Ms. Fan is a 59 year old female with personal history of bilateral breast cancer (right breast - DCIS/1997; left breast IDC/2011). She now has recurrence in the right breast with locoregional disease. Evaluate extent of disease prior to initiation of chemotherapy. Mild parenchymal enhancement is noted bilaterally.Right breast: There is extensive masslike enhancement identified throughout the entire superior right breast, spanning approximately 4.3 x 6.3 x 9.1 cm. A Hydromark clip is identified within the antero-superior portion of the abnormal area of enhancement. In addition, there is linear non-mass enhancement in the inferior right breast which spans approximately 2.5 cm, with similarly suspicious kinetics as the superior mass-like enhancement. This entire span of abnormal enhancement comes to within 1.4 cm of the nipple anteriorly and 1.0 cm of the pectoralis muscle posteriorly. Multiple enlarged right axillary lymph nodes are identified, the largest of which measures approximately 1.7 cm. A Hydromark clip is identified within one of these enlarged right axillary lymph nodes. Left breast: There are two foci identified within the left inferior breast, which were seen on prior MRI dated 5/10/2011 and are stable to slightly smaller in size. There is no new abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.
(1) 9.1 cm span of abnormal mass-like enhancement in the superior right breast with extent detailed above. Enlarged right axillary lymph nodes. Additional non-mass enhancement in the inferior breast. (2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.