43 year old female with BRCA 1 mutation. Personal history of benign right breast biopsy in 2003 as well as an FNA aspiration of a right breast nodule at 7 o'clock in 2009 compatible with a fibroadenoma. Family history of breast carcinoma in her sister at age 36, in two paternal aunts in their 40s, and a grandmother. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.RIGHT BREAST: There is redemonstration of an ovoid homogeneously enhancing mass in the posterior right breast, approximately 7:00 position. This mass measures19 x 10 x 17 mm (AP X ML X CC), previously measured 20 x 13 x 15 mm and is not associated with a biopsy clip. However, it corresponds to ultrasound findings from 2014 and the reported site of FNA aspiration biopsy in 2009 confirming a fibroadenoma. Located just anterior to this mass, there is another smaller lesion compatible with fibroadenoma, unchanged from recent MRI.At approximately the 10 to 11:00 position, posterior depth the previously demonstrated enhancing mass is not seen on today's imaging probably slowly enhancing or hyalinized. A T2 correlate at that site measures 12 x 9 x 14 mm which corresponds to the previously enhancing mass that measured 16 x 9 x 18 mm (this is mostly unchanged in size when I compare to the T2 correlate on the prior MRI). This mass is also most likely a fibroadenoma and was seen on prior ultrasound exam.Multiple other smaller enhancing foci are mostly unchanged. No abnormal axillary lymph nodes are identified in right axillary region. LEFT BREAST:A new oval heterogenously enhancing mass with mostly dark T2 signal is seen in the left breast 6:00 position, posteriorly measuring 17 x 20 x 16 mm (AP x ML X CC). Left axillary lymph node has increased in size with altered morphology (2 foci of high T2 signal within it), measuring 20 x 12 mm. Multiple T2-hyperintense lesions in the liver may represent cysts or hemangiomas but are incompletely characterized but stable.
1. Previously described enhancing FNA proven fibroadenomas in the right breast 7:00 position are unchanged. 2. New left breast 6:00 heterogenously enhancing mass needs MRI directed ultrasound for evaluation with biopsy under ultrasound guidance (MRI guided biopsy will be difficult due to location). 3. Increase in size and altered morphology of left axillary lymph node also needs MRI directed ultrasound for further evaluation. 4. Multiple other enhancing foci or non enhancing mass (lesion at 10 to 11:00 position posterior depth) are mostly unchanged. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.