Ms. Wesley is a 47-year-old female with known right breast IDC with lobular features/DCIS and a metastatic right axillary lymph node. She presents today for I-SPY research MRI (#4). Note that this exam is performed for her research protocol, as the necessary images were not obtained on the scan from earlier this week. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST: The reference biopsy-proven malignancy in the right retroareolar region measures 3.2 x 1.4 x 3.0 cm, unchanged when compared to the prior study from 5/9/2016, however, this previously measured 3.2 x 2.7 x 3.3 cm (AP x ML x SI) on 3/14/2016. The biopsy-proven malignancy demonstrates less avid enhancement compared to the study from several days ago, likely due to differences in technique (3T vs. 1.5 T). Again seen is a biopsy marker clip located centrally within this malignancy. There continues to be minimal persistent periareolar skin thickening. Multiple benign enhancing masses in the right breast are unchanged. Biopsy-proven metastatic right axillary lymph node now measures 1.5 x 0.9 cm, unchanged compared to the prior study from 5/9/2016, however, this previously measured 1.8 x 1.1 cm on 3/14/2016. Biopsy marker clip is located centrally within this lymph node. No new abnormal enhancement is identified in the right breast. LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region. Vascular port again present in the left medial chest wall.
(1) Decreased enhancement of right breast cancer compared to the March study. No significant change comparing the two studies performed this week. (2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.