Ms. Tsoutsias is a 44 year old female with known multifocal left breast IDC currently on neoadjuvant therapy. She presents today for MRI evaluation as part of ISPY2 trial. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Bilateral retropectoral silicone implants are present.Left breast: In the left lower inner breast, the index malignancy now measures approximately 1.3 x 1.0 x 1.3 cm, previously measuring 2.8 x 1.4 x 2.1 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip continues to be seen in the mass. The index mass continues to abut against the pectoralis muscle, with no obvious enhancement or abnormal contour of the pectoralis muscle itself.In the left inferior breast, the linear nonmass enhancement surrounding a cyst now measures approximately 5.1 x 1.4 x 1.4 cm, previously measuring 5.1 x 2.3 x 2.8 cm. The total span of abnormal enhancement (index malignancy + nonmass enhancement) measures approximately 5.1 x 3.4 x 3.9 cm, previously measuring 5.2 x 4.4 cm.Right breast: There is no abnormal enhancement seen in the right breast.Axillae: A total of four abnormal lymph nodes continue to be seen in the left axilla. Representative lymph node now measures 1.0 cm in the axial plane, previously measuring 1.1 cm. No abnormal axillary lymph nodes are identified in the right axillary region. Extra-mammary: A port-a-cath is present in the right upper chest wall. A high T2 signal hepatic lesion is partially visualized, likely a benign cyst.
(1) Continued interval decrease in index malignancy and malignant non-mass enhancement in the left breast, with residual enhancement measuring up to 5.1 cm. Stable metastatic left axillary lymph node.(2) No MRI evidence for malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. 