Ms. Rudsinski submitted outside study for review. Submitted for review:-breast MRI: 12/8/2015This examination was performed at Silver Cross Hospital. Multiple MR sequences were obtained per the outside institution. Unfortunately, this examination is severely limited by motion artifact, such that the subtraction sequences (and even the post-contrast sequences) are very tough to evaluate.In addition, there is moderate-severe background parenchymal enhancement noted bilaterally, which inherently limits the sensitivity of this examination.Within these limitations, there is a peripherally enhancing, centrally necrotic mass identified in the right medial breast measuring approximately 2.7 x 4.2 x 4.2 cm (AP times ML times SI). The mass does abut against the pectoralis muscle, causing obscuration of the fat plane. However, due to the severe motion, the actual pectoralis muscle cannot be adequately assessed. However, the possibility of underlying muscle invasion cannot be excluded. Located approximately 0.9 cm lateral to this mass is an additional enhancing lesion measuring 0.9 x 0.5 x 1.1 cm. This is highly suspicious for an additional satellite lesion.In addition, seen throughout the majority of the superior right breast and the anteromedial breast are numerous areas of non-mass enhancement and enhancing foci. These are very difficult to further characterize on this MRI, but they are certainly asymmetric when compared to the contralateral breast. Susceptibility artifact from multiple surgical clips project over the right axilla, of uncertain etiology/significance. Two enlarged right axillary lymph nodes are seen, the largest of which measures approximately 2.6 cm. No definite abnormal enhancement seen in the left breast.
(1) Extremely limited MRI examination due to motion artifact. In addition, there is moderate-severe background parenchymal enhancement, which inherently limits the sensitivity of this examination.(2) 4.2 cm enhancing mass in the right medial breast abutting the pectoralis muscle, compatible with biopsy proven malignancy. Due to the above limitations, the actual muscle cannot be adequately assessed, however, there is obscuration of the fat plane. The possibility of underlying muscle invasion cannot be excluded. (3) 1.1 cm enhancing mass seen just lateral to the index lesion in the right breast, suspicious for a satellite lesion.(4) Enlarged right axillary lymph nodes, measuring up to 2.6 cm. One of which has apparently been biopsied and is positive for malignancy.(5) Multiple additional areas of non-mass enhancement and enhancing foci seen in the right superior breast/right antero-medial breast which are very difficult to further characterize on this MRI, but are asymmetric when compared to the contralateral breast.RECOMMENDATIONS:(1) Clip placement in the index lesion/axillary lymph node cannot be assessed on this limited MRI. Recommend a postprocedure right unilateral mammogram to confirm placement and appropriate positioning of biopsy marker clips in the right breast and right axillary lymph node.(2) An MR directed US can be performed for the suspected satellite lesion seen just lateral to the index lesion. If correlate identified, an US-guided biopsy with clip placement can be performed if clinically warranted.(3) Based on the EMR, patient will not be able to return until July 2016 for official treatment. At that time, it will have been approximately 6 months since her original MRI. A repeat MRI can potentially be performed at that time to re-assess the multiple additional areas of asymmetric enhancement seen in the right breast, which may all be artifactual given the limited MRI. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.