) 0.9 cm intramammary lymph node in the right upper outer breast, for which ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(5) Additional circumscribed enhancing mass in the right inferior breast, suspected to be a benign intramammary lymph node. An MR directed ultrasound will be performed for confirmation of this finding.(6) No MRI evidence for malignancy in the left breast. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.