38-year-old woman personal history of triple negative left breast cancer status post lumpectomy and sentinel biopsy in April 2012 and adjuvant radiation therapy presents for screening MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Left breast: Postsurgical changes of lumpectomy with distortion of the breast parenchyma in the upper-outer quadrant. No abnormal enhancement in the left breast or axilla.Right breast: There are three new areas of non mass enhancement in the right breast. All of these demonstrate mixed kinetics on dynamic evaluation and are indeterminate.-The first focus is seen in the central right breast, anterior depth, near 6:00 immediately inferior to the nipple measuring 14 x 7 x 7 mm (AP x TV x CC).-A second focus is seen posterior and lateral to the first focus near 7:00 measuring 8 x 4 x 7 mm (AP x TV x CC).-The third focus is seen in the lateral breast, posterior depth, near 9:00 at the level of the nipple measuring 11 x 6 x 6 mm (AP x TV x CC).The distance between the areas are 4.5 cm (AP), 3.8 cm (CC) and 4.1 cm (TV). Further evaluation of these areas is recommended with right unilateral diagnostic mammogram and MR guided second look ultrasound. If there is no MR correlate identified, MRI guided biopsy should be performed.
Three new indeterminate areas of non mass enhancement in the right breast as described, with the largest area measuring 14 x 7 x 7 mm. Further evaluation of these areas is recommended with right unilateral diagnostic mammogram and MR guided second look ultrasound. If there is no correlate identified, MRI guided biopsies can be performed.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.