Ms. Bray is a 46-year-old female presenting from outside hospital with two suspicious lesions identified in the left breast. These were biopsied and final pathology revealed atypia, but no malignancy. She presents today for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, limiting the evaluation of MRI.In the left breast, far posterior depth, there is a lobulated T2 hyperintense lesion identified with associated enhancement. This lesion measures approximately 2.1 x 1.8 x 1.5 cm. Susceptibility artifact from biopsy marker clip is seen at the posterior aspect of this lesion, compatible with one of the biopsied lesions at outside hospital (labeled on outside images as left breast 2:00 location, approximately 7 cm from the nipple).In addition, in the left breast, mid depth, there is an additional lobulated T2 hyperintense lesion identified with associated enhancement. This lesion is slightly harder to measure due to its irregular margins, but approximately measures 2.8 x 1.4 x 1.6 cm. Susceptibility artifact from biopsy marker clip is seen at the lateral aspect of this lesion, compatible with the second of the biopsied lesions at outside hospital (labeled on other images as left breast 2:00 location, approximately 3 cm from the nipple). The two biopsy marker clips are separated by approximately 7 cm in the AP dimension. Of note, these two lesions were re-biopsied on the same day as the MRI, and the new biopsy marker Hydromark clips are separated by approximately 6 cm in the AP dimension on the ML view. Although there is significant background parenchymal enhancement identified in both breasts, there is no additional abnormal enhancement identified. No abnormal axillary lymph nodes are identified in either axillary region.
(1) Two enhancing lesions with T2 hyperintense signal (suggestive of mucin content) in the left breast, corresponding to the biopsied lesions at outside hospital. Repeat US guided biopsies of these two lesions was performed on same day as MR. Awaiting final pathology. (2) No additional MR evidence of malignancy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.