Ms. Herrera is a 61 year old female with newly diagnosed left breast cancer with metastatic left axillary lymph node. Ultrasound examination from OSH suggested additional satellite lesions in the same breast. She presents today for MRI evaluation for staging. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked nodular background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.LEFT BREAST: In the left upper inner breast, there is an irregular enhancing mass identified measuring approximately 2.8 x 2.1 x 2.6 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen at the superolateral aspect, compatible with biopsy-proven malignancy.Seen just superior to this index malignancy is an additional irregular enhancing mass measuring approximately 1.5 x 1.4 x 1.3 cm. This was seen on the outside hospital ultrasound from 10/2016, and is highly suspicious for satellite lesion. In addition, seen just inferior to the index malignancy is an additional irregular enhancing mass (seen on the outside hospital ultrasound from 10/2016 labeled as 9:00 lesion) suspicious for additional satellite lesion, measuring approximately 1.0 x 1.4 x 1.2 cm. The total span of abnormal enhancement (index malignancy + 2 additional suspicious satellite lesions) measures approximately 3.1 x 2.6 x 4.8 cm.In the left lower outer breast, there is an irregular enhancing mass identified measuring approximately 0.7 x 1.0 x 1.4 cm. Susceptibility artifact from biopsy marker clip is seen at the inferior aspect of this lesion, compatible with biopsy proven radial scar.In the left breast, there are several oval enhancing lesions identified, the largest one of which is located in the far posterior depth measuring up to 1.1 cm. These are compatible with benign fibroadenomata. RIGHT BREAST: No suspicious enhancement is identified within the right breast.AXILLAE: In the left axilla, there is a single abnormal morphology lymph node identified measuring approximately 1.9 x 1.5 x 1.5 cm. This likely represents the biopsy-proven metastatic left axillary lymph node with no associated biopsy marker clip.There are no abnormal lymph nodes identified in the right axillary region.
(1) Biopsy-proven index malignancy of the left upper inner breast with two associated satellite lesions. Total span of abnormal enhancement measures approximately 4.8 cm in the SI dimension. Ultrasound-guided biopsy with clip placement can be performed for these 2 additional satellite lesions as clinically warranted.(2) Biopsy-proven radial scar of the left lower outer breast with associated enhancement. If this area is to be excised, please note that the biopsy marker clip is seen inferior and lateral to the area of abnormal enhancement.(3) Metastatic left axillary lymph node with no associated biopsy marker clip. A biopsy marker clip can be placed into this lymph node if clinically warranted.(4) No MRI evidence of malignancy of the right breast.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.