31 year old female with palpable mass right breast 12:00 position. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Right breast: Large lobulated heterogenously enhancing mass in right breast 12:00 position measures 15 x 15 x 17 mm (AP X ML X SI). Two anterosuperior small adjacent satellites measure 5 and 7 mm each and an adjacent posterior satellite measuring 4 mm are noted. Total extent of the mass with the satellites measures 28 x 22 mm. The mass abuts the pectoralis muscle without any abnormal enhancement within the muscle or fascia. In right breast 8:00 position there is an irregular mass with heterogenous enhancement and irregular margins that measures 15 x 9 x 12 mm (AP X ML X SI) and is located 1 cm inferolateral to the above mentioned palpable mass. Total extent of both the masses is 25 x 36 mm. Left breast: A round enhancing indeterminate mass is seen in left breast 10:00 position measuring 6 x 6 x 9 mm (AP X ML X SI). Multiple enhancing foci seen in left breast. Axillae: Two lymph nodes with eccentrically thickened cortex are noted in the right axilla. No abnormal lymph nodes are identified in left axillary region.
1. Palpable mass right breast 12:00 is suspicious and was subsequently biopsied. 2. MR directed ultrasound is recommended for mass in right breast 8:00 position and left breast 10:00 position. If lesions are not found on ultrasound, MR guided biopsy of right breast and possible left breast MR biopsy (difficult due to posterior location) vs. MRI guided needle localization can be considered. 3. Eccentric cortical thickening of two right axillary lymph nodes, ultrasound of right axilla can be considered. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.