35-year-old with known right breast cancer on I-SPY protocol. MRI #3. Evaluate response to neoadjuvant chemotherapy. Redemonstration of a large anterior right breast mass with central necrosis. The necrotic cavity extends to the skin surface and the previously present central fluid has decompressed through a defect in the skin. The residual mass now measures 2.1 x 3.0 x 2.9 cm (AP by transverse by CC), previously 6.5 x 4.9 x 5.2 cm. There are 2 dominant enhancing nodules felt to reflect the larger peripheral nodular components of the primary mass noted previously. The medial enhancing nodule measures 16 mm while laterally it measures 10 mm in maximum dimension, previously 13 mm and 9 mm.The posterior satellite enhancing masses are no longer clearly separable from the main mass. There is associated anterior skin thickening and enhancement compatible with tumor involvement.Scattered benign enhancing foci within the left breast are not significantly changed.The biopsy-proven metastatic right axillary lymph node measures 1.9 x 2.0 cm (previously 2.4 x 1.6 cm). An additional enlarged enhancing lymph node located more posteriorly measures 1.7 x 1.5 cm (previously 1.6 x 1.3 cm).There are innumerable enhancing lesions within the liver compatible with metastases. These are increased compared to the prior MRI, but this is grossly similar to the CT chest performed on 9/8/2015 accounting for differences in technique.
1. Interval decompression of the central necrotic core of the primary right breast mass resulting in significant reduction in size and change in the mass morphology which limits comparison measurements. Best comparisons are provided. 2. Minimal interval reduction in size of metastatic right axillary lymph nodes with measurements provided.3. Innumerable enhancing metastatic lesions within the liver grossly similar to recent CT chest accounting for differences in technique.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.