52-year-old woman with self palpated suspicious right breast mass presents for further evaluation with bilateral breast MRI. The patient is involving the Alan Penn research study. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast: In the upper inner quadrant near the 2:00 position, posterior depth, there is a homogeneously enhancing macrolobulated mass, suspicious for malignancy. The mass measures approximately 14 x 18 x 15 mm (AP x TV x CC). Portions of this mass demonstrates rapid uptake and washout on dynamic evaluation. A distinct fat plane is noted between the mass and pectoralis muscle. There is no pectoralis muscle enhancement. Few scattered subcentimeter enhancing foci are seen, likely related to background parenchymal enhancement.There are a few prominent right axillary lymph nodes, which demonstrate borderline increased cortical thickness similar to the findings on mammogram and ultrasound. The most prominent node measures up to 9 mm in maximum diameter. Left breast: Few scattered subcentimeter enhancing foci are seen in the right breast, not uniquely suspicious and likely related to bagging or parenchymal enhancement. There is no suspicious mass, morphology or focus of temporal enhancement. There are a few scattered lymph nodes in the left axilla, none uniquely suspicious.Other: There is enlargement of the cardiac silhouette, better evaluated on prior cardiac MRI and related to patient's history of sarcoid.
(1) Homogeneously enhancing right upper inner breast 2:00 position mass measuring up to 18 mm, suspicious for malignancy. This mass was biopsied under ultrasound guidance later today and reported under separate accession.(2) Indeterminate prominent right axilla lymph nodes some of which demonstrate borderline increased cortical thickness measuring up to 9 mm in maximum diameter. One of these lymph nodes were biopsied under ultrasound guidance today and reported under accession.(3) No MR evidence of malignancy in the left breast or left axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.