Ms. Mallory is a 60-year-old female with biopsy-proven left breast cancer with multiple enlarged ipsilateral axillary lymph nodes. Breast parenchyma is almost entirely fat in both breasts. There is mild background parenchymal enhancement noted bilaterally.LEFT BREAST: In the left breast, there is an irregular enhancing mass in the left lower outer breast measuring approximately 3.1 x 2.7 x 3.3 cm. The mass is associated with peripheral enhancement and central necrosis. Susceptibility artifact from biopsy marker clip is seen abutting the posterior margin of the mass, compatible with biopsy-proven malignancy. Of note, the malignancy does extend to within 1 cm from the skin margin at the infero-lateral margin.No additional abnormal enhancement is identified within the left breast. Specifically, there is no abnormal enhancement identified anterior to the biopsy-proven malignancy, as suggested on the diagnostic mammogram. The focal asymmetry seen on the mammogram likely represents normal fibroglandular tissue.There are at least 4 abnormally enlarged left axillary lymph nodes, the largest of which measures approximately 1.9 x 1.0 cm in the high left axilla. RIGHT BREAST: In the right breast, there is no abnormal enhancement identified . No abnormal axillary lymph nodes are identified in the right axillary region.
(1) Unifocal centrally necrotic left breast malignancy with biopsy marker clip located at the posterior margin. (2) Multiple abnormal left axillary lymph nodes, raising the suspicion for node-positive disease. An US-guided biopsy with clip placement can be performed if clinically warranted. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.