Left breast cancer at 9:00 position about 2 to 3 cm from the nipple with possible satellite lesion at 7:00 position, MRI for further evaluation There is heterogeneous amount of fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.Left breast:Spiculated enhancing mass in the left breast 9:00 position which corresponds to biopsy-proven cancer with a clip artifact within it measures 16 x 20 x 31 mm (AP X ML X CC). Located posterior to it by 6 mm is a an oval lobulated mass showing heterogeneous progressive enhancement that measures 20 x 12 x 8 mm, at approximately 7:30 to 8:00 position of the left breast. Based on the morphology and enhancement characteristics, this lesion could represent a benign fibroadenoma. Multiple small satellite lesions are identified extending posteriorly and laterally with associated non mass enhancement. The lateral anterior focus of enhancement located at 2:00 position measures 5 x 4 x 3 mm. The posterior-most and lateral spiculated mass located at 4:00 position of the left breast measures 9 x 6 x 8 mm (AP X ML X CC). The left nipple also shows abnormal enhancement that measures 11 x 12 x 10 mm however similar intense enhancement is also seen in the right nipple. These could be seen due to inverted nipple however given the intensity of enhancement and irregular shape of the lesion, neoplastic process cannot be excluded.Total extent of the left nipple, biopsy-proven cancer at 9:00 position and the farthest lateral satellite lesions is approximately 88 x 63 mm (AP X ML). Eccentric thickening of 2 left lower axillary lymph nodes, could be reactive given the recent biopsy however further evaluation with ultrasound is recommended.Right breast: Right nipple also demonstrates intense enhancement with irregular shape which could be seen due to inverted nipple however additional MR directed ultrasound is recommended to confirm benignity.No abnormal area of enhancement identified in the right breast. Normal morphology right axillary lymph nodes were identified.
1. Biopsy-proven cancer in the left breast 9:00 position with additional satellite lesions suggestive of multicentric disease. MR directed ultrasound to identify satellite lesions farthest from the index cancer for example left breast 4:00, left nipple and left breast 2:00 are recommended. The lobulated oval mass posterior to the index mass has most likely benign characteristics.2. Eccentric thickening of 2 left lower axillary lymph nodes for which MR directed ultrasound is recommended.3. Enhancing right nipple which is very similar to the enhancement characteristics of the left nipple. Differential includes inverted nipple bilaterally versus additional satellite lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.