47 year old female patient with biopsy proven invasive ductal carcinoma grade 3, ER/PR positive, HER 2/neu positive cancer in the left breast 4 o'clock position. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the left breast at the 4 o'clock position there is a spiculated enhancing mass containing clip artifact that measures 8 x 8 x 7 mm (AP x ML x CC). There is non-mass enhancement extending posteriorly and inferiorly with a total extent that measures 4.3 cm in AP dimension. Approximately 4.5 cm medial, anterior, and inferior to the spiculated mass there is a lobulated enhancing mass that measures 8 x 7 x 5 mm (AP x ML x CC) in the 6 o'clock position 7 mm away from the skin. There is a possible correlate seen on recent mammogram that appears more conspicuous compared to mammogram in 2013. No abnormal lymph nodes are identified in either axillary region. No abnormal enhancement noted in the right breast.
1.Spiculated mass containing biopsy clip in the 4 o'clock position of the left breast compatible with patient's known cancer. There is non-mass enhancement extending posteriorly and inferiorly that measures up to 4.3 cm in maximal extent slightly less in comparison with the calcifications seen on mammogram.2.Lobulated enhancing mass in the 6 o'clock position of the left breast with possible mammographic correlate. Recommend spot compression views and MR directed ultrasound to further evaluate.BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.