55-year-old woman with ER positive IDC of the right breast. I-Spy 2 research MRI performed. There is relatively extensive non-mass enhancement, new since the 8/31/2016 comparison examination, presumably related to the biopsy performed on 9/8/2016. Within the limitation created by this enhancement, the following observations can be made:There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Within the right outer breast, the patient's biopsy-proven malignancy is seen as an enhancing mass measuring up to 220 mm. The biopsy clip is again noted within this mass. Immediately anterolateral to the index mass is 6 mm mm satellite mass. Medial to the index lesion there are 3 additional small enhancing masses, 2 of which are immediately anterior to and abut the pectoralis major muscle. An enhancing mass is again noted within the anterior chest wall musculature, posteromedial to the index lesion and presumed satellites. The other areas of chest wall muscular enhancement are less prominent on today's examination, which may relate to differences in technique.The previously described 9 mm area of non-mass enhancement is not definitively seen on today's examination, also possibly due to technique and effect of yesterday's biopsy.The overall extent of masses, inclusive of the mass suspicious for pectoralis involvement is up to 6.2 cm. The nonspecific focus of increased T2 signal within a midthoracic vertebral body has been evaluated using other imaging modalities and is of doubtful clinical significance given those results.There are scattered foci of increased T2 signal within the liver, likely representing cysts or hemangiomas, without corresponding hypermetabolic activity on the PET scan dated 9/9/2016.No abnormal enhancement is seen in the left breast. A few scattered foci and areas of edge parenchymal enhancement are not suspicious. No abnormal axillary lymph nodes are identified in either axillary region.
Biopsy proven right breast cancer with multiple additional enhancing masses within the right breast and the right anterior chest wall musculature. The overall extent of masses, inclusive of the mass suspicious for pectoralis involvement is up to 6.2 cm. Presumed biopsy related non-mass enhancement is a limitation of this study compared to the recent MRI exam. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.