Ms. Luna-Yassin is a 38 year old female with multifocal left breast cancer with metastatic left axillary lymph node. She presents today for MRI evaluation while on neoadjuvant therapy to assess treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Left breast - In the left lower outer breast, the known index malignancy now measures approximately 1.6 x 1.0 x 1.0 cm (AP x ML x SI) previously measuring approximately 2.2 x 1.9 x 2.0 cm. The biopsy marker clip is present anteromedial to this mass. Extending anteromedially from the index malignancy are two additional enhancing foci, one of which has been biopsy-proven to be a satellite lesion. The total span of abnormal enhancement (index malignancy + enhancing satellite lesions) measures approximately 5.7 x 1.4 x 1.7 cm and 5.9 cm in the AP oblique dimension, previously measuring approximately 4.9 cm in the AP dimension. The two biopsy marker clips (one at the index malignancy and one at the satellite lesion) measures approximately 2.4 cm in the AP dimension. Right breast - There is a new rim-enhancing lesion identified in the right inferior breast measuring approximately 1.4 x 0.9 x 0.8 cm. This enhancing mass is associated with internal high T1 signal intensity, likely representing benign fat necrosis. Axillae - The known metastatic left axillary lymph node with associated biopsy marker clip now measures approximately 1.7 cm in maximal dimension, previously measuring 2.0 cm. There are no abnormal lymph nodes identified in the right axilla.
(1) Overall interval decrease in size of known multifocal left breast malignancy. Residual abnormal enhancement (index malignancy + satellite lesions) continues to measure up to 5.9 cm in the AP dimension, greater than the distance between the two biopsy marker clips (one at the index malignancy and one at the satellite lesion) of approximately 2.4 cm. (2) Slight interval decrease in size of metastatic left axillary lymph node.(3) New rim-enhancing lesion in the right inferior breast, with imaging features suggestive of benign fat necrosis. Recommend correlation with an MR-directed ultrasound and/or mammogram. If no correlate is identified, then a short term 6 month MRI is recommended to confirm stability of this finding. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.