47-year-old woman with suspicious breast mass and right axillary lesions presents for for research MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast: There is a heterogeneous lobulated mass in the right breast 12:00 position involving the nipple, morphology and enhancement characteristics highly suspicious for malignancy. The mass measures 4.6 x 4.6 x 5.7 cm (AP x TV x CC). There is associated neovascularity, nipple retraction and periareolar skin thickening up to 7 mm. Additionally, there are benign morphology mildly enhancing masses (three in the lateral breast and one in the medial breast, posterior depth) which are stable when allowing for differences between MRI and mammograms when comparing to an old mammogram from 2010. There is an abnormal size and morphology right axilla lymph node measuring 3.1 x 1.9 x 1.9 cm, highly suspicious for malignancy. There is a small subpectoral node measuring up to 6 mm that has no clear fatty hilum, indeterminate.Left Breast: A few scattered benign enhancing foci are seen. There is no discretely enhancing mass, suspicious morphology or foci of suspicious enhancement. There are a few mildly prominent indeterminate left axillary lymph nodes that maintain fatty hila but have some cortical thickening. A left axilla ultrasound should be considered.
(1) Heterogeneously enhancing right upper outer quadrant mass highly suspicious for malignancy, and measuring up to 5.7 cm in craniocaudal dimension. An ultrasound-guided biopsy with clip placement was performed for this mass today. (2) Abnormal morphology right axilla lymph node measuring up to 3.1 cm. An ultrasound-guided biopsy with clip placement was performed for this today as well. (3) A few mildly prominent indeterminate left axilla lymph nodes with mild cortical thickening up to 6 mm for which left axilla ultrasound should be considered for further evaluation. (4) Small right subpectoral lymph node. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.