Ms. Greer is a 39 year old female with known left breast cancer currently on neoadjuvant chemotherapy. She presents today for I-SPY2 protocol MRI #3. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left retroareolar region, the known malignancy now measures approximately 5.1 x 4.4 x 5.4 cm, previously 4.6 x 4.4 x 5.2 cm (AP x ML x SI), and originally measuring 4.1 x 4.5 x 4.5 cm. The malignancy continues to extend towards and involve the anterior skin and nipple. The biopsy marker clip is seen peripherally at the anterior aspect of the malignancy. The interval increase in measurement is partially due to enlargement of the lateral nodular component of the mass. There is additionally a 1.3 cm area of enhancement along the posterior lateral aspect of the mass that is more nodular and suspicious in appearance on this exam. No abnormal enhancement is seen in the right breast. At least two enlarged left axillary lymph nodes continue to be seen, the previously measured node again measures 3.0 x 1.7 cm. A biopsy marker clip is seen within this lymph node. However, an additional deeper lymph node is enlarged compared to the prior studies, now measuring up to 2.0 cm. No abnormal lymph nodes are identified in the right axillary or internal mammary region.
1. Interval increase in enhancement in the left breast, with the index mass enlarged to 5.4 cm in greatest dimension. 2. Interval increase in size of one axillary lymph node, now measuring up to 2.0 cm. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.