Ms. Selvie-Brown is a 50 year old female with biopsy proven malignancy of the left breast (ILC). She presents today for MRI evaluation for staging purposes. There is scattered fibroglandular tissue in both breasts. Marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.Left breast - There is a large conglomerate of enhancing masses identified in the left superior breast measuring approximately 10.7 x 8.1 x 5.9 cm (AP x ML x SI) and 10.0 cm in the AP oblique dimension. This corresponds in distribution and span to the mammographically detected area of architectural distortion. Susceptibility artifact from biopsy marker clip is seen at the inferolateral aspect of this enhancement, compatible with biopsy-proven malignancy.Right breast - There is no abnormal enhancement seen in the right breast. Scattered foci of enhancement are seen diffusely throughout the right breast, none of which are more suspicious than the rest.Axillae - A single lymph node with uniformly thickened cortex is identified in the left axilla, measuring approximately 1.7 cm in maximal dimension. No abnormal lymph nodes are identified in the right axillary region.
(1) 10.7 cm of abnormal enhancement in the left superior breast, corresponding in distribution and span to the mammographically detected area of architectural distortion. Biopsy marker clip present at the infero-lateral aspect of this enhancement.(2) Uniformly thickened cortex of a single left axillary lymph node. Recommend MR-directed ultrasound with possible biopsy of this lymph node.(3) No MRI evidence for malignancy in the right breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.