Ms. Green is a 43-year-old female with a history of newly diagnosed right breast DCIS with a family history of breast cancer in the patient's cousin at the age of 30. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally. RIGHT BREAST:In the right medial breast, anterior depth, there is faint nonmass enhancement identified measuring approximately 3.0 cm in the AP dimension. This corresponds in location and distribution to the mammographically detected calcifications that are biopsy proven to be DCIS. Susceptibility artifact from biopsy marker clip is seen immediately postero-lateral to this MR enhancement. There is also associated skin thickening/enhancement, which is likely related to post-biopsy changes.There is no additional abnormal enhancement seen in the right breast.LEFT BREAST: There are two enhancing foci/masses identified in the left retroareolar region. The more medial enhancing focus measures 0.5 cm and has internal fat signal intensity, compatible with a benign intramammary lymph node. The more lateral enhancing mass measures 0.8 x 1.2 cm and has a benign morphologic appearance. AXILLA:No abnormal lymph nodes are identified in either axillary region.
(1) 3.0 cm linear nonmass enhancement in the right medial breast, corresponding in distribution and span to the mammographically detected calcifications that are biopsy proven to be DCIS. Of note, the clip is slightly postero-lateral to the area of non-mass enhancement. A bracketed wire localization can be performed mammographically for preoperative surgical guidance. (2) 1.2 cm enhancing mass in the left lateral retroareolar breast for which an MR-directed ultrasound is recommended for further evaluation. If no sonographic correlate is identified, then a short term 6 month MRI follow-up is recommended. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.