Ms. Simeran is a 52-year-old female with known left breast cancer with positive lymph nodes status post neoadjuvant chemotherapy. She presents today for imaging evaluation to assess for treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Bilateral prepectoral silicone implants are identified. There has been an interval increase in size of all previously measured left breast reference lesions:-Interval increase in size of index malignancy in the left retroareolar breast, now measuring 3.7 x 2.6 x 2.8 cm (AP x ML x SI), previously measuring 2.6 x 1.9 x 2.5 cm. This mass now invades and includes the entire left nipple.-Interval increase in size of mass located postero-inferior to the index malignancy, at site of mammographically detected asymmetry with calcifications, now measuring 0.9 x 0.6 x 0.9 cm, previously measuring 0.5 x 0.7 x 0.4 cm.-Interval increase in size of left intramammary lymph node, now measuring 0.9 x 0.7 cm, previously measuring 0.6 x 0.6 cm.-In addition, there are two new enhancing foci seen lateral to the left retroareolar index malignancy, suspicious for additional disease.-The total span of enhancement (index malignancy + postero-inferior mass + two new enhancing foci) measures approximately 3.6 x 4.0 cm (AP x ML).In the axillary regions, reference measurements are as follows:-Interval increase in size of previously identified left axillary lymph node, now measuring 5.0 x 3.0 cm, previously measuring 3.0 x 2.2 cm. This node is now centrally necrotic.-Interval increase in size of previously identified right axillary lymph node, now measuring 1.9 x 0.9 cm, previously measuring 1.4 x 0.9 cm. Of note, there are multiple additional enlarged right axillary lymph nodes, some of which are new/progressed since last exam.No abnormal enhancement is seen in the right breast.
Interval progression of disease in the left breast and bilateral axillary regions. Continued surgical consultation is recommended for further evaluation at this time. All results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.