Ms. Slay is a 77 year old female with recently diagnosed IDC/DCIS of the left breast. She presents today for MRI evaluation for staging purposes. Of note, there is motion artifact seen in this exam which limits the proper evaluation of the subtraction images. Therefore, all saved images are from the non-subtracted dynamic sequence.There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left superior breast, there is a focal area of heterogeneous nonmass enhancement identified measuring approximately 3.9 x 2.6 x 2.9 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen at the superior aspect of this, compatible with biopsy-proven malignancy. This area of enhancement corresponds in distribution and span to the mammographically detected calcifications, which span approximately 4 cm. In the left inferior breast, there is a linear distribution of clumped nonmass enhancement identified measuring approximately 7.5 cm in AP dimension. This abnormal enhancement extends up and into the left nipple. Upon comparison with recent diagnostic workup, there does appear to be a mammographic correlate with linearly distributed calcifications. In addition, there is a rim-enhancing mass identified in the left lateral breast which measures approximately 0.8 x 1.0 cm. This corresponds to the mammographically and sonographically identified intramammary lymph node and has a suspicious enhancement pattern.RIGHT BREAST: There is no abnormal enhancement seen in the right breast. AXILLA: Biopsy marker clip is identified in one of the left axillary lymph nodes, with benign pathology. No abnormal lymph nodes are identified in either axillary or internal mammary region.
(1) Biopsy-proven malignancy in the left superior breast, measuring up to 4 cm in total span. MR detected enhancement corresponds in distribution and span span to the mammographically detected calcifications.(2) 7.5 cm span of clumped nonmass enhancement in the left inferior breast, which likely corresponds to the mammographically detected linearly distributed calcifications. A stereotactic biopsy targeting one of these calcifications can be performed if clinically warranted.(3) Suspicious rim-enhancement of the intramammary lymph node of the left lateral breast with sonographic correlate. An ultrasound-guided biopsy of this intramammary lymph node is recommended for further evaluation.(4) No MRI evidence for malignancy in the right breast.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.