45 year old with FNA proven left breast cancer with left axillary lymph node metastasis presents for MRI study. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There are multiple enhancing foci and small round masses in both breasts, likely parenchymal enhancement.In the left breast, there is a spiculated mass measuring 24 x 20 x 25 mm (AP x LR x CC) at posterior 4 o'clock position, consistent with FNA proven carcinoma. There is a round enhancing mass, measuring 8 x 9 x 8 mm, located at posterior medial from the index mass. This is likely a fibroadenoma from imaging findings, including round shape, circumscribed margins with dark internal septations. However, MR directed ultrasound is recommended for confirmation, as this mass is located at vicinity of the index tumor. No other suspicious enhancing lesions are present in the left breast.In the left axilla, there is one lymph node with thickened cortex, likely a FNA proven metastatic lymph node. This lymph node measures 15 mm in maximum diameter.In the right breast, there is an oval enhancing mass at middle 6 o'clock position, measuring 17 x 7 x 7 mm, likely fibroadenoma. MR directed ultrasound is recommended for this lesion. Elsewhere, there are multiple enhancing foci and small round masses, likely parenchymal enhancement.No abnormal lymph nodes are identified in right axillary region.
1. Index cancer is present at posterior 4 o'clock position in the left breast.2. Benign appearing round enhancing mass near the index cancer. MR directed ultrasound was performed later today, and this mass was confirmed as a typical benign fibroadenoma.3. A lymph node with thickened cortex in the left axilla, likely a known metastatic node.4. Benign appearing mass in the right middle 6 o'clock position. Ultrasound guided biopsy was performed for this mass later today.5. No abnormal lymph nodes in right axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.