Ms. Watson-Pitts is a 57 year old female presenting with recently diagnosed right breast cancer. She presents today for MRI staging of disease. Mild parenchymal enhancement is noted bilaterally.Right breast: In the right lower inner breast, 4:00 location, there is a spiculated, enhancing mass measuring 3.6 x 2.5 x 1.7 cm. Susceptibility artifact from biopsy marker clip is present within the central aspect of this lesion, compatible with biopsy proven malignancy. Extending medially from this index lesion are multiple enhancing foci/masses, which are highly suspicious for additional satellite lesions. The largest of the satellite lesions is identified at the right lower inner breast, 7 o'clock location, measuring approximately 1.1 x 1.0 x 0.8 cm. The total span of abnormal enhancement in the right inferior breast measures approximately 6.2 x 5.3 cm.In addition, there are several enhancing foci in the right superior breast, which are also suspicious for additional satellite lesions. One of these enhancing foci in the right upper outer breast was biopsied, measuring approximately 1.0 x 0.9 cm.Diffuse skin thickening is identified around the right breast with a focal area of enhancement within the dermis at the 1 o'clock location, which may be related to recent postbiopsy changes. Multiple enlarged axillary lymph nodes including subpectoral lymph nodes are identified, the largest of which measures approximately 1.1 cm. One of these lymph nodes has a Hydromark clip present, compatible with recently biopsied axillary lymph node measuring approximately 0.8 cm.Left breast: In the left superior breast, 12 o'clock location (mid depth), there is a peripherally enhancing, circumscribed mass which corresponds exactly to the mammographically stable benign morphology mass with biopsy marker clip. There is no abnormal enhancement identified within the left breast.
(1) Multiple enhancing masses and foci compatible with multicentric right breast cancer with multiple enlarged right axillary/subpectoral lymph nodes.(2) No MRI evidence of malignancy within the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.