A patient submitted outside study for review. Submitted for review are breast MRI (9/18/15) performed at Advocate Christ Medical Center. Breast MRI protocol is outlined in the outside radiology report.Per outside radiology report, there is a proven invasive ductal carcinoma grade 3 in the left breast, and a metastatic left axillary lymph node. No mammograms or ultrasound images are submitted for comparison.Submitted images could not be processed at our MRI workstation.There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST:An enhancing irregular mass, measuring 26 x 23 mm (AP x LR) is present at middle 3:00 position in the left breast, consistent with proven malignancy. A metallic artifact, presumably from a marker clip, is seen at the central portion within the mass. There are 2 additional masses at 6:00 position in the left breast; one at anterior measures 8 mm, and one at posterior measures 12 mm. Both masses are suspicious, showing a rim enhancement.There are multiple cysts throughout the breast.LEFT AXILLA:In the left axilla, there is an enlarged lymph node measuring 3 cm. Metallic artifact is seen at anterior medial aspect within this enlarged lymph node. Just inferior to this abnormal lymph node, there is another enlarged lymph node measuring 2 cm. There is a regional enhancement at left axilla/axillary tail, likely post-biopsy changes.RIGHT BREAST:There are multiple cysts throughout the breast.The largest cyst is located at anterior upper outer quadrant with proteinaceous fluid.The lateral aspect of the breast tissue shows relatively strong enhancement, likely background parenchymal enhancement. RIGHT AXILLA:No abnormal lymph nodes are identified.
1. Biopsy proven left breast cancer with metastatic left axillary lymph node. Two suspicious enhancing masses in the left breast at 6:00 position. If clinically indicated, MR directed ultrasound and possible biopsy can be performed for those 2 masses.2. Two enlarged lymph nodes in the left axilla, one of which is proven metastatic.3. Strong parenchymal enhancement in the right breast at lateral aspect. Six-month follow-up MRI is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.