Ms. Wilson is a 67-year-old female presenting with mammographically detected pleomorphic calcifications in a segmental distribution with sonographic correlates in the left breast. Of note, she is scheduled for a two-site ultrasound guided biopsy of the left breast immediately following the MRI examination. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left lower outer breast, there is a 7.8 x 4.1 cm span of segmentally distributed clumped nonmass enhancement. The nonmass enhancement extends up to the nipple base. Within this clumped nonmass enhancement are several discrete irregular masses, the largest of which measures approximately 1.2 cm at the posterior-most extent. This suspicious area of clumped nonmass enhancement corresponds in location and distribution to the 7cm span of segmentally distributed pleomorphic calcifications identified on the diagnostic mammogram. No additional abnormal enhancement is identified in the left breast. Specifically, there is no abnormal enhancement at the site of mammographically detected 0.4 cm cluster of calcifications in the left upper outer breast.Several normal axillary lymph nodes are identified in the left axillary region.In the right breast, there is no abnormal enhancement identified. No abnormal axillary lymph nodes are identified in the right axillary region.
(1) Segmental distribution of clumped nonmass enhancement in the left lower outer breast, measuring approximately 7.8 cm, corresponding in location and distribution to the mammographically detected pleomorphic calcifications. A two-site ultrasound guided biopsy was performed on the same day as the MRI with clip placement. Of note, the two Hydromark clips (placed at the anterior and posterior extent of suspected disease) are separated by approximately 4.7 cm in the AP dimension.(2) Mammographically detected cluster of calcifications in the left upper outer breast with no associated abnormal MR enhancement. A 6 month mammographic follow-up is recommended in order to confirm stability of these calcifications. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.