Newly diagnosed right breast ILC presents for staging MRI. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, a limitation to the study.The biopsied cancer in the right upper outer breast measures 2.1 x 1.4 x 2.0 cm and has internal artifact from the biopsy clip. Extending anterior to the mass are two 7 mm masses which are suspicious for satellite lesions given their proximity to the known cancer. The AP extent of the index lesion and satellites is 4 cm. Additionally, in the mid depth of the right inner breast near 2:00, there is an enhancing focus measuring 5 mm. In the right axilla, there are multiple lymph nodes that are slightly enlarged compared to the left side. These however retain fatty hila. A subpectoral node has a uniformly thickened cortex of 4 mm, though it too retains a fatty hilum. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in the left axillary region.
1. Biopsy proven cancer in the right breast measures up to 2.1 cm and is associated with anterior satellite lesions for an AP extent of 4.0 cm. MRI directed ultrasound is suggested to look for correlates to the satellite masses. 2. Right inner breast focus measuring 5 mm may be benign. An MRI directed ultrasound is recommended to ensure no suspicious sonographic correlate. As long as ultrasound is negative or typically benign, a 12 month MRI follow up is suggested to ensure stability. 3. Asymmetric right axillary lymph nodes, including a borderline thickened subpectoral node.4. No evidence of left breast malignancy. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.