Ms. Jones is a 28-year-old female with biopsy-proven left breast invasive carcinoma. Diffuse disease is suspected. MRI is needed for further evaluation due to dense breast tissue. There is extreme amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.LEFT BREAST:The entire left breast demonstrates diffuse, markedly abnormal enhancement with associated skin thickening (measuring up to 0.7 cm) and nipple retraction. The enhancement extends up to and into the left nipple itself. Susceptibility artifact from a biopsy marker clip is seen in the left lower inner breast, far posterior depth, consistent with biopsy proven malignancy. There are multiple enlarged left axillary lymph nodes present, the largest one of which measures 2.2 x 1.0 cm. RIGHT BREAST:There is a linear segment of clumped non-mass enhancement identified in the medial right breast, far posterior depth, that measures up to 2.6 cm in the AP dimension. There is a right-sided chest port.There is a prominent right axillary lymph node identified that measures approximately 1.6 x 1.0 cm.
(1) Diffuse abnormal enhancement affecting the entire left breast with associated skin thickening and nipple retraction. Findings are highly suspicious for inflammatory breast cancer. Recommend correlation with recent skin punch biopsy. If skin punch biopsy is negative, then an additional biopsy can be performed to confirm extent of disease.(2) Bilateral enlarged axillary lymph nodes. An ultrasound-guided biopsy with clip placement can be performed if clinically warranted.(3) 2.6 cm linear segment of clumped nonmass enhancement in the medial right breast. An MR guided biopsy with clip placement is recommended for further evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.