40 year-old female whose recent diagnostic mammogram and ultrasound demonstrated highly suspicious mass in the left breast with suspicious left axillary lymph node, and a suspicious mass in the right breast, presents for Alan Penn research MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.LEFT BREAST:There is a highly suspicious, irregularly shaped enhancing mass, measuring 16 x 15 x 15 mm (AP x LR x CC), at 6 o'clock position. This mass is located closely to the anterior skin. There is an additional enhancing focus in the 7 o'clock position, which is lokely a satellite lesion. Distance between two enhancing lesions is 19 mm (center to center measurement).Although recent ultrasound study detected a small mass at 5 o'clock position, there is no correlating lesion on this MRI.At 3 o'clock position, there is a lobulated mass, measuring 10 x 10 x 8 mm, likely an enlarged intramammary lymoh node.In the left axilla, there is a large oval mass, measuring 24 x 20 x 20 mm, suspicious of a metastatic lymph node.Inferior to this mass, there is a smaller lymph node with asymmetric cortical thickening.RIGHT BREAST:At 3 o'clock position, there is an enhancing multilobulated mass, measuring 4 x 7 x 4 mm. This mass correlates with a mass detected at the recent ultrasound.No abnormal lymph nodes are identified in right axillary region.
1. Highly suspicious mass at 6 o'clock position with possible satellite at 7 o'clock position in the left breast. Ultrasound study performed later today detected a sonographic correlate of the possible satellite. Ultrasound guided biopsy was performed for both lesions. 2. An enlarged intramammary lymph node at 3 o'clock position in the left breast, and one highly suspicious and one borderline left axillary lymph nodes. Ultrasound guided biopsy of the largest lymph node in the left axilla was performed later today. 3. Small enhancing mass in the right breast at 3 o'clock position, correlating to the sonographically detected mass. Ultrasound guided biopsy of this mass was performed later today. 4. No abnormal lymph nodes in right axillary region.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.