67-year-old woman with right breast ILC and DCIS presents for staging bilateral breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. This limits the sensitivity of MRI in detecting subtle lesions.RIGHT BREAST: In the right breast upper outer quadrant, there is a heterogeneously enhancing mass with clip artifact along the anterior aspect consistent with the biopsy proven cancer. The mass has a tubular bilobed morphology and measures 3.0 x 1.0 x 1.5 cm. Also in the right breast at the upper quadrant near the 12:00 position, superior and medial to the index cancer is an area of non mass enhancement, indeterminate. This area measures approximately 1.7 x 0.8 x 0.8 cm and when correlated to the most recent mammogram, heterogeneous/amorphous calcifications are extending close to this area. Stereotactic biopsy targeting the amorphous calcifications can be performed. Alternatively, MR guided biopsy of the non mass enhancement could be considered if there is difficulty targeting the calcifications. Additional rounded subcentimeter foci of enhancement seen scattered throughout the right breast while nonspecific are likely related to background parenchymal enhancement.No abnormal lymph nodes are identified in the right axilla.LEFT BREAST: Clip artifact is seen near the 12:00 position at the site of benign stereotactic biopsy. Scattered rounded subcentimeter foci of enhancement are seen throughout the left breast, nonspecific and likely related to background parenchymal enhancement. No discrete enhancing mass or suspicious focus of enhancement is identified. No abnormal lymph nodes are identified in the left axilla.
(1) Heterogeneously enhancing mass with associated clip artifact in the right upper outer quadrant measuring up to 3.0 cm, consistent with biopsy-proven cancer.(2) Non-mass enhancement in the right breast 12 o'clock location, superior and medial to the index cancer measuring up to 1.7 cm, indeterminate. When correlated to the most recent mammogram, heterogeneous/amorphous calcifications are identified near this area. Stereotactic biopsy targeting the calcifications can be performed.(3) No abnormal enhancement in the left breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.